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Not Your Grandpa’s Health IT: Highlights from Health 2.0’s 7th Annual Fall Conference

Dec 3, 2013

Nancy Fabozzi, Principal Analyst at Connected Health shares her thoughts.

We recently attend the Health 2.0 7^th Annual Fall Conference held at the Santa Clara Convention Center in early October. This meeting is held every fall in the San Francisco area and is considered to be one of the premier events to gage the latest trends in disruptive health IT, particularly related to consumer health and patient engagement.

The conference was put on by Health 2.0, a San Francisco-based organization that provides events and media services designed to showcase innovative companies, technologies, and thought leaders focused on shaking up the status quo in healthcare. They also run the Health 2.0 Developer Challenge, a platform for connecting healthcare organizations to health technology developers, operate a media channel, and provide market intelligence services among other things. Health 2.0’s various conferences, developer challenges, and live code-a-thons have a global reach, extending across major U.S. cities as well as Europe, Latin America, the Middle East, and India. Matthew Holt and Indu Subaiya, M.D. founded the organization in 2007. Holt serves as Co-Chairman of Health 2.0.

His background includes over 20 years in healthcare and healthcare IT market research and strategy consulting, and he is also the founder and publisher of The Health Care Blog, a highly influential and popular blog that features contributions from leading figures across the healthcare industry. The blog launched in 2003 and currently attracts around 150,000 visitors a month. Indu Subaiya, Health 2.0’s Co-Chairman and CEO, is a physician who also has a background in strategy consulting and business. The Health 2.0 enterprise has become a powerhouse in the world of health IT start ups. According to their website, the organization has introduced over 500 technology companies to the world stage, hosted more than 11,000 attendees at their conferences and code-a-thons, and awarded over $5,277,000 in prizes through their developer challenge program. In addition, they have inspired the formation of 70 new chapters in cities around the world.

Healthcare.gov Is Working. But Is It Working Well Enough to Withstand the Enrollment Surge?

Dec 2, 2013• 64

By ROBERT LASZEWSKI

From 27,000 enrollments in October to a reported 100,000 enrollments in November, the Affordable Care Act’s website is apparently working better and getting more people signed up.

But is it fixed well enough to handle the expected wave of at least many hundreds of thousands of people eager to get guarantee issue health insurance for the first time or replace a canceled policy by January 1?

Here are some of the press reports covering the December 1 HealthCare.gov relaunch:

Reuters: “A surge of visitors clogged the U.S. government’s revamped healthcare insurance shopping website on Monday, signaling that President Barack Obama’s administration has a way to go in fixing the portal that showcases his signature domestic policy.”
Bloomberg reporting on a navigator’s experience: “It’s still kind of glitchy. Now it just kicked me out. It went back to the front page. I’ve been here all afternoon and it’s been like that.”
Miami Herald: Long waits, error messages, unresponsiveness. Hallmarks of the troubled launch of the Health Insurance Marketplace at healthcare.gov continued to stymie South Florida residents and counselors trying to access the website on Monday––more than two months after the October 1 launch, and despite the government’s self-imposed deadline of Nov. 30 for the system to function smoothly for the ‘vast majority of Americans.”
Los Angles Times: “The Obama administration’s overhauled healthcare website got off to a bumpy relaunch Monday as a rush of consumers caused an uptick in errors and forced the administration to put thousands of shoppers on the HealthCare.gov site on hold.
Ezra Klein, Washington Post: “Of course, that means the site still suffers a disastrous outage rate.” And, “We have no idea whether the 200 fixes left on the list are really important ones, or really difficult ones. The repair job is likely proceeding quickly enough to protect Obamacare from the most severe threat to its launch: Democrat-backed legislation unwinding the individual mandate or other crucial portions of the law.

And then there is the backroom. The administration apparently decided that it was more important to fix the front-end of the system before the back-end was fixed. Do they think that big customer service issues come January, if the “834” back-end enrollment problems are not fixed by then, will be blamed on the insurance industry and not the administration?

Associated Press: “Private insurers complain that much of the enrollment information they’ve gotten on individual consumers is practically useless. It is corrupted by errors, duplication or garbles. Efforts to fix the underlying problems are underway, but the industry isn’t happy with the progress and is growing increasingly concerned.”

As I have said before, the Obama administration is likely in the midst of a four month project to properly fix and test this system. It will likely be at least late January or early February before not just HealthCare.gov but the other key information systems supporting the new law are built and repaired to just minimal standards.

