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Above the Fold

The Ghost of Steve Jobs and Your Bottom Line

Mar 19, 2013• 12

By JOE FLOWER

The progeny of the iPhone and the iPad will change the shape of your institution — and your balance sheet.

One of the more striking images, to me, out of the online spew in the last few months was from the inauguration. It was a wide view of an inaugural ball. There was the president waltzing with the first lady, and a crowd of several hundred watching them. What was striking about that image was that the several hundred people held several hundred small glowing rectangles in their hands. Practically every member of the crowd was carrying a smartphone and was photographing or videotaping the moment.

The scene was commonplace in its moment, remarkable only in the perspective of history — but such a short history. We could not have imagined so many people carrying smartphones at Obama’s first inaugural only four years ago. Four years before that, we could not have imagined any. The iPhone had not been invented.

There had been attempts at smartphones before the iPhone, and devices like tablets before the iPad. But the rampant success of iOS devices did far more than establish two profitable niche. It changed our relationship with the world.

Gauging if Chronic Diseases can be Tamed By Enlisting Residents of an Entire County

Mar 19, 2013• 3

By Alan Player

Increasingly, the health care community is experimenting to see if managing the health of a defined population – say diabetics – improves their health and also reduces the cost of health care or its rise over time. In other words, the healthcare profession seeks to determine if value can displace volume (our fee-for-service tradition) in delivering medical services. Humana’s first-of-its-kind, two-year pilot health-and-wellness program may provide some welcome answers.

A unique factor of the Team Up 4 Health program reflects its participants – hundreds of residents in Bell County, Kentucky (population: 28,750). Statistics show that its population bears a high incidence of preventable chronic illnesses. One-third of the county’s adults are obese and one-in-eight has Type 2 diabetes.

What the Early 2013 Match Day Numbers Tell Us About Where We’re Going

Mar 18, 2013• 17

By Vineet Arora, MD

After the mayhem and jubilation of celebrating a successful match at the Pritzker School of Medicine with our students, I went onto Twitter to follow the #match2013 hashtag to understand what the reactions were. Most were positive, but one headline caught my attention ‘In Record-Setting ‘Match Day,’ 1,100 Medical Students Don’t Find Residencies.”

It is true this was the largest match because it was “All-in” – programs either were in the match for all their positions (including international medical graduates or IMGs) or they were not. Obviously, many programs put more positions up for grabs in the Match. After I reposted this article to Twitter, there were many theories and questions about who these unmatched students were and why – some of which I have tried to answer to the best of my ability below. I welcome your input as well.

Who are these unmatched students? Why didn’t they match?

-Are these IMGs? This number is US Senior medical students who have been admitted and graduated from US medical schools but now have no place to go to practice medicine.

-Does this include those that entered the “scramble” now called SOAP. Technically, those that entered SOAP and were successful would have been counted as “matched” on Friday. Last year, 815 Us seniors went unmatched after the SOAP.

The #CommonWell Open Discussion Forum

Mar 18, 2013• 13

By Adrian Gropper, MD

The EHR vendor lock-in business model is under attack by frustrated physicians and patients and the reality that health care cost and quality are more opaque than ever. Doug Fridsma of ONC politely talks of the need to move from vertical integration of health care services to horizontal integration where patients can choose with their feet. Farzad Mostashari calls for moral behavior and price transparency. The Society for Participatory Medicine says “Gimme My DAM Data” and Patient Privacy Rights asks HHS to allow physicians to prescribe health IT without interference from the institution or the vendor.

The vendors’ response is a charm offensive called CommonWell Health Alliance with a pastel .org website. The website is presumably the official source of information about CommonWell and it lays out the members’ strategy to preserve the vendor lock-in business model for a few $Billion more. Ok, maybe more than a few.

The core of the CommonWell strategy is to avoid giving patients their data in a timely and convenient way.

States Must Step Up to Help Consumers Gain Access to Health Care Prices

Mar 18, 2013• 23

By Suzanne Delbanco & Francois de Brantes

American consumers know more about the quality and prices of restaurants, cars, and household appliances than they do about their health care options, which can be a matter of life and death. While we have made some progress in getting consumers reliable quality information thanks to organizations like Bridges to Excellence and The Leapfrog Group, for most Americans, shockingly little information still exists about health care prices, even for the most basic services. And several studies have shown us that the price for an identical procedure can vary as much as 700 percent with no difference in quality. Moreover, with health care comprising 18 percent of the US economy and costs rising every day, it is extremely troubling that most health care prices are still shrouded in mystery.

Our organizations have been steadily pushing health plans and providers to share price information more freely, and we are seeing progress. But public policy—or even just pending legislation—can provide a powerful motivator as well.
Unfortunately, our new Report Card on State Price Transparency Laws shows most states are not doing their part to help consumers be informed and empowered to shop for higher value care. In the Report Card released Monday, 72 percent of states failed, receiving a “D” or an “F.” Just two, Massachusetts and New Hampshire, received an “A.” The Report Card based grades on criteria including: sharing information about the price of both inpatient and outpatient services; sharing price information for both doctors and hospitals; sharing data on a public website and in public reports; and allowing patients to request pricing information prior to a hospital admission.

