The Health Care Blog – Page 644 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Will the ONC provide a huge stimulus to Health 2.0 startups?

Apr 16, 2012• 5

By Dave Chase

The federal government is on the cusp of leveling the playing field for healthtech startups. Health 2.0 events have shown an unprecedented wave of innovative healthtech startups have developed over the last few years. You can also see them at demo day events that Blueprint Health, Healthbox, Rock Health and StartUp Health host. However, the health sector may be the single most challenging arena for startups.

I would argue nothing would result in population health improvement (while decreasing healthcare costs) more than having greater engagement by patients in the healthcare process. The Office of the National Coordinator (ONC) could catalyze an unprecedented wave of innovation with a stroke of a pen by strong inclusion of patient engagement requirements in the Meaningful Use requirements.

Having high expectations for Patient Engagement will cause healthcare providers to rise to the occasion to solve this critical issue. It’s well documented that three-quarters of healthcare spend is on chronic disease and decisions that drive outcomes are made by individuals (aka “patients”). It’s long been said the most important member of the care team is the patient. Now is the time to transform that from a catchphrase to reality. The ONC can do that.

The biggest potential stimulus ever for healthtech startups

We have seen how Stage 1 Meaningful Use requirements (PDF) have spurred providers into action. By and large, that has meant an infusion of customers to EHR vendors. Legacy healthIT has had very, very little focus on the patient because financial incentives motivated the development of systems designed to get as big a bill out as fast as possible — i.e., there has been no incentive to involve the patient.

TEDMED Goes to Washington

Apr 16, 2012• 1

By Matthew Holt

Last year Priceline founder Jay Walker bought TEDMED –a conference that licenses the TED style and brand but is separately owned from its famous cousin. While there was some fun controversy about the sale, Walker made two key decisions. First he moved the conference from San Diego to Washington D.C. to try to get it more central to the health policy debate, and second he initiated a set of 50 Great Challenges from which the community voted a top 20. These are things like tackling the obesity crisis, getting transparency in medical research, training next generation of leaders and more.

Much of the fun and high production value entertainment from previous years stayed, but there was a new sense of urgency in the air concerning making changes from a top down and bottom up level in the way policy works for science and technology. There was rather less information technology than in years past and more emphasis on things like training of physicians, food policy, and basic science.

Like TED there’s a strong sense of celebrity at TEDMED with entrepreneurs like Walker and buddy AOL founder Steve Case on hand, mixing with newscaster Katie Couric and volleyball pro Gabby Reece. There’s also an interesting (and we hear not cheap) sponsorship model with the exhibit hall being more about zones for discussion rather than tradeshow demos. We like Philips sleep discussion and Booz Allen Hamilton’s discussion area.

How I Fell In Love at TEDMED

Apr 16, 2012

By Marya Zilberberg, MD

Over the exhilarating four days this past week, we all fell in love a little bit — with the city, the Center, the meeting, the ideas, and one another. The city was Washington, DC, a touch past its cherry-blossom blush; the meeting was, of course, TEDMED. The ideas were of about honoring our health, environment, food, and about making health and healthcare efficient and kind for all.

I fell in love with dreamers. Though their dreams were varied, their paths to fulfilling them all converged into the same stream. Like a trip down the Amazon that the biggest dreamer of all, Jay Walker, the curator and the force behind the meeting used as a metaphor for TEDMED 2012, they accepted their tortuous and demanding journeys and, much to our delight and benefit, made a stop at the Kennedy Center. And although I will only mention a few, many others will stay with and inspire me for the months to come until TEDMED 2013.

I fell in love with Bryan Stevenson, who spoke about his grandmother and identity and justice.

Health Care, Not Coverage

Apr 14, 2012• 48

By Carly Fiorina

For the next three months, the Supreme Court will mull the constitutionality of the new health care law. At stake is the government’s requirement that its citizens buy private health insurance. But whatever the outcome, it’s a foregone conclusion that some fundamental change must be instituted in the financing of health care delivery.

Today, enormous sums of taxpayer money are spent on the administration of health care programs such as Medicaid. Those administrative costs could be sharply reduced and the savings put to what is really needed — providing health care. With the information technology available today, public agencies should consider eliminating their function as a government-run insurance operation and focusing their resources on paying providers to deliver care.

Consider Medicaid, the shared federal and state program for the poor. When Medicaid was created, it was designed to replicate the private insurance function. But the basic purpose of insurance is to protect the policy holder’s assets against a catastrophic event causing risk of personal bankruptcy. Because the very nature of qualifying for Medicaid requires recipients to first spend down their assets and then earn an annual income below a certain percentage of the federal poverty level, what assets is the policy protecting? The person doesn’t need health insurance. He needs health care.

