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The Summer of Sequels

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By DAVID DRANOVE

I have seen this film before. Folks get all excited about the potential for vertical integration to save our healthcare system, and then the facts emerge.

The results of the first major ACO demonstration project are in and unless there is some hidden meaning behind all the data, it looks like ACOs may not be the magic bullet that the Obama administration had hoped. The demonstration began under President Bush and the specific payment structure and quality incentive differ somewhat from the ACO rules under the Affordable Care Act, but the main features are the same – give an integrated provider organization a share of the savings if it can hold down Medicare spending while also offering some quality bonuses.

Despite the fact that the participants included ten of the nation’s best known physician-led integrated organizations, less than half were able to lower Medicare costs by the final year of the project and only two demonstrated consistent cost savings. And the methods used to achieve savings – nurse call centers and telephone health checkups – are the sorts of thing that don’t exactly require vertical integration.

There are going to be excuses – the ACOs need to be run by hospitals, they need more time to develop their information technologies, the performance incentives need to be strengthened. But that is the kind of ex post rationalizing one hears any time an experiment fails to support a theory. Maybe the theory (that vertical integration is the panacea for our ailing system) is wrong.Continue reading…

Creating Value-Based Incentives For Primary Care

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By BRIAN KLEPPER & DAVID KIBBE, MD

In a remarkable recent interview, Donald Berwick MD, Administrator of the Centers for Medicare and Medicaid Services (CMS), eloquently described his vision of value-based health care.

Paying for value is an incentive…The underlying idea of improvement is that American health care, historically built in fragments, often cannot achieve for patients what it really wants to achieve…Health delivery system reform refers to really reconfiguring care into much more seamless coordinated-care operations so that people, especially those with chronic illnesses, experience continuity of care over time and space.

So when patients come home from the hospital, there is a smooth handoff, and all the necessary information follows them. When they are seeing a specialist, that specialist is coordinating care with their primary care doctor.

This description probably resonates with most health care professionals as a better approach than the current paradigm’s fragmentation and lack of continuity of care. But as with many things in health care, it won’t be easy getting to a value-based health care approach in Medicare and Medicaid. Despite wide acknowledgement that fee-for-service perpetuates our health system’s most undesirable characteristics, the mainstream of American health care seems stuck. One wonders whether CMS can rise above the special interest lobbying, get beyond the interminable pilots and decisively act on payment reform with the conviction required to help save health care from itself.

Still, the idea of value-based reimbursement begs questions. What payment methodology will incentivize the best quality and most efficient care? What path can take us there?Continue reading…

Why Angry Birds Gets More Play Than Health Apps

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By JESSIE GRUMAN


I have been musing about why, despite our fascination with gadgets and timesaving devices, so few of us use the apps and tools that have been developed to help us take care of ourselves.

The range of options is staggering – my iPhone coughed up 52 applications for medication reminders just now – but most of us don’t make use of the (often free) high-tech help available to us.  There are hundreds of websites and portals to help us monitor our diets, physical activity and blood sugar, talk to our doctors by e-mail and understand our test results.  Apps can help us watch for drug interactions, unravel our test results, adjust our hearing aids and track our symptoms.  Devices can monitor whether our mom is moving around her house this morning or continuously monitor our vital signs.

Interesting ideas.  Modest pickup.

In an essay published in the May issue of the American Journal of Preventive Medicine supplement “Cyberinfrastructure for Consumer Health,” I make some observations about why this may be so, based on my experience as a person who daily responds to an exciting variety of chronic and acute conditions that ebb and flow in my body.  My remarks are addressed to those who fund and develop devices and Web-based tools to help those of us with chronic conditions better care for ourselves.Continue reading…

Health Data-Palooza!!!

