THIS IS A GOOD idea. Barry Katz came up with Lotsa Helping Hands after his wife’s four year ordeal with cancer. The web-based calendar system he developed helps friends and family volunteer their time and support. Beth Israel Deaconess Medical Center, the Colon Cancer Alliance and the other groups have already signed on.
—Mr JiB
IN CALIFORNIA things are starting to heat up in advance of the November special election. Proposition 78, the drug-industry backed ballot measure targeting high prescription drug costs, picked up a key endorsement this week. On Monday, Governor Arnold Schwarzenegger gave his blessing to the proposal. The politically powerful American Association of Retired People (AARP) formally announced its support on Wednesday, said it is siding with Proposition 79.
Proposition 79, the alternative backed by Health Access California, key consumer groups and major unions, is seen as taking a tougher line on costs. It is also intensely disliked by drug companies, who see it as likely to encourage similar attempts to pass tougher laws in other states. Recent tracking polls show support among Californians for the two measures about even. That is a bit of a surprise for those who were predicting the campaign would essentially be a formality, given the lobbying power and resources of the pharmaceutical industry.
HealthVote.org has been tracking ad spending, as it did during last year’s election. Huge amounts of money have been spent already. But the real action is likely to come over the last six weeks of the campaign. According to the group’s release today:
Prop. 78 supporters aired 11,485 ads in California’s five largest media markets (Los Angeles, San Francisco, San Diego, Sacramento and Fresno) through September 25 at an estimated cost of $13.4 million. Proponents of Prop. 79 launched their ad campaign on September 29.
When the Prop. 79 spot is posted, I’ll link to it, so you can take a look. But for now, you can go take a look at the spots the campaign for Prop.78 is running here.UPDATE: Lisa Girion has a piece on the topic in today’s LAT. The paper’s take:
Californians like the idea of a statewide drug-discount program for the poor: A recent Field Poll found Proposition 78 leading by a healthy margin. But that support sagged when respondents learned that the nation’s big drug makers were behind the initiative. And therein lies the problem for supporters of the measure: Its biggest backer is also its biggest liability.
— Mr JiB
Greg Pawelski with a view on the new head of the FDA
More and more physicians and patients are turning to individualized therapies to treat cancers. Under this approach, scientists study how an individual’s cancerous cells respond to several drugs. Doctors have learned that even when the disease is the same type, different patients’ tumors respond differently to chemotherapeutic drugs. Treatments need to be individualized based on the unique set of molecular targets produced by the patient’s tumor, and these important treatment advances will require individualized assay-testing which can improve patient survival in chemotherapy for cancer. Assay-directed chemotherapy is an individualized approach to killing cancer. It’s time to set aside empiric one-size-fits-all treatment in favor of recognizing that breast, lung, ovarian and other forms of cancer represent heterogenous diseases, where the tumors of different patients have different responses to chemotherapy. It requires individualized treatment based on testing the individual properties of each patient’s cancer.
From yesterday’s Associated Press article:
WASHINGTON (AP) — The new acting chief of the Food and Drug Administration says he will be presiding over a transformation in medicine as scientists come to understand diseases in a more detailed way that could improve doctors’ ability to treat patients.
Now,"We are discovering so much about diseases like cancer at the molecular level,"said von Eschenbach, a urologic surgeon by training. "Much of what we have done … has been based on a model of empiricism." Soon, doctors will be able to intervene with medical treatments more effectively matched to a specific patient’s illness.
Read the rest at USA Today
Dr. Andrew C. von Eschenbach, tapped by President Bush as the temporary chief of the regulatory agency, said Sunday that discoveries about diseases at "a molecular level" will lead to a new kind of health care. Doctors treat illnesses based on how well other people have responded to a given treatment. Soon, they will develop a tailored response built around specific understandings of the patient, the treatment and the disease, he said.
Today the Wellpoint Borg collective has assimilated the last of the resistant for-profit Federation Blues spaceships that was challenging them in the outer Galaxy. But shouldn’t it be the Empire crushing the rebels rather than being the rebels (or am I mixing two famous sci-fi memes).
Given that the attempts by other Blues to turn for-profit have mostly been nixed, the health insurance now left with a big chunk of regional non-profit Blues, and 6-10 big national for-profit giants (with Wellpoint and United being more gigantic than the rest) and Kaiser and its lookalikes. But there isn’t such a thing as a national health insurance company–all of them are basically still running local market plans, and all are vulnerable to the cream-skimming going on in the HDHP market.
