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Care Innovations Summit Live Blog

Jan 26, 2012• 2

By Connie Chen and Laura Montini

Wrapping up the CI Summit with a Health Affairs Chat

By Laura Montini

The Care Innovations Summit wrapped up with a fireside chat, and moderator Susan Dentzer observed that there hadn’t been much discussion about the Medicaid population throughout the day, even though the summit was co-hosted by the Centers for Medicare and Medicaid Services. Dentzer asked Deputy Administrator Director of CMS Cindy Mann how innovation could play into the care of the Medicaid population.

Mann mentioned three major ways: experimentation (with payment rules and service delivery), peer to peer learning and data. Though she mentioned data last, she emphasized it the most.

“We need to be much more intentional about getting the data that we need to see what’s working, what’s not working,” Mann said.

Occupational Health In the Electronic Age

Jan 25, 2012• 1

By Sanjay Bansu, MD

When we say our products are made “in China”, what we really should say it that they’re made in Shenzhen–a city in Guangdong Province, just north of Hong Kong. Shenzhen is one of China’s “special economic zones” (SEZs)–754 square miles of industrial space in which foreign corporations are permitted unique rules and regulations, permitting them to run high-throughput factories that currently use 3.3 million people to make products for the Western consumer market. This is where Xboxes and cell phones come from, produced by Chinese contractors like Foxconn (which makes the new iPhone). There is an unusually high rate of suicide in Shenzhen, and in Foxconn factories in particular; behind these suicides are a broader set of public health issues among electronic workers–from those who make the new gadgets, to those who dismantle them after we throw them away.

The Rise of the Programmable Self

Jan 24, 2012

By Fred Trotter

Programmable self is a riff on the Quantified Self (QS). It is a simple concept:

Quantify what you want to change about yourself + motivational hacks = personal change success.

There are several potential “motivation hacks” that people regularly employ. The simplest of these is peer pressure. You could tell all of your co-workers every morning whether you kept your diet last night, for instance. Lots of research has shown that sort of thing is an effective motivator for change. Of course, you can make peer pressure digital by doing the same thing on Facebook/Twitter/Google+/whatever. Peer pressure has two components: shame and praise. It’s motivating to avoid shame and to get praise. Do it because of a tweet and viola, you have digital peer pressure motivation.

Several books have recently popularized using money, in one form or another, as a motivational tool. There is some evidence, for instance, that people feel worse about losing $10 than they feel good about earning $10. This is called loss aversion, and it can easily be turned into a motivational hack. Having trouble finishing that book? Give 10 envelopes with $100 each to your best friend. Instruct them to mail the envelopes to your favorite (or most hated) charity for each month that you do not finish a chapter. Essentially, you’ve made your friend a “referee” of your motivational hack.

Health 2.0 News

Jan 23, 2012• 2

Market for cloud-based storage of radiology images to reach $5.4B in 2017, 70% of health care organizations planning on health information exchange participation after half million personal health data downloads, Blue Button expands to most federal health care plans | Your weekly health tech news now on the Health 2.0 News Blog.

What Does Failure Mean?

Jan 23, 2012• 2

By Aaron Carroll, MD

I’ve seen a number of responses to the news that the Medicare demonstration projects were not successful. Some have claimed that they were only demonstration projects, and the fact that some succeeded means we should look into those further. Others asserted that this once again proves that the government is incapable of making the health care system better.

As to the first point, it’s hard to get excited about this. By chance alone, a couple of programs were likely to save money. Four out of 34 reducing hospitalizations (when the best of them might have had inadequate data)? Hardly something to get excited about. Remember that two out of the 34 actually saw increased hospitalizations, too. I think it’s totally reasonable to think hard before just assuming there was something special about those four programs, and throwing more money at them.

But I think the latter point, made by Peter Suderman, is a bit of an over-reach as well. It’s important to remember that these were attempts by private hospitals and private physicians to change the way they care for patients. Granted, government was paying the insurance bills through Medicare, but this would have looked awfully similar if a private company had footed the bill. And, yes, private insurance companies have tried to use care coordination and disease management to reduce costs as well.

A Promise Made to Be Broken

Jan 23, 2012• 8

By David Dranove

In last week’s Wall Street Journal, Princeton economist Alan Blinder exposes four myths about the federal deficit. He saves the most important myth for last. After noting that the long term deficit problem does not cut across all areas of spending, he observes that the problem is almost entirely rooted in the need to fund Medicare and Medicaid. If we base future spending projections on past trends, then Blinder is absolutely correct. Spending growth on Medicare and Medicaid nearly always outstrips the growth in tax revenues. The main contributors to spending growth – demographics, labor costs, and, especially, technology – are likely to keep this trend alive indefinitely. Blinder challenges us to focus the debate about the deficit on the key facts, which essentially means that we should focus on Medicare and Medicaid spending. Let me take up his challenge.

