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Publicity is Cheap, Privacy is Expensive

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By JOHN HALAMKA, MD John Halamka

When I was 18 years old, publicity was hard to come by. Media outlets were limited to newspapers with very high editorial standards, television with few channels and very limited news time, and a few high profile news magazines.

My first 15 minutes of fame came in 1981 when I was interviewed by Dan Rather for a CBS Evening News spot on entrepreneurialism in the Silicon Valley. In 1982, I appeared in Newsweek, as a student correspondent at Stanford, writing about religion, politics and the culturally important trends of the day. In 1983, I appeared in US News and World Report in an article about the emerging importance of software.

Today, blogs, wikis, forums, YouTube, Facebook, Twitter, and Google enable fame and publicity without editorial control. Use your phone to take a video of a squirrel doing something amusing and a few minutes later you’ve got publicity and thousands of people watching your work.

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The Non-Scalability of Charisma

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By BOB WACHTER, MD

Early on, many social movements depend on a charismatic leader to focus attention, build a burning platform, and inspire people to action. You know when the movement has made it when it no longer needs such a leader for fuel.

The safety and quality movements have picked up tremendous steam over the past decade, but they haven’t yet hit that self-sustaining tipping point. Last week, there were two things that reminded me of this: the announcement of a new leader of the Institute for Healthcare Improvement (IHI), and a doleful JAMA essay by Peter Pronovost.

During the circus that was Don Berwick’s recess appointment to lead the Centers for Medicare & Medicaid Services (CMS), all eyes were trained Inside the Beltway. But 440 miles north, in Cambridge, MA, arguably the most important organization in the quality and safety galaxy needed to get on with its business. On July 8th, IHI announced its choice of Maureen Bisognano to become its new CEO. Maureen is a nurse and former hospital exec who has spent the last 15 years at IHI as Don’s consigliere. She is a terrific person, with boundless energy and great organizational skills – insiders will tell you that she was the reason that IHI’s trains ran on time for the past decade, as Don is the quintessential big picture guy.Continue reading…

The Conservative Way Forward on Health Care

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By RICHARD AMERLING, MDRichard Amerling

The landslide Republican victory, in taking the House and electing some strong conservatives to the Senate, can be interpreted as a mandate to rein in government spending, and specifically to repeal ObamaCare, as these issues were clearly behind the large turnout.  There is still a very real possibility the Supreme Court will find the “individual mandate” to buy private insurance unconstitutional.  If this provision is thrown out, it’s hard to see how the law survives, since the mandate is needed to finance it.

Now is an excellent time to construct a conservative alternative vision for true reform of our health care delivery system.  Since most current problems with the health care system stem from government, a conservative plan should seek to reduce its role.

It goes without saying that the Patient Protection and Affordable Care Act must be repealed since, like all the laws passed by this administration, it does precisely the opposite of what its name suggests.   By massively increasing the health care bureaucracy at the expense of actual providers of care, it will make care harder to access and more expensive.   Many physicians will take early retirement and the already great physician shortage will be exacerbated.

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Are prescription drugs going the way of Napster, YouTube and iTunes?

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By DAVID E. WILLIAMS

The distribution of prescription pharmaceuticals is beginning to take on some of the characteristics of online videos and music. Traditionally, access to prescriptions works as follows:

  1. Patient has a problem
  2. Patients sees his/her physician
  3. Physician diagnoses problem and writes prescription
  4. Patient takes prescription to traditional pharmacy or PBM-owned mail order company
  5. Pharmacy fills prescription with a drug manufactured by an FDA-regulated brand name or generic pharmaceutical company
  6. Patient takes medication
  7. If patient needs more medication after initial prescription and refills are exhausted, patient requests renewal from physician and repeats steps 4 to 7

But steps 2 through 7 are breaking down. Instead of seeing their physicians, increasing numbers of patients are either going directly online to order from pharmacies or are borrowing pills from friends and family who’ve received prescriptions. According to MedPage Today (Adults Commonly Share Prescription Drugs with Friends and Family) almost 30 percent of adults reported sharing prescription medications with others. Younger people are the most likely to share.

Meanwhile, shady web-based pharmacies that don’t require prescriptions and often sell counterfeit drugs are becoming increasingly sophisticated and impressive. MarketMonitor estimates that about 1000 shady pharmacy sites generate an average of 100,000 hits per day each and that such pharmacies spend about $25 million per year on search advertising. An acquaintance who works in the pharmaceutical security business told me that these pharmacies aren’t what they used to be. In fact they are adopting marketing and customer service best practices that are used by legitimate vendors. Rather than going for a quick score, the web-based companies are looking for repeat business and word-of-mouth referrals by providing products that work, offering easy-to-navigate websites and low prices.

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The preview of the Health 2.0 Accelerator Apps Network is now available on video

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At the Fall 2010 Health 2.0 Conference
seven companies demonstrate composite applications
to connect and support patients, caregivers and providers.

San Francisco, November 10, 2010 – The preview of the Health 2.0 Accelerator Apps Network is now available on video – showing 7 interoperating health sites and composite applications – at http://www.health2con.com/2010/11/11/health-2-0-accelerator-group/.

The Health 2.0 Accelerator Apps Network is a growing ecosystem of web applications and services that work together – collaborating 2, 3, 4 and more at a time, serving as platforms for other apps and as interoperable bridges between apps – all to connect and support patients, caregivers and providers. This year's preview was presented at the Fall 2010 Health 2.0 Conference, during the "Tools and Unplatforms Part II: the Emerging Consumer-Centric Ecosystem" session, (www.health2con.com) moderated by Matthew Holt, Co-Founder of Health 2.0. Following the presentation, the Health 2.0 Accelerator companies discussed the process of working together to build these connected and composite applications and how others can join the network.