In Which Your Author Does the Math

Dec 2, 2013

By SETH J. CHANDLER

Healthcare.gov appears to be working much better, at least in enabling individuals to select plans. And some of the state exchange web sites appear to be improving their functionality too. Some have heralded these advances as providing hope that the Exchanges will be able to meet the enrollment projections on which the economics of insurance without medical underwriting in part depend. But do these claims stand up to the cold light of mathematics? Not very well.

Here’s the headline:

A close look at the numbers shows that the pace of enrollments from here to the close of open enrollment needed to meet projections is high in every state, even those touted as successful, and almost impossibly high in many. Given the incredibly slow start in most jurisdictions, it will not just take a little pickup over the next few months to achieve the projected and needed number of persons in the Exchanges. It will take a miraculous last minute stampede. Since miracles seldom occur, the result may be two different stories of the Affordable Care Act: a few states in which the Exchanges proved from the start to be a somewhat stable mechanism for providing health insurance without medical underwriting but a significant number of other states in which the results for at least the first year represent a large failure.

Recent News

News appears to be breaking out that the federal exchanges enrolled about 100,000 in November. This is being heralded as somewhat of a success compared to the 26,000 who enrolled in October. And, of course, enrollment figures from healthcare.gov are difficult to assess due to the actual and feared dysfunctionality of the web site. But one way to look at this is to consider what has to happen between December 1, 2013, and March 23, 2014, the close of open enrollment to make projections. The states that are dependent on healthcare.gov need about 4.84 million enrollees by the end of that period if the nation is to meet the goal of having 7 million enrolled in the Exchanges by the close of open enrollment. If, right now, there are about 126,000 enrollees in those states, we are just 2.5% of the way there.

The pace of enrollment on healthcare.gov will need to increase by a factor of about 20 in order to meet goal. In absolute terms, healthcare.gov needs to be enrolling about 42,000 people per day. And while perhaps not every single one of those people need to enroll for the system to succeed, the 7 million enrollment goal isn’t just a mere wish. There are, as I and many others have noted potentially serious consequences to the stability of insurance markets if the figures fall well short, even in several states.

How One Bad Thanksgiving Shaped Amazon

Dec 2, 2013• 9

By GRETCHEN GAVETT

It’s officially the holiday season, which means 70,000 people have temporary jobs at Amazon fulfillment centers to ensure that your gifts arrive exactly when they’re supposed to. While these jobs aren’t exactly easy or high-paying – there’s been plenty written about the not-so-awesome working conditions – it’s in many ways remarkable that Amazon is able to easily leverage the population of a small town less than 15 years after a panic-filled Thanksgiving led to the mammoth and tightly-controlled supply chain system that’s in place today.

The “Save Santa” incident, described in Businessweek reporter Brad Stone’s recent book The Everything Store: Jeff Bezos and the Age of Amazon, was an “all-hands-on-deck emergency” in 1998 resulting from one of the biggest problems an online store can have: there were far more orders coming in than shipments going out. This required all employees – including the executives – to work a graveyard shift at one of two warehouses. “They brought their friends and family,” writes Stone, “ate burritos and drank coffee from a food cart, and often slept in their cars before going to work the next day.” Bezos held contests to see who could pick items off shelves the fastest. Then he vowed the company would never have an inventory shortage again.

“The underlying truth is that Amazon becomes, like almost like all retailers, a different company during the holidays,” Stone explained to me over the phone. “Volume grows over the previous year. The already aggressive and fast-moving environment in the headquarters and fulfillment centers become manic. I describe it as two Amazons: one that operates for 10 months and the other that operates for two months out of the year.”

Are Smokers Really the ACA’s Biggest Losers?

Dec 1, 2013• 23

By Al Lewis & Vik Khanna

Facing thousands in extra insurance costs, smokers appear to be the Affordable Care Act’s (ACA) biggest losers. Employers are allowed charge smokers up to 50% more for their medical coverage than nonsmokers , starting in 2014.

On November 25, Fox News put it best: “Obamacare Policies Slam Smokers,” , noting that “smokers are the only group with a pre-existing condition that Obamacare penalizes.” THCB itself has headlined: Smokers Face Tough New Rules under Obamacare.

And these headlines are absolutely accurate — meaning that, with the possible exception of the e-cigarette, ACA is the best thing that has happened to employed smokers ever.

