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Above the Fold
Health Impact Assessment: A Tool That Can Build A Healthier America
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
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
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
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
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
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…
New Year’s Resolution Diets
By HERBERT MATHEWSON, MD
A NEW YEAR’S RESOLUTION IS SOMETHING THAT GOES IN ONE YEAR AND OUT THE OTHER.
– attributed to both Oscar Wilde
and Anonymous
– just another reminder not to believe
everything you read on the web
It is very hard not to write about New Year’s resolutions at this time of year since almost everyone (83%) say they make them, and the majority of us (64%) are not following them six months later. Just one Google search turned up a myriad of medical New Year’s resolutions from a variety of medical institutions and medical newsletters. Some were even age-restricted; “Parental Resolutions” and “Children Resolutions” (3 different age groups). Most seem related to eating healthier, exercising more, losing weight, and new this year, “refrain from bullying”.
New Year’s resolutions probably originated in 156 B.C. when Janus, the two-faced God able to look both forward and backward at the same time, was selected as the symbol of January. Julius Caesar really closed the deal in 46 B.C.when he decreed that January would be the first month of the year. Of course, now-a-days we “have an app for it”.
One problem with resolutions is that they usually exhibit some ambiguity or are overly general, without specificity. For instance, how does one “eat healthier”? Oneprofessor of nutrition ate Twinkies, Dorrito Chips, and Oreos for 10 weeks and lost 27 pounds. His ‘bad cholesterol dropped by 20%, his “good” cholesterol increased by 20%, and his triglyceride level dropped by a whopping 40%. He did this by lowering his calorie intake from 2600 calories a day to under 1800. And that was his point. Weight loss is a result of reduced calories alone. The mix of carbohydrates, fats, and proteins is not important in a “weight-loss diet”. Any diet works, if it reduces your calorie intake.
What Would A Truly Patient-Centered ACO Look Like?
By
Health care leaders are busy talking to attorneys and consultants about how to set up Accountable Care Organizations (ACOs). A recent Advisory Board survey found that 73 per cent of hospital finance executives said that creating such an organization was a top priority for their health system.
Last year my most popular keynote topic was patient-centered medical home creation; this year everyone wants a presentation on ACOs.
However not everyone has jumped on the ACO bandwagon. Bruce Bagley, MD of the American Academy of Family Practice was recently quoted as saying, “There are probably no experts about ACOs. It’s a developing concept.” And Jeff Goldsmith, PhD, of the University of Virginia stated at the same conference: “I think this is a stupid idea. Managed care without the risk – that’s like gin and tonic without the gin. How do you end up making choices if you’re not forced to make them?”
I started thinking about what an ACO would look like if it was truly patient-centered. What if we designed an ACO that gave patients what they say they really want?
Don Berwick wrote an article in Health Affairs in 2009 that examined what patient-centered should mean, and since he became the head of Medicare in 2010 it might make sense to start there. After all, Medicare is pushing the ACO concept by creating pilot projects and encouraging the shift from fee for service payments to global payments for medical care reimbursement.
The “Unreasonable” Premium Increase Rule
By
HHS has now released its final set of draft regulations for provisions of the Affordable Care Act scheduled to go into effect early in 2011. This last regulatory publication—actually a “notice of proposed rulemaking” inviting comments prior to implementation—provides proposed rules for disclosure and justification of “unreasonable” premium increases.
The proposed “confess and explain” regulation requires insurers to publicly disclose rate increases in the individual or small group markets of ten percent or more in 2011, or above individual state-by-state thresholds starting in 2012. The thresholds will be set by HHS, presumably in conjunction with the states.
Although the proposed rules require review either by HHS or, if a state has an “effective rate review system,” by the state, no authority is provided for the rejection or modification of rate increases. Apparently, the Congressional drafters of the ACA language—which the proposed rule generally follows—felt that the threat of a premium increase being called unreasonable would have an adequate sentinel effect. However, insurers who show a “pattern or practice of excessive or unjustified premium increases” can also be excluded from insurance exchange participation.