Unnecessary bureaucracy

When the government created Medicaid as a look-alike insurance product, it developed an oversight operation that has not kept up with what technology can do to make a system run more efficiently. And unlike private insurance, it built a system requiring monthly updates of each of its 50 million recipients’ eligibility, including filled-out and faxed-in monthly reports, income receipts, etc.

TEDMED 2012: NIH Director Francis Collins and Jill Sobule Perform “Disease Don’t Care”

Apr 13, 2012• 2

[youtube width=”560″ height=”270″]http://www.youtube.com/watch?v=qKJiYkcWs0M[/youtube]

Compliance

Apr 13, 2012• 6

By Rob Lamberts, MD

“Why aren’t you taking your cholesterol medication?” I asked the woman.

With the coronary disease I diagnosed a year ago, my discovery that she had not taken her medication was very troubling.

“It made me tired,” she replied matter-of-factly. ”And besides, the cardiologist said the stress test was negative, so my heart is fine!”

I ordered the stress test after her heart calcium score was significantly elevated, revealing significant atherosclerosis. She totally misunderstood the results, and I needed to fix that problem. So I pulled out my secret weapon: a good analogy.

“The purpose of the calcium score test was to see if you had termites in your home” I explained. ”I found them. The negative stress test just said that the termites hadn’t eaten through your walls. It’s good news that your walls aren’t falling down, but they will if we don’t stop the termites.”

Her eyes opened wide comprehension: the termites were eating her walls. She was living on borrowed time.

“Would you take a medication if it didn’t have side effects?” I asked.

She quickly nodded. Of course she would. From now on she would be a compliant patient.

Compliance is good. Noncompliance is bad. It’s something I learned very early in my training: patients who do what their doctors say are compliant (good), and those who don’t follow instructions are noncompliant (bad). If you are lucky as a doctor, you have compliant patients. They are the best kind. They obey their doctors. They are submissive. Noncompliant patients are bad; they are a bunch of deadbeats.

Please hold your nasty comments; I don’t really believe my patients should obey or submit to me.*

Medicare Announces 27 ACOs. A New Species?

Apr 12, 2012• 22

By Vince Kuraitis

I’m surprised and intrigued by Medicare’s announcement of 27 new Shared Savings model ACOs.

Surprised

I had been anticipating this announcement as a defining moment for Medicare’s thrust into accountable care. My expectations had been that we would see either:

Boom — a big splash of new Medicare shared savings ACOs announced, including big name hospitals and medical groups that were starting large scale ACOs, perhaps with hundreds of thousands of patients.

Bust — no one showed up at the party. Providers would have concluded that Medicare ACOs were too risky, bureaucratic, and high effort.

Intrigued

What we got is something in the middle:

Very small ACOs. Many only meet Medicare’s minimum of 5K patients; most are in the 8 to 25K range; and the largest ACO anticipates 70K patients. Collectively these 27 ACOs plan to serve 375K patients, less than 1% of the entire Medicare population.
13 are smaller, physician led
Only 10 hospitals are involved across the 27 ACOs
Very few household names

Another Look at Health Insurance Exchanges

Apr 11, 2012• 23

By JONATHAN HALVORSON

Of all the provisions of the ACA, probably none has received greater attention from health insurers than the exchanges. Though the exchanges are expected to be the conduit for just a small fraction of all the insured at their start in 2014, they will be where most of the growth in health insurance lies. Given the rule that the individual exchanges must be integrated with Medicaid, their role will be critical for any insurer that wants to compete and grow in the individual or Medicaid markets. The dominance of the exchanges for growth in the small group and even the Medicare markets may not be not far behind. It should be no surprise if, eventually, all fully-insured business goes through the exchanges, leaving only self-insured plans outside.

So getting it right matters. Now is the time to think hard about getting it right, before the exchanges are created and inertia sets in. And, as some have argued, getting it right means that we think about the exchanges as places for people to choose their health care, not just their health insurance. So how should we do that?

Here is what we should not do: make it easy to choose care without considering both the quality and the cost of care delivered by the care system. It would be an enormous lost opportunity to improve consumer attitudes towards health care if we built the exchanges to make it easy for people to reason: “I like doctor A. Doctor A accepts insurance products X, Y and Z. Of these three, insurance product X seems to have the lowest cost, so I’ll choose product X.”