Want to be part of a health innovation fund with a social conscience? This best of all world’s job could be yours with the wonderful people at the California Health Care Foundation. Here’s what CHCF’s Veenu Aulakh wrote to me: “The Health Innovations Fund Program Officer would help lead analysis in investment opportunities, analyze business plans, work with outside consultants and companies, and support team activities. Our ideal candidate has a strong interest in the broader work of CHCF and the Innovations program as well as knowledge of the health care system and experience in investing or market analysis. We’re looking for a health care type person who has a business background but cares about the mission of what we’re trying to do.” Here’s the full posting.
Above the Fold
Primary Care Revolt: Replace the RUC
By RICHARD REECE, MD
An under-the-radar revolution is going on out there. It is a revolt of primary care physicians against the AMA and CMS. It is a request for parity with specialists. It is a movement to replace how primary care practitioners are paid.
Why the revolt against the AMA and CMS? Because primary care doctors yearn to correct myths about primary care vis-à-vis specialists, and because they believe, by altering how the AMA and CMS pay doctors, health costs can be brought down, and primary care can be re-invigorated. Health systems with a broad primary care base have lower costs. In the U.S., two-thirds of doctors are specialists, and one-third are in primary care, the reverse of most nations, which have 50% or lower costs.
In the early 1990s, the AMA formed the Relative Value Scale Update Committee (RUC), which specialists now dominate. RUC sets payment codes for doctors. Since RUC’s inception, the payment differential has been growing between primary care doctors and specialists, so much so that the typical primary care doctor now makes only 30% of what an orthopedic surgeon makes. On average, primary care incomes are 50% of those of specialists.Continue reading…
Interview: Resilient
Matthew Holt interviews Jonathan Hare of Resilient Network Systems at HIMSS.
And for a bonus, here’s Resilient’s product introduction at Health 2.0 last Fall
Interview: MEDecision
Matthew Holt interviews Eric Demers, Senior Vice President of Health and Life Sciences of MEDecision, at HIMSS.
Patient-Driven Care Instead of Patient-Centered Care
By PAUL LEVY
After being part of a discussion at the Institute for Healthcare Improvement today, I have decided to change my profile, above, from this:
Advocate for patient-centered care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement.
To this:
Advocate for patient-driven care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement.
What I am suggesting is that clinicians should do their best to collaborate with patients to understand their needs and desires and to jointly design plans of care that are as consistent as possible with those needs and desires.Continue reading…
Could Facebook be Your Platform?
By VINCE KURAITIS
My guess is you’ve probably never asked yourself this question. A quick preview:
- Technical barriers aren’t the limiting factors to Facebook becoming a care coordination platform.
- Facebook’s company DNA won’t play well in health care.
- Could Facebook become the care coordination platform of the future? If not Facebook, then what?
1) Technical barriers aren’t the limiting factors to Facebook as a care coordination platform.
Can you imagine Facebook as a care coordination platform? I don’t think it’s much of a stretch. Facebook already has 650 million people on its network with a myriad of tools that allow for one-to-one or group interactions.
What would it take to make Facebook a viable care coordination platform?
- More servers to handle the volume — not a problem
- Specialized applications suited for health care conditions — not a problem
- Privacy settings that made people comfortable — more on this later
- A mechanism to identify and connect the members of YOUR care team — really tough, BUT this is NOT a technological problem, but a health system one
Suppose you are a 55–year-old woman who is a brittle diabetic. Your care team might include a family physician, an endocrinologist, a registered dietitian, a diabetic nurse, a ophthalmologist, a podiatrist, a psychologist, and others. Ideally you’d have one care plan that coordinates the care among members of the team, including you.Continue reading…
Finding A Path Through The Health Insurance Market ‘Gobbledygook’
My ZIP code is a black hole for individual health insurance.
That’s what I recently discovered when I tried to find the coverage I want at an affordable price. What hubris I had.
My story started in 2009, when my position as a journalism professor at a small college was eliminated, and I lost my health benefits along with the job. In the ensuing months, as the clock ticked on my COBRA extension, I began to focus on finding a new health plan. I thought it would be a matter of dealing with mild sticker shock and doing comparative shopping. I was wrong.
As an experienced writer and researcher, I am used to making calls, asking questions and digging through hard-to-understand details. But it never occurred to me that the answers I uncovered about Tompkins County, N.Y. — a paradise of farmland, lakes and waterfalls close to the cultural attractions of Ithaca, home for me and Cornell University — would be so frustrating. It turns out it’s one of the state’s worst places to find good individual health coverage.