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Thursday June 9, 2011, 9:00am EDT
Watch the Live Webcast: http://videocast.nih.gov/ or http://www.hhs.gov/live/

Harnessing the Power of Data to Improve Health

Featured Speakers: Aneesh Chopra, US CTO; Tim O’Reilly, O’Reilly Media; Matt Miller, NPR; Harvey Fineberg, IOM President; Todd Park, HHS CTO; and many others

The Health Data Initiative is a public-private collaboration that encourages innovators, entrepreneurs, startups, data geeks, community activists and policy makers to utilize health data to develop products and applications to raise awareness of health and health system performance and spark action to improve health.

On June 9th the Department of Health and Human Services and the Institute of Medicine will hold a second health data forum that will bring together over 500 people in person to showcase how health data can create tools and applications to support more informed decision-making by consumers/patients, health care systems, and community officials.

The innovators presenting are a great example of how data and technology can be harnessed in powerful ways to help provide better care and better health.

Over 40 companies will be featured. This event will be live streamed throughout the day with a series of major announcements (challenges issued, new university programs and partnerships, and new major activity in the startup world).

Follow along on twitter: #healthapps

Sign up for a reminder!

See the Agenda (The full day will be webcast live)

Attend a Viewing Party near you

Costs are Up…Because They’re Higher Than They Were

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By EVAN FALCHUK

In perhaps no other country is there a greater abundance of data about health care than there is in the United States.  And in perhaps no other country is there more confusion as to what’s really going on.

Take the recent report by powerhouse actuarial firm Milliman (disclosure:  Best Doctors uses Milliman for actuarial work).  It’s a fascinating report with some of the best information on American health care there is.

The major take-away:  U.S. health care costs continue going up.

But when people start interpreting the data, well, that’s where the trouble starts.

For example, NPR reports on why costs are going up:

For three straight years, outpatient care has led all other categories of care in cost increases. Ninety percent of the increase is in more types of care being delivered in outpatient settings.

Factually, of course, this is correct.  More and more care is being delivered in outpatient settings.Continue reading…

First Meaningful Use Dollars Are Just the Start

By JONATHAN BUSH

The first of our clients just got issued his Meaningful Use check. He is Dr. Allen Ferguson, a family practice doc in Eaton, Ohio. He practices in a health professional shortage area so it was a little bigger than the $18K maximum year one payment. He was thrilled and we are thrilled for him…but not ecstatic, yet.

Unlike other companies, our goal is not and was never to build an application that could only be used to get a bonus like the Meaningful Use bonus. It is to actually GET EVERY BONUS available and every payment dollar deserved by every doc on our network.  Our mantra for each service team is this: Be the best in the world at getting docs paid for doing the right thing.

This presents a two-fold challenge in this mini-era of Meaningful Use bonus infatuation. First, we want it all, and less than all will not do.  We have guaranteed that every Medicare eligible doc on our athenaClinicals EHR service who signs up and does his or her part will in fact get it. Hence, our real measure of success is 100% of docs winning and NOT the idea that winning is possible. Second, we are committed to ensuring that every doc actually achieves the measures even though the government has taken a “don’t ask/tell” stance by requiring only that docs “attest” that they are compliant rather than show it. We can’t play that way. Since we’re on this thing called the cloud, we actually do know exactly how Meaningful Use compliant every one of our docs is and exactly what they have to do to cross the threshold to meet the definition. Continue reading…

The Role of Conflicted Science in the Cell Phone-Cancer Link

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By MERRILL GOOZNER

Dr. Len over at the American Cancer Society is raising legitimate questions about the early release of findings by the World Health Organization’s International Agency for Research on Cancer (IARC) that cell phone use may increase the risk of brain cancer (hat tip to Gary Schwitzer’s HealthNewsReview).  The actual study — drawn from an analysis of “hundreds of scientific articles ” — won’t be published in Lancet Oncology “for a few days,” according to IARC. Says Dr. Len:

Unfortunately, drawing broad and sweeping conclusions based on a press release and a news conference leaves many of us wondering just what the evidence shows that led to the conclusion announced today that “radiofrequency electromagnetic fields” may be possibly cause cancer in people.

