The Health Care Blog – Page 761 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Needle In the Haystack

Jan 6, 2011• 2

By J. LEONARD LICHTENFELD, MD

Well, it didn’t take long to get into the New Year, did it?

There I was this earlier this week, starting my New Year right by getting exercise on my elliptical when I heard the announcement that Johnson & Johnson was partnering with researchers at Massachusetts General Hospital’s cancer center and other major cancer centers to evaluate the potential of a new technology which can isolate single cancer cells circulating in the blood of patients with known cancers.

The news in itself is an impressive step forward in this type of research. Being able to isolate a single cancer cell in a sample of blood is in a sense one of the holy grails of cancer research. Scientists have been working diligently on developing these techniques for a number of years, and to now have a technology that may in fact move that dream closer to a clinical reality where it actually improves the treatment of patients with cancer is exciting.

However, there is always a caution that comes along with these types of announcements.

First, and perhaps the most obvious, is the fact that this is an announcement of a research deal. Nothing more, nothing less. It is not a new breakthrough. It is not something that has been proven effective in improving cancer detection and treatment. Not that it is anything less than stunning to develop and demonstrate that this technology works-but as with all research it is a giant step to go successfully from the laboratory phase of development to the clinical phase of making a real difference in patients’ lives.

A Healthcare Information Services Provider Business Model

Jan 5, 2011• 8

By JOHN HALAMKA, MD

I’ve written previously about Healthcare Information Exchange Sustainability and the need for Healthcare Information Services Providers (HISPs) to serve as gateways connecting individual EHRs.

How should HISPs be funded and how can we encourage HISP vendors to connect every little guy in the country?

We’ve started to think about this in Massachusetts.

There are numerous vendors promising HISP services – Medicity (Aenta), Axolotl (Ingenix), Surescripts, Verizon, and Covisint.

An HIE needs to include at least one common approach to data transport, a routing directory, and a certificate management process that creates a trust fabric. Existing HISP vendors have heterogeneous approaches to each of these functions. In the future, the Direct Project may provide a single approach, but for now HISP vendors will need to be motivated to adhere to State HIE requirements.

An idea that has been embraced by some State HIEs, such as New Hampshire, is to pay HISP vendors a modest fee (under 100K) to support State requirements. This “connectivity” incentive results in interoperable HISPs, creating a statewide network of networks.

Once a standardized HISP approach is supported by multiple vendors, then individual practices need to be connected. Some practices will be aggregated into hubs by EHR software vendors as has been done in cities such as North Adams (Massachusetts), projects such as the New York City PCIP project, and physicians organizations such as the Beth Israel Deaconess Physicians Organization. However, it’s not likely to be cost effective for a vendor to connect every isolated practice to a HISP for the $50/month the practice is willing to pay.

Eighth Annual Healthcare Conference at Harvard Business School

Jan 5, 2011• 3

Please join us for the 8th Annual Healthcare Conference at Harvard Business School on Saturday, January 29th from 8:00 AM to 5:00 PM.

Hosted by the HBS Healthcare Club, the student-run Conference – titled “The State of Healthcare Reform: Challenges. Strategies. Success.” – will address the implications of healthcare reform for various constituents in the global healthcare industry.

Keynote addresses will be delivered by Dr. Robert S. Epstein, Chief Medical Officer of Medco Health Solutions, and Ms. Angela F. Braly, Chair, President, and Chief Executive Officer of WellPoint.

The Conference will also feature a wealth of panel discussions for a wide variety of healthcare interests – from venture capital and entrepreneurship to health policy and healthcare IT to medical technology and biopharmaceuticals. Finally, Conference participants will enjoy access to the highly-attended Networking Luncheon and afternoon Career Fair events. For registration and additional Conference details, please visit the Conference website at www.hbshealthcareconference.org.

Job Post: THCB Editorial

Jan 5, 2011

THCB is looking for talented interns to assist with editorial, research and web production tasks as our web site undergoes a major expansion. Perfect for a grad or med student with an interest in journalism, public policy, and/or the business of health care.

Health Impact Assessment: A Tool That Can Build A Healthier America

Jan 5, 2011• 11

By AARON WERNHAM, MD

In December, the Department of Health and Human Services released “Healthy People 2020” — a 10-year blueprint aimed at improving the health of the nation. The plan comes amidst rising rates of many diseases – such as asthma and diabetes — and skyrocketing health care costs.