When I tell people about my dilemma, they get curious — even participatory. “Did you try a professional group?” they ask. “Did you try an online broker?” (Yes and yes.) Maybe they get caught up in my story because, unlike many people with tales of insurance woes, I’m in my fifties and healthy. My story doesn’t involve a medical condition that’s unsolvable or hard to talk about. Or maybe it’s just that my experience lights a path, however convoluted, through the insurance gobbledygook.Continue reading…
Controlling the Medicare Budget – Two Infeasible Proposals
By ROGER COLLIER
How to slow Medicare’s escalating costs has been the big health care policy issue this month, with Republicans and Democrats offering competing proposals, each part of broader plans for reducing the federal deficit—projected to be $1.5 trillion this year, with the government borrowing 40 cents for every dollar it spends.
Unfortunately, neither the Medicare proposal of Representative Paul Ryan’s House Budget Committee, nor that offered in response by President Obama, can be considered realistic.
Both proposals do have some merits. Representative Ryan’s plan for switching Medicare to a quasi-voucher premium support program in which beneficiaries would pay part of the premium for their choice of health plan could make seniors more cost conscious and introduce more competition among insurers. President Obama’s proposed strengthening of the Independent Payment Advisory Board provision of the ACA by lowering the trigger point for IPAB action would force further efforts to reduce costs, while doing much to remove Medicare policy from lobbyist-vulnerable political considerations. Both, if implemented, would effectively guarantee that federal Medicare expenditures would drop dramatically from current projections.
Neither, however, has any chance of enactment. The Congressional Budget Office’s projection of the average 65-year-old paying more than two-thirds of the cost of Medicare coverage by 2030—and more than twice as much as under the present program—almost certainly dooms Representative Ryan’s proposal. (The CBO’s assumption of the continuation of the differential between traditional Medicare and insurers’ equivalent offerings can be questioned, but it’s the forecast of the unfortunate 65-year-old’s 68 percent share of the tab that will resonate for seniors, their lobbyists, and their political supporters.)Continue reading…
The Cusp of Consumer Engagement
By JOHN MOORE
When Chilmark Research was founded, the primary area of focus was healthcare IT that was consumer facing, consumer enabling – tools that would help consumers better manage their health and the health of loved ones. This led to our first major study on Personal Health Records (PHRs) published in May 2008. But alas, I was idealistic in the belief that there was enough interest in this area, enough of a market to sustain and grow this young company. Sure, there are loads of small companies trying to make a consumer health play and there is certainly plenty of hype surrounding it but at the end of the day when one takes a close look at this market one finds a multitude of small companies struggling to break through. Exceedingly few companies have been able to really capture the consumer market potential and scale to a size that would support the kinds of services that Chilmark Research offers. This led to a rethinking of what Chilmark Research would focus upon.
Stepping back and looking at the market one sees several critical technical gaps:
- Lack of Data: Despite all of the incredible medical advances taking place and the amazing technologies that are being used today to practice medicine, the industry as a whole is a laggard in adoption of IT. One can point the finger in many directions but the bottom line is that there is simply not a lot of clinical, personal health information (PHI) in a readily computable digital format that a consumer can tap into.
- Data Liquidity: A consumer’s PHI, even when it is in digital form is most often scattered across a multitude of silo’d applications making it virtually impossible for a consumer to readily and securely access and manage their complete health records using the data contained therein to personally guide them to make better health decisions. There are a number of contributing factors at play here, primary among them lack of clear standards & terminology as well as reluctance of healthcare organizations to release data to the consumer.
- Ease of Access: Providing the consumer with “on-the-go” access to their health information allowing them to easily call up or input data to their personal health system, via a mobile device. Today, most mHealth apps in this category are rudimentary and it is not necessarily the fault of the app developer but often the lack of good data as a result of points 1 & 2.Continue reading…
Stubborn
This week I had the occasion to be at UCLA for a very interesting meeting (more on that in a future post). As I arrived at LAX to return my rental car, I drove past a huge billboard at the corner of 96th Avenue and Airport Blvd (just across from the Renaissance Hotel) that made me do a double take. The billboard, said in gigantic white letters on a red background: “This year thousands of men will die from stubbornness.”
Naturally, my first thought was this: Why thousands? If men can die from stubbornness, aren’t they all doomed? If stubbornness is the proximate cause of death, we are looking at a wipe-out of society on a pretty imminent basis. The bad news: no more future generations. The good news: no one will hassle us women about buying too many shoes and all the top-paying private equity jobs will soon be available.
So figuring that I had misread this billboard, I actually made a U-turn and drove past it again (not sure what made me do it: alarm or wishful thinking). What I noticed on my second pass was the very fine print, which said, “Learn the preventative medical tests you need. AHRQ.gov.”
The billboard is apparently part of an U.S. Government Agency for Healthcare Research and Quality Department ad campaign targeted to get men to stop avoiding the doctor and to go and get the medical screening tests recommended each year, such as those for cholesterol, diabetes, high blood pressure, cancer and other illnesses.Continue reading…