The evidence, when it appears, will be murky. A few years ago, I spent several months reviewing some of the evidence in this troubling field, largely from a conflict-of-interest perspective. The global telecommunications industry funds much of the science. Even when government agencies fund research, the results are difficult to interpret. The studies invariably involve looking for a very small number of negative health outcomes (brain cancers) in very large populations. Two researchers, looking at the very same set of epidemiological facts, will often come to different conclusions. And, as often as not, those conclusions correlate with whether the the researchers are independent or whether they are on industry’s payroll.Continue reading…

Getting Transparency Right

By PAUL LEVY

This is about transparency, when it is useful and when it is not. The term is now an established part of the health care lexicon, but there is little substantive discussion about how it is being used.

As I said in an article in Business Week over three years ago:

There are often misconceptions as people talk about “transparency” in the health-care field. They say the main societal value is to provide information so patients can make decisions about which hospital to visit for a given diagnosis or treatment. As for hospitals, people believe the main strategic value of transparency is to create a competitive advantage vis-à-vis other hospitals in the same city or region. Both these impressions are misguided.

Transparency’s major societal and strategic imperative is to provide creative tension within hospitals so that they hold themselves accountable. This accountability is what will drive doctors, nurses, and administrators to seek constant improvements in the quality and safety of patient care.

Now, there rises an additional misconception. The perversion of the transparency concept that has evolved rides on the desire of CMS and private insurance companies to use publicly published outcome data to financially reward or penalize hospitals. As expected, this is raising hackles. The complaints often heard from hospitals are ones we have discussed before: “The data are wrong.” “Our patients are sicker.”Continue reading…

The NYTimes gets sensible on privacy

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Today I got pretty depressed. I saw a link that 13 tech companies were funding a seminar put on by Deb Peel’s Patients Privacy Rights.org (and no I’m not helping with a link) It’s a big pity that sensible companies have been pressured into funding that organization and worse that somehow despite the gibberish Peel has spoken in so many places she’s accepted as being the main face of consumer concerns about privacy. Of course I’ve had my say about her in the past. However I was a little heartened by this Milt Freudenheim NY Times article which after decrying the “epidemic” of personal health information violations had both David Brailer and Wes Rishel basically saying, 1) yes there will be breaches, 2) no, that’s not a reason not to go electronic and c) we need a system that bans the illegitimate use of the data–rather than punishes the accidental breach. And no Deb Peel in sight. Well done NYT.

Coordinating Care: It’s A Moral Question, But Not A Hard One

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By JOE FLOWER

Under the headline, “Medicare Plan for Payments Irks Hospitals,” today’s New York Times details the opposition stirred up by the government’s “value-based purchasing” initiative. If you’re buying anything (and the US federal government is the largest purchaser of healthcare in the world), on what basis other than value would you want to buy?

The measure at issue is “Medicare spending per beneficiary” during hospitalization, and in the 3 days before and 90 days after. The hospitals and hospital associations that are complaining have, mostly, two beefs: “Our patients are sicker,” and “We can’t be responsible for what happens, and what tests and procedures doctors order, outside our walls.”

The government’s response to the first is that the system will be adjusted for older populations, more acuity, and other variables. The response to the second is more complex, but it amounts to: “Work it out.”

And there is good reason for this. In studies going back two decades, the Dartmouth Group has shown wide disparities in Medicare payments per beneficiary between regions and between hospitals. A recent Institute of Medicine study took the Dartmouth stats and, in response to all the talk from hospitals that “our patients are sicker,” or “but we have to pay for teaching and research,” re-worked them to back out all those confounding factors. The Dartmouth Group’s study showed that the most expensive areas spent three times as much as the least expensive. After the IOM backed out the confounding factors, the data still showed that the more expensive areas spent twice as much.  And the expense does not vary so much with inner-city status or number of illegal aliens as it does with whether health care in a given area is well-organized and coordinated or unorganized and fractured. It’s a really easy pattern to see if you stare at the maps of expense long enough, and know a lot about different healthcare markets.Continue reading…

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