Here is how we arrive at this conclusion. The data is mixed on whether smokers incur much higher healthcare costs or just slightly higher healthcare costs during their working ages than non-smokers do. None of the data shows that their costs are lower, but let’s say there is no impact on health spending.

Nonetheless, the following is incontrovertible: smokers take smoking breaks.

Remarkably, there are no laws specifically governing smoking breaks, and like most other quantifiable human resources issues, no one has quantified them. But we all observe these breaks, and about a fifth of us participate in them. They reduce productivity. By definition, if you are outside smoking, you are not inside working.

Sure, some smokers make up the time by working harder when they aren’t smoking…but (1) many non-smokers work hard too and (2) some workplaces, such as inbound call centers, don’t offer the luxury of catching up later because they operate in real time. Lacking quantification, fall back on your imagination…and imagine what you would do if you ran a company in which non-smokers spent as much time mulling around outside as smokers do. That should give you an understanding of the impact of smoking breaks on productivity.

I Would Rather Die at Home

Dec 1, 2013• 31

By THCBist

A THCB reader in Tennessee writes:

Thanks for listening. I am a single 55 year old male in Tennessee. I’m not offered insurance from my employer. June of 2012 I was diagnosed with Essential Thrombocytosis. A blood disease that messes up your platelets. Took every test they could think of to figure it out. In and out of hospital, adding up debt by the second, I stopped going to doctors, stopped buying meds. I drag myself to work, every day, just to survive. Under Obamacare it will be, for the worst plan, $571.00 a month, with a $ 5100.00 deductible. I can’t afford that. I would rather die in my home as it would be better than being homeless. Is this a joke?

The Presidential Healthcare Curse – Why Do They Even Try?

Dec 1, 2013• 30

By DAVID BLUMENTHAL, MD

Until now, virtually every president who has dabbled with comprehensive health reform has failed spectacularly, often at huge political cost. Think of Harry Truman’s lonely campaign for national health insurance, Jimmy Carter’s devastating conflict with the late Senator Edward Kennedy over universal health care coverage, the first George Bush’s ineffectual (and little-remembered) health insurance proposal, or Bill Clinton’s damaging first-term effort to pass health reform.

Health reform is a presidential nightmare. No sane presidential consigliere would ever recommend his or her boss try it. Our health care system is so complicated and convoluted that any conceivable proposal is bound to make someone worse off. And in health care, worse off can mean real pain and suffering that creates powerful, emotional stories that echo through the news cycle. There is simply no way for presidential health care reformers to avoid grievous political harm, as the experience of President Barack Obama is now demonstrating in spades.

Which raises the question: why bother? It would have been so easy for President Obama, in the midst of the Great Recession of 2008, to kick the health care can down the road, saying that his all-consuming priority was economic revival, and that health reform could wait.

The answer provides critical context for the relentless stream of troubling news—and the cacophony of charges and counter-charges—about the implementation of the Affordable Care Act (ACA) that fill the media each day. The reason to proceed with this painful technical and political process is that there is no alternative. Before the ACA, the current health care system—and especially its private insurance market—was collapsing before our eyes, like a house tipping into a sinkhole.

Obamacare Has Failed My Family

Nov 30, 2013• 10

By TONY JEWELL

The Obamacare debacle remains … well, a debacle.

At a time when I should have my family’s insurance coverage locked up for 2014, I learned this past week that — despite previous assurances from the government’s call center — my application for coverage has not been completed or submitted to AmeriHealth.

Let’s start at November 13, when I attempted to finally enroll via healthcare.gov and over the phone.

Even though I had completed all of the necessary steps to that point, the site didn’t work that day and locked my account — allowing me to do nothing more on the healthcare.gov site. I called the call center, who couldn’t even find me in the system — despite the fact I had an account, had selected an insurer and clicked enroll.

They discovered my family in the system once they figured out healthcare.gov had determined my 8-year-old son was the head of the household. The call center operator said we couldn’t do anything until he gave me permission to access the account (he was in school, so that wasn’t happening).

Once they found me and I convinced them I wouldn’t be calling my son’s school for permission, however, they couldn’t access my account because healthcare.gov was down. She advised me to call the insurer to see if they had received my application.

The insurer helpfully said that they wouldn’t even receive the application for three to six weeks after it was submitted via healthcare.gov — which, at best, put us at early December and at worst past the deadline to have insurance on January 1.

The Two Million Scenario: What if the Affordable Care Act enrolls a lot fewer people in the Exchanges than predicted?