In his role as Lead Architect of the Health 2.0 Accelerator, Erick Von Schweber explained the architecture and standards the group is using to enable these powerful but relatively easy to implement integrations. Enhanced Medical Decisions facilitated data interoperability by retrofitting deidentified free text medical records with the addition of interoperable codes, transforming misspelled drugs to NDC medication codes and user entered symptom descriptions to ICD-9 condition codes and thus supporting action on standard data forms.

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The Cost of Success

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By ROB LAMBERTS, MD Rob Lamberts

For those of you who didn’t know, I entered the National Novel Writing Month “contest” (which has no winners).  I got to the goal of 50,000 words yesterday.

One of the main questions that is asked in my novel (which may or may not ever see the light of day) is this: What would happen if a wonderful cure came along that would take away most, if not all sickness? Remember, it is fiction.

The answer is, of course: utter chaos and collapse of our system.

Our system is designed to deal with sickness.  It is designed to fix problems.  If a wonder-drug came along, here’s what I think would happen:

  • Pharmaceutical companies and hospitals would have to oppose it, as they would suffer financial ruin if people became healthy.
  • Doctors, especially those focused on chronic illness or treatment of serious problems, would take a huge cut in pay.
  • A huge number of healthy people would enter the workforce, disrupting an already fragile economy.

Human stupidity, of course, would remain.  There would be some work for those in the medical profession, but only a fraction of what is there now.

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SF 2010: Keynote Address from Jeff Goldsmith

By Bianca Grogan

Jeff Goldsmith, President, Health Futures, Inc., gave a keynote address at the Health 2.0 Fall Conference in San Francisco, CA on October 7-8, 2010. Since the 1970s he’s worked in academia, in government, advised virtually every major health care delivery, insurance and supplier organization, been a national advisor to Ernst & Young, and is on the Board of Health Affairs. On the main stage Jeff spoke about transforming our health care system and the problems and challenges that we face.

The Ryan/Rivlin Plan

By JOHN GOODMAN, PhD

Congressman Paul Ryan (R-WI) and Alice Rivlin, former director of the Congressional Budget Office (CBO), have proposed an entitlement spending reform plan that is striking both for its boldness and its left-right-coming-together origins. There are a number of interesting parts, but I want to focus on the three most important:

  • Medicare would, for the first time, be transformed into rational insurance. Beginning in 2013, all enrollees would be protected by a $6,000 cap on out-of-pocket expenses; in return they would pay for more small expenses on their own.
  • After a decade, people newly eligible for Medicare would receive a voucher to purchase private insurance instead. The value of the voucher would grow at the rate of growth of GDP plus 1% (note: for the past four decades, health care spending per capita nationwide has been growing at about GDP growth plus 2%).
  • Medicaid would be turned into annual block grants to the states. The value of the block grants would also grow at GDP growth plus 1%.

Bottom line verdict: This is a good proposal that deserves serious attention. To guarantee its success, however, more needs to be done to (1) allow the private sector to control costs through economic incentives, competition and entrepreneurship and (2) allow young people to save for the growing share of expenses they will be expected to bear.

How Does This Plan Compare with the Affordable Care Act (ACA)? Given that Ryan has been previously attacked by Paul Krugman and others on the left because of his ideas about voucherizing Medicare, a natural question arises. How does the Ryan/Rivlin slowdown in Medicare spending compare to the health reform bill Congress passed last spring — a bill supported by some of the very people attacking Ryan?

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Is This Normal?

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By PAUL LEVYPicture 26

This is a story about consumer choice using publicly available information. Unfortunately, it is also about the power of suggestion as used by an incumbent provider organization.

The friend who sent me this note is a research fellow at one of the Boston teaching hospitals, so I guess he is more likely than most to do the kind of research he summarizes. Most people would have taken the referral advice offered without question. If they ever did ask to see a different doctor, most would never get past the “need” for asking for “special permission.”

Hi Paul,

I had a strange encounter, and I was wondering if you could tell me if this is normal.

A few months ago my primary care physician recommended I see dermatology for my eczema. His clinic recommended the names of two dermatologists within the same health care system. I looked up both dermatologist on healthgrades.com and found that their patients had given them luke-warm reviews. (There were many reviews, so this wasn’t a sampling problem). Also, I have been reading the medical literature about eczema, and knew there were a lot of recent advances, so I wanted somebody who had published and was familiar with the research.

I found another dermatologist, Dr. Caroline Kim. Her patients loved her (according to healthgrades.com), she had published articles in dermatology research (from scholar.google.com), and she trained at top institutions: Harvard Medical School and MGH. I made an appointment with her.

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“Don’t Litigate, Innovate.”

Robert Laszewski By ROBERT LASZEWSKI

What if a Republican governor and a Republican legislature had the ability to implement their version of health insurance reform and the federal government would have to pay for it? It’s a great idea. And I’m thrilled to say that a bi-partisan bill has already been introduced in the Senate by Ron Wyden, D-Ore., and Scott Brown, R-Mass., that would help facilitate exactly this end.

First, let’s review section 1332 of The Patient Protection and Affordable Care Act to realize how states are already — at least eventually — given the ability to innovate in this manner. Here is a simplified summary:

  • A state may apply to the Health and Human Services secretary for a waiver of all or any requirements with respect to the insurance exchanges, mandates, and subsidies with respect to health insurance coverage within that state for plan years beginning on or after January 1, 2017.
  • The secretary has to provide for an alternative means by which the aggregate amount of the tax credits and subsidies, which would have been paid on behalf of participants in the exchanges, would instead be paid to the state for purposes of implementing their own version of the law.
  • The secretary may grant a request for a waiver only if the secretary determines that the state plan will provide coverage that is at least as comprehensive as the coverage defined under the new law and offered through similar exchanges established by the states.

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