I guess there are some consolidation savings somewhere in all this mix, but I don’t see how any of this revolutionizes healthcare, although it does seem to have succeeded in revolutionizing the bank accounts of lots of execs at formerly sleepy health plans.
So Navigant Consulting has been gilding the lily on its expenses in the apparently somewhat shoddy consulting job it’s doing at King-Drew. Their basic excuse is that their private sector clients (almost all non-profit hospitals by the way) are quite used to not caring about the fact that they do things like leave rental cars in airport short-term parking for a week, take one day trips to work on other clients business, and fly their employees from San Diego to Los Angeles (a two hour drive) on a routine basis, and then send their clients the bill.
So Navigant is apparently dumb enough to think:
a) that their other clients won’t notice them basically calling them dumbb) that the King/Drew contract was sufficiently low profile that no one would care about what they did, despite the fact that the LA Times just won a Pulitzer Prize for investigating other malfeasance at the hospital, andc) that contracts they sign about expense reimbursement policies don’t apply to them.
BTW almost all of my clients either give me a total "capitated" fee for my expenses, or I make damn sure that they have an idea of what expenses are coming down the pike. And I don’t work for anyone who would have to respond to a Freedom of Information Act request!
So just like that after a contentious time getting confirmed, FDA Commissioner Lester Crawford resigns, after only formally being in the job for less than three months (although effectively having basically run the agency for three years). I wonder what further skeletons have crawled out of his closet?
Get ready for more confirmation fatigue as the Administration searches for someone else ready to screw their reputation by placing politics (and deeply unpleasant, mean spirited politics at that) before science.
I haven’t had a chance to comment on this, but anything Jamie writes is usually pretty good, and here he is in the NEJM on Health Savings Accounts — The Ownership Society in Health Care.
In the home stretch now. Don Kemper, the guru of this information therapy, self-care stuff is up now. His goal is that every medical encounter ends with an information prescription, which would then drive better compliance and better health outcomes — and by the way save a whole lot of money.
Don wants to pay for IX by finding all the big disease categories and incorporate IX into disease management. He things that we need more members for this "billion dollar club".
And to move this along, the Center for Information Therapy is going to become a new, independent center with no direct connection to HealthWise.
And it’s a new dawn for Information Therapy….at least he thinks and we ought to hope.
More from Park City….
Shorter Mark Bard (Manhattan Research)– two thirds of docs are suggesting that younger female patients go to the web, but there’s no financial mechanism for it, and no real business case for physicians to do better websites, eVisits, or anything much else so far.
Shorter Susan Denzter (PBS NewsHour Corespondent) (via phone as she’s on the way to cover Rita) — Consumers don’t understand numbers, they don’t understand simple instructions, and simple numeracy and literacy is a big challenge especially among the elderly and less educated, which is a lot of people. Plus no-one understands (and this includes journalists and drug detail people) the difference between relative and absolute risk. And people make irrational choices even when presented with the correct information. She calls it not Information Therapy, but Information Fughedaboutit. So she asks her sources to talk to her on air as if she’s an intelligent 12 year old. So there are lots of reasons why information is good but no way is it enough to explain behavior.
I’m reminded of the time that at IFTF we put the California HEDIS measurements up on one chart and asked the audience to pick their health plan by looking at it. It was a rainbow of conflicting color-coded circles. No one could figure out until about a year after we’d been showing it one bright guy said "look you should join Cigna Southern California as they do the best on the most measures". And he was right. Then we told him that Cigna Southern California was the staff-model Medicaid HMO with clinics in Compton and South-Central LA. Somehow we felt that that information, even though it was irrelevant to objective care measures, may well have swayed his choice of plan.
At the conference I met David Vinson who (unlike yours truly) did successfully sell his benefits comparison analysis company to WebMD and now is running their private portal business for plans. Finally all the stuff I was trying to sell at i-Beacon is coming true and WebMD has convinced Empire, now Wellpoint and others to do this on an ASP basis. They are integrating the PHR, claims and benefit information, and a bunch of stuff creating a consumer CRM experience–all of which I’ve talked about at length, and done so bitterly.
Below is what I say about it in FierceHealthcare today
For many years health insurers have struggled (or refused) to represent the information they have about their members back in useful form to their members. In an era of on-line banking and airline reservations systems, health plans have been badly behind. Finally this trend may be changing, with WebMD Health, on an ASP basis, leading the provision of personal health records, personalized health information and tools and benefit information directly linked to members claims and service use. Senior VP at WebMD Health, David Vinson told an audience at the Information Therapy conference in Utah that the service is up and running at Empire Blue Cross Blue Shield, with other partnerships announced — including one with health insurance giant Wellpoint.
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