What the US Can Learn From China’s Health Care Reform

Mar 18, 2013• 10

By Leana Wen, MD

Wang Li is a 48-year-old farmer from Dalian, China. After a two-day trip to the major provincial hospital, he’s heading home to his village to die. Wang has lung cancer, and even with insurance, his surgery will cost him 20,000 RMB — $3,000, which is twice his annual salary. The surgery would be curative, but it doesn’t matter. “I cannot burden my family,” he said.

I am a Chinese-born, American physician who just returned from a two-month research trip spanning twelve cities and nine provinces in China, where many of the health care reforms in contention in the U.S. have already been tried. As Americans contemplate the decisions ahead, consider China’s cautionary tale.

Today’s China is one of great disparity. The wealthy minority receives top-notch care, while the poor majority suffers from little access to care and no way to pay for it. Stories abound of patients like Wang Li who sign out of hospitals when they run out of savings, knowing they will die without treatment.

The State of Self-Tracking

Mar 17, 2013• 17

By ERNESTO RAMIREZ and GARY WOLF

In January we started asking ourselves, “How many people self-track?” It was an interesting question that stemmed from our discussion with Susannah Fox about the recent Pew report on Tracking for Health. Here’s a quick recap of the discussion so far.

The astute Brian Dolan of MobiHealthNews suggested that the Pew data on self-tracking for health seems to show constant – not growing – participation. According to Pew, in 2012 only 11% of adults track their health using mobile apps, up from 9% in 2011.

All this in the context of a massive increase in smartphone use. Pew data shows smartphone ownership rising 20% just in the last year, and this shows no signs of slowing down. Those smartphones are not just super-connected tweeting machines. They pack a variety of powerful sensors and technologies that can be used for self-tracking apps. We notice a lot of people using these, but our sample is skewed toward techies and scientists.

What is really going on in the bigger world? How many people are actually tracking?

A few weeks ago ABI, a market research firm, released a report on Wearable Computing Devices. According to the report there will be an estimated 485 million wearable computing devices shipped by 2018. Josh Flood, the analyst behind this report indicated that they estimated that 61% of all devices in wearable market are fitness or activity trackers. “Sports and fitness will continue to be the largest in shipments,” he mentioned “but we’ll start to see growth in other areas such as watches, cameras, and glasses.”

One just needs to venture into their local electronics retailer to see that self-tracking devices are becoming more widespread.

So why are our observations out of synch with the Pew numbers?

A Time Out For Health IT?

Mar 17, 2013• 17

By Hayward K. Zwerling, MD

A recent RAND(1) study has concluded that the implementation of health information technology (HIT) has neither effected a reduction in the cost of healthcare nor an improvement in the quality of healthcare. The RAND authors confidently predicted that the widespread adoption of HIT will eventually achieve these goals if certain “conditions” were implemented. I do not believe that there is sufficient scientific data to support the authors’ conclusion nor validate the Federal Government’s decision to encourage the universal installation of “certified” electronic medical records (EMRs.)

As a “geek” physician who runs a solo, private practice and the creator of one of the older EMRs, I believe that I can provide a somewhat unique perspective on the HIT debate which will resonate with a large fraction of private practitioners.

Ready For O’Ryancare?

Mar 15, 2013• 77

By J.D. KLEINKE

This is how sexy the chatter gets over cocktails at health policy wonk-ins in Washington. This is how sexy the chatter gets over cocktails at health policy wonk-ins in Washington.

“No pre-ex’s, community rating, guaranteed issue.”

“No, that’s Obamacare stuff,” I said to my colleague, as she read a summary of Congressman Paul Ryan’s House Republican budget plan released on Tuesday. “Everyone in Medicare already has those. You must have the wrong memo.”

She scrolled to the top of her iPhone and pointed at the screen. “Summary of the Ryan Budget Plan – Medicare.”

“Maybe just a gimme for popular support?” I speculated, knowing from headline coverage earlier in the day that the Ryan plan sought to repeal Obamacare, not strengthen its most popular consumer protections. “Guaranteed issue but no mandate — that would sure hang the insurers out to dry. But why would you put that in a budget?”

“Here’s why,” she read. “‘Seniors buy coverage through new Medicare Exchange.'”

“Oh.”

Consumers need protections only when they are turned into consumers. And that is what Congressman Paul Ryan’s budget seeks to do for — or do to, depending on your feelings about medical capitalism — future Medicare beneficiaries.

Naked political plug: Aneesh Chopra in California this week

Mar 15, 2013

While my politics are well known to THCB readers, I rarely encourage people to do anything about it–especially in a state where I don’t get to vote, but today is different. Aneesh Chopra is running for Lt Gov in Virgina. He’s the former CTO of the US and a really good guy–who is running based on improving science and technology in a vital state, where the Republicans are literally into trans-vaginal ultrasounds & creationism. To my SF and LA-based friends, you can meet Aneesh at Cigar Bar & Grill on Mon 18th 5.30-7 in downtown SF and in in 1240 Shadow Hill Way, Beverly Hills on Tuesday 19th 7-9pm. This is a chance for the tech community to support one of its own, so I encourage you to go along and write a check. For more information or to RSVP please contact Caitlin Blair at Ca*****@*********va.com or (703) 468-1456, or I’m sure if you show up Aneesh will be happy to see you!–Matthew Holt