Nov 30, 2013• 80

By SETH J. CHANDLER

People can be blinded by dreams in many spheres.

Many people who remain basically positive about the Affordable Care Act are viewing the enrollment statistics like the football fan whose team is 2-6 and who point out that the team could win 7 out of its 8 remaining games and still probably make the playoffs.

Yes, getting off to a really bad start doesn’t preclude a happy ending. Success may still be mathematically possible. But unless there’s good reason to think that the fundamental factors such as poor coaching, poor game plans or unexpected injuries that have led to the bad start no longer apply, the more reasonable prediction is that things will continue more or less as they have.

It’s time to start thinking realistically about what happens if a core component of the Affordable Care Act, subsidized, non-underwritten health insurance available from private insurers, essentially fails to provide many with better access to medical care. This might not happen in every state — there might be a few whose Exchanges can be deemed “successful” — but it is looking more and more to me as if we are heading for enrollments in many states well, well short of that on which the arguments for the ACA were significantly premised.

Indeed, some supporters of the ACA have started moving the goal posts, revising history to say that the real goal of the Act wasn’t to reduce the number of uninsureds but to have an actuarially sound pool. (So the purpose of the Act was to help insurance companies stay afloat?) And it hardly helps enrollment when President Obama urges his allies to hold back enrollment efforts so the insurance marketplace does not collapse this coming week under a crush of new users even after he earlier assured the nation healthcare.gov was supposed to be working much better by this time.

For purposes of this blog entry, I’m going to assume that enrollment in the Exchanges ends up being about 2 million for 2014 instead of the projected 7 million. I can’t rigorously justify that number — but, of course, neither could the pundit who is now saying 4 million. And, if I had time and space I’d prefer to do this analysis under a variety of scenarios, but, for now, the 2 million figure feels about right. And if I were betting on which side of the 2 million we will fall, it would be the lower side. What are the consequences? I can’t address all of them in a single blog entry — and trying to predict matters past 2014 gets very treacherous — but here are some.

And, for those of you who don’t want to read further, here’s the headline:

Insurance sold through Exchanges without medical underwriting — a central promise of the Affordable Care Act — is likely to implode in a significant number of states by 2015 while limping along in several others but providing little net desired decrease in the number of people without quality health insurance. The silver lining in this failure will be that the program will likely cost less than projected due to fewer number of people receiving subsidies, although this reduction will be partly offset by higher-than-projected subsidies to the insurance industry. Expect significant pressure to grow among supporters of the Affordable Care Act to use these net savings to increase the subsidies available to people buying coverage through the Exchanges and to lure insurers in the problem states back into the Exchanges.

The Month of Anti-Deadlines

Nov 30, 2013• 2

By Billy Wynne

As we shake off the carb-coma and make our pre-resolutions, Congress and the Administration head into a sprint to the holiday recess fraught with health policy implications. Unlike every December in recent memory, there isn’t very much Congress actually has to do. Here are the top five things you need to know to follow the fun and prepare your organization for the changes afoot. A key theme to take home is that December 2013 is a month of anti-deadlines.

The Nov. 30/Dec. 1 “fix” to Healthcare.gov was set arbitrarily and has simply teed up another pivot point for opponents to pounce. We already know the wand hasn’t tapped the electro-synapses of the site yet to make the dang thing work like it should. Expect more incremental improvements through the month and enrollment numbers to come in above current rock-bottom expectations, with a healthy chunk coming from the proud, the few … the state-based exchanges.
The Dec. 13 deadline for budget conferees to produce a joint resolution is similarly fictional and self-imposed. While there are some burgeoning reports that co-chairs Murray and Ryan might be able to agree to FY14 funding levels and potentially alleviate some of the sequester, the buzz-o-sphere in Washington still has deep doubts. Even if the two negotiators come to agreement, House and Senate leadership have the bigger challenge of getting a bipartisan deal through their chambers.
Jan. 15 is the real deadline for a budget agreement and the real goal is writing a check to fund the government through Sept. 30. A budget resolution is helpful to give appropriators time to write actual spending policy, but it can be bypassed if the end-game is a continuing resolution that keeps current funding allocations in place. (Congress hasn’t passed an actual budget resolution since Democrats controlled both chambers.) At the end of the day, we’ll be back to the all-too-familiar roundtable of congressional leaders and Obama reps hatching a last-minute deal to avert a shutdown.