Now at the dawn of 2011, federal, state and local officials are faced with the tough job of turning the public health goals outlined by that plan into reality.

However, they will almost certainly fail at that increasingly urgent task unless they start factoring health into proposals being considered in non-health sectors like energy, housing, agriculture and transportation.

What does a decision to build a new highway have to do with health?

Plenty, as it turns out.

Depending on how it is planned, a new highway may change levels of air pollutants and the risk of asthma for people living nearby. New traffic patterns may also increase the risk of traffic-related injuries. Furthermore, the roadway might unintentionally cut off an important walking route to and from a transit stop or local school, making it harder for adults and children to get enough exercise.

2010 Unplugged

Jan 4, 2011• 4

By BOB WACHTER, MD

For people like me, who, perversely enough, get a certain thrill from studying healthcare policy, there’s never been a more exciting, if also dizzying, year than 2010. Passage of the reform bill last March was only the start – and in some ways merely a marker – of the Shifting of the Paradigms: from provider to system; from pen to keyboard; from pay-for-piecework to pay-for-performance; from secrecy to transparency; from patient as passive actor to patient as star of our show.

I’ve been catching up on my reading during the holidays, so bear with me as I devote this blog – lengthier than usual – to a handful of articles, talks, and experiences that, while seeming unrelated, helped me better understand some of the threads of this vibrant healthcare tapestry we’re now weaving.

For decades, one of the defining characteristics of the American healthcare enterprise has been the remarkably poor value – quality divided by cost – it produces. Most of the changes afoot represent a push by a variety of stakeholders, using the tools at their disposal, to improve this value equation. And much of the push-back can be seen as the predictable acts of those who benefited from the old order. As the late William Safire once observed, when you zap a sacred cow, you need to brace yourself for the ensuing mooing. Welcome to Old MacDonald’s Farm.

Turning the Clock Back Isn’t Enough: The Nasty Surprise Awaiting the GOP on Health Care and the Deficit

Jan 4, 2011• 23

By SCOTT BITTLE and JEAN JOHNSON

The Republicans who will take control of the House this January have made it clear there are two things they hate: deficits and President Obama’s healthcare reform. They’ve promised to reduce the first and repeal (or at least hobble) the second. But if you’re worried about deficits, repealing the Obama plan won’t do any good unless you’ve got a better idea. In fact, the numbers say repealing it could make the government’s budget problems worse.

Despite the outrage over spending on the Wall Street bailout, the stimulus or the Iraq war, at least these costs are temporary. But the combination of an aging population and health costs that keep rising faster than inflation means that spending on Medicare, Medicaid and Social Security are going up – – and they’ll keep going up for years on end. With an aging population, there will be more older people eligible for these programs. The health care they need will cost more on top of it.

When people argue about the costs of an aging America, they often lump Social Security and Medicare together like they were the identical twins of public policy. If they are twins, they’re more like the 1980s movie Twins, featuring Arnold Schwarzenegger and Danny DeVito as the world’s most improbable pair of brothers. Maybe you remember the iconic movie poster. It shows the two dressed alike, but with an enormous Schwarzenegger looming over DeVito. In the budget world, Medicare and Social Security are both problems, but Medicare is definitely played by Arnold. Here’s why.

Health care spending has been rising faster than the inflation rate for decades. In 2007, the Consumer Price Index went up 2.8 percent, and health spending went up 6 percent. In 1997 inflation went up 2.3 percent, and health spending went up 5.4 percent. In 1990, when inflation was 5.4 percent, health spending climbed nearly 11 percent.

Wanted: A PCAST Patient Portal

Jan 4, 2011• 3

By ADRIAN GROPPER, MD

What do the President’s Council of Advisors on Science and Technology (PCAST), the recent Institute of Medicine (IOM) report and the New England Journal of Medicine article on value in health care by Porter have in common?

They call for increasing aggregation of information around individual patients even as they seek to avoid complications for and interference with providers.

Even so, the debate between provider-centered and patient-centered health information exchange is still very much with us. Recent progress with the Direct Project, Blue Button and Kaiser’s donation of terminology suggest a trend toward simplicity and open-source collaboration as essential catalysts for health information exchange.

The next logical step is a PCAST-inspired patient portal.

The essential elements of a PCAST Patient Portal are already available:

Blue Button success proves that patients appreciate and will adopt enhanced portal features and that providers can readily connect their databases to the portal if the technical and policy requirements are truly minimal.
The Direct Project shows that combined federal and industry support can produce accessible open source code for bidirectional health information exchange in record time.