Let’s start with the obvious debating points. There is a lot of fat in both programs. CMS just acknowledged that as much as 10 percent of spending in Medicare and Medicaid is “improper.” This does not include spending on defensive medicine, unnecessary services demanded by fully insured patients, unwarranted variations in practice, and all the other usual suspects. Nor does it reckon with all the waste due to poor health behaviors, although eventually the grim reaper will have his say and dying is usually very costly no matter how well you have pampered your body along the way.

Will Consumers Pay for e-Health?

Jan 23, 2012

By Laura Montini

Lots of health startups out there are trying to zero in on ideas that will improve the lives of patients with chronic conditions. And even though patients are the target audience of this technology, companies seem to be designing their products by first asking, “What will health care providers and and health insurers pay for?” It makes sense, assuming that these two groups will foot the entire bill for electronic health (e-Health) innovations. But it doesn’t make common sense. Why not design the tech for those who are going to use it in the end?

The discussion came up at the Digital Health Summit, a two day conference at the International Consumer Electronics Show. Health 2.0′s Matthew Holt moderated a segment called “Who’s Paying the Bill for e-Health?” When Holt asked a panel if consumers would be willing to pay, Senior Advisor of of the American Association of Retired Peoples Bill Walsh indicated that most AARP members would answer “no.”

“What they’re telling us about mobile health is, ‘Gee, this is interesting but why isn’t my insurance company paying for this? This is just another medical device,’” Walsh said.

Newt Gingrich Reveals His Inner Democrat

Jan 22, 2012• 8

By Al Lewis

Perhaps Newt Gingrich’s book Saving Lives & Saving Money has been quietly redacted of a few lines since its original 2003 printing, because otherwise a simple read of the copies now in circulation would find a blueprint for Obamacare just like the first printing did. I dusted off my old, autographed, copy and re-read it, and am providing some highlights for THCB readers.

Much of the book does propose market-based solutions, such as the use of disease management programs to “dramatically improve outcomes.” However, the book also calls for bigger government, in the form of (1) drug coverage for seniors (since passed) and (2) a “tripling” of the National Science Foundation budget.

In addition to those two specific calls for increased government spending, the first printing contains language that might comfort Don Berwick more than Fox News, and not just because Dr. Berwick gets favorably mentioned twice.

Some samples:

P. 31: “The number of uninsured in America is a threat to our civilization.”

P. 54 “Don Berwick[has] pioneered the translation of the teachings of quality experts such as Edwards Deming and Joseph Juran to the healthcare profession.”

P 59 “It is justified to mandate the use of electronic systems to drag the medical system into the 21^st century.”

Stopping an Epidemic By Redefining It

Jan 22, 2012

By GAYNELL PAYNE

Finally a proposition to stop the epidemic of ASD (Autism Spectrum Disorder). But is it valid? An expert panel at the American Psychiatric Association is proposing to do just that. The D.S.M., Diagnostic and Statistical Manual of Mental Disorders is undergoing the most dramatic revision in 17 years. The D.S.M. is the standard used to diagnose mental disorders.

By new definitions, most of those now diagnosed with high functioning Aspergers will lose their diagnosis. Experts believe that this will stem the rising tide of numbers of those diagnosed with ASD, numbers which now are reaching “epidemic proportions.”

“We would nip [the rising Autism rate] in the bud,” said Dr. Fred R. Volkmar, director of the Child Study Center at the Yale School of Medicine and an author of the new analysis of the proposal.

There has been an argument raging for years with one faction claiming that the numbers are merely the results of better diagnoses, while many experts still hold that that still doesn’t account for the fact that one child in a hundred is now diagnosed with ASD.

(Almost) Nothing Works

Jan 21, 2012• 49

By Robert Laszweski

I will suggest that most of us believe the way to control health care costs, and at the same time maintain or improve quality, is to both use the managed care tools we have developed over the years, and perhaps more importantly, change the payment incentives so that both cost control and quality are upper most in the minds of providers and payers.

The Congressional Budget Office (CBO) has just released an important review of Medicare’s results in testing those ideas. The news is not good.

From the CBO’s blog post:

In the past two decades, Medicare’s administrators have conducted demonstrations to test two broad approaches to enhancing the quality of health care and improving the efficiency of health care delivery in Medicare’s fee-for-service program. Disease management and care coordination demonstrations have sought to improve the quality of care of beneficiaries with chronic illnesses and those whose health care is expected to be particularly costly. Value-based payment demonstrations have given health care providers financial incentives to improve the quality and efficiency of care rather than payments based strictly on the volume and intensity of services delivered.

In an issue brief released today, CBO reviewed the outcomes of 10 major demonstrations—6 in the first category and 4 in the second—that have been evaluated by independent researchers. CBO finds that most programs tested in those demonstrations have not reduced federal spending on Medicare.

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