Health 2.0 Heads to San Diego: Early Bird Pricing Ends TODAY

Jan 3, 2011• 1

The New Year is here and Health 2.0 is celebrating by announcing some new updates for the Spring Fling Conference in San Diego, March 21-22, 2011 and the Fifth Annual Fall Conference is San Francisco, September 26-27, 2011. We also want to remind you that the last day to purchase the EARLY BIRD tickets for BOTH the San Diego Conference and the COMBINED tickets for both Spring and Fall is TODAY.

We are happy to be returning to San Diego with an awesome line-up of speakers including; Best-selling author, Dr. Dean Ornish, President of the Preventive Medicine Research Institute giving our keynote address and J.D. Kleinke, author of the new novel “Catching Babies”. We also have Three Great Themes where Health 2.0 technologies and services are making a big difference:

Making Health Care Cheaper – The cost of care goes up every year, and the specter of “unsustainability” looms large. Speakers who are addressing how Health 2.0 tools are being used to reduce the cost of care include Rushika Fernandopulle, President of Iora Health, which is running revolutionary primary care clinics for large employers, and Don Casey, CEO of West Wireless Health Institute which is building tools that use technology to lower costs. There will be commentary from Stephen Downs, the Assistant Vice President of the Health Group of the Robert Wood Johnson Foundation, and Margaret Laws from the California Health Care Foundation.

The Evolution Of Research – The Web has changed how health data is collected, how people learn, how research is being done, how patients are recruited for trials, and how discoveries are made. Some of the leaders in this change will tell us how they’re doing it. Hear from George Lundberg, Editor in Chief of Cancer Commons, Susan Love, President of Dr. Susan Love Research Foundation, Paul Wallace, Medical Director for Health and Productivity Management Programs, Kaiser Permanente, and Gilles Frydman,Founder, ACOR

Prevention, Wellness, Exercise & Food; We’ll take a closer look at how Health 2.0 tools can become part of the fabric for better micro-and macro-decisions about food and healthy behaviors, with a special focus on how we can make a real contribution to ending childhood obesity. As well as Dean Ornish, you’ll hear from Alan Greene, Founder of DrGreene.com and leader of the “Whiteout” movement, and Preston Maring, Founder of Kaiser Permanente Farmers’ Markets.

To find out more, check out the San Diego agenda at Health2con.com.

Health 2.0 is also excited to continue a Fall tradition. The Fifth Annual Fall Health 2.0 Conference will be in San Francisco on September 26-27. In 2011 more than 1,000 people from the worlds of technology, health plans, providers, government, finance and more will gather to see the most comprehensive line-up of technology innovation in health care, and discuss the latest changes. It’s one of the most highly rated conferences around and you want to be there.

To see the full press release please CLICK HERE

Pharmaceutical Research Expenditures and Industrial Policy

Jan 3, 2011

By FRANK PASQUALE, JD

Anyone familiar with pharmaceutical industry restructuring will not be surprised by this prediction from the FT’s John Gapper for 2011:

A drugs company will drop early-stage research. Big Pharma has struggled for a decade with a dearth of potential blockbusters. Companies such as GlaxoSmithKline have restructured and slimmed down their research arms but the sector remains troubled, as the departure of Jeff Kindler, Pfizer’s former chief executive, on the grounds of “exhaustion” indicates.

The obvious course with something that is not working is to drop it. Shire Pharmaceuticals pioneered a strategy of outsourcing early-stage research to smaller companies and focusing on developing and trialling promising drugs. This will be the year when one of the industry’s biggest takes a similar tack.

Gapper seems pretty unworried about this transition, and perhaps from the standpoint of pure economic theory it makes little difference whether research is conducted in-house or purchased from other, smaller firms. But as a matter of public relations and political economy, this is a troubling development.

The Post-R&D PR and Jobs Crises

First, the pharmaceutical industry has long justified its profits by arguing that it invests in research and development. For those who favor a market-based approach to drug research, this is a vindication of laissez-faire. Rather than relying on the heavy hand of government to try to direct the research done at pharmaceutical firms, we can expect the “invisible hand” of the market to spin off solutions for everyone’s problems–from the richest to the poorest. Innovations eventually filter down from the highest-income individuals to those with fewer resources. Spending by the wealthy on health care leads to investment in research infrastructure that ultimately redounds to the benefit of all.Continue reading…