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The Massachusetts Connector: Success or Just a PR Coup?

Oct 11, 2010• 13

By ROGER COLLIER

With the passage of insurance exchange legislation in California, and the release of a template for state exchange statutes by the National Association of Insurance Commissioners, many state eyes are turning towards the only existing exchange comparable to that required by PPACA: Massachusetts’ Connector.

The Connector, which offers Commonwealth Care subsidized coverage for those with incomes below 300 percent of FPL but not eligible for Medicaid, and Commonwealth Choice private plans for other families and individuals and small employer groups, has been touted as a major success by current and former Commonwealth officials and many national reform advocates.

But, after four years of operation, just how successful has the Connector really been? Has it simplified health plan choice and enrollment, increased the number of insured, reduced marketing costs, created competition, or driven down premiums? It turns out that the answers are far less positive than the Connector’s boosters have admitted.

HAS THE CONNECTOR SIMPLIFIED PLAN SELECTION AND ENROLLMENT?

For some, at least.

For the 33,000-enrollee unsubsidized CommChoice program the answer is yes. Health plan selection and enrollment for the seven plans (with six levels of benefits each) is directly available via the Connector website, with simple well-designed screens and navigation, and easy comparison of alternatives. Even so, only half of thepost-reform non-subsidized insured have chosen coverage via CommChoice.

Letting the Data Flow, Part One

Oct 11, 2010• 3

By JOHN MOORE

Making clinical data liquid permeated a series of events I attended last week during Health Innovation Week in San Francisco. Monday and Tuesday found me at the HIE/REC conference. Wednesday was HealthCamp at Kaiser-Permanente’s Garfield Research Center (KP was extremely gracious in hosting this event and the opportunity to get a tour of the facilities prior to event kick-off was great). The week concluded with the annual and well-orchestrated Health 2.0 conference.

This first post will focus on the HIE/REC event as it was quite distinct from the other events: smaller audience, more staid, dominated by government officials and tied at the hip, for good and bad, to the existing healthcare system infrastructure.

The HIE/REC conference was an odd event with attendance hovering around 200 or so attendees. The event was focused almost entirely on what the States are doing with the federal funds coming their way to establish Regional Extension Centers (RECs) whose main objective is to get priority primary care physicians (PPCPs) to adopt and meaningfully use a certified EHR. Now, having been to this event and heard many of the State REC initiatives that are now underway via this program, sad to say that my original opinion has not changed. Rather than picking preferred EHRs and assisting with deployment, these RECs may be better off just helping to these PPCPs understand exactly what the HITECH Act is, what are their options, what questions to ask of a vendor or service provider and leave it to EHR consultants and vendors to take it from there.

Physician Report Cards: Don’t Shoot the Messenger

Oct 11, 2010• 6

By JOHN R. MORROW

There is a BIG difference between the popular consumer/physician matching Websites such as: Vitals.com, RateMDs, Angies List, Healthgrades, Zagat and UCompareHealthcare (a NYTimes property), and the other initiatives in place to monitor physician performance as driven by hospitals, government and other payers and health plans. Soon, these differences will be merging with the more complex score cards from hospitals joining forces with the consumer tools.

OPPE (Ongoing Practice Performance Evaluation) and FPPE (focused Practice Performance Evaluation) are initiatives set in place by The Joint Commission (TJC), an arm of the American Hospital Association that accredits health care organizations. These initiatives are coming main stream to provide structured and frequent review of a hospital’s physician personnel. There is nothing new about these initiatives, (TJC has always been a follower in health care business intelligence), but soon ongoing reporting will be required by all and supplied by a variety of experienced commercial firms.

Private enterprise has been helping hospitals benchmark, profile and rate physicians on a broad spectrum of metrics relevant to specific acute service lines for decades. Of course mortality, length of stay, risk-adjusted complications rates, patient safety events and indicators, patient satisfaction, and a long list of Core Process Measures have all been part of that analysis. Progressive hospitals have been sharing this information with physicians, and for the most part physicians have accepted that the profiling analytics have done a good job of educating them on their performance. Medical Evaluation Committees have their hands full with information to help credential and reappoint physicians to hospital privileges, and a more informed dialog has been fostered.

Patients 2.0 – The Growing Demographic of Networked Patients

Oct 10, 2010• 6

By JANE SARASOHN-KAHN

In a ballroom at the Hilton Union Square in San Francisco last week, several hundred people shared ideas, debated, and painted a multi-faceted picture of the NewPatient: the networked patient.

The meeting was convened, in “unconference” style, in conjunction between the Health 2.0 Conference and Gilles Frydman, founding father of ACOR, the Association of Cancer Online Resources. Gilles knows a lot about the NewPatient: he’s organized people focused on cancer for over 15 years through his organization, which has helped tens of thousands of health citizens connect to clinical trials, researchers, information, and each other – all seeking to cure virtually every form of known cancer, and identifying forms unknown.

As Jeremy Shane of Health Central kicked off the meeting, he set the theme: this session was, “Not Meet the Parents, but Meet the Patients.” As Health Central sees 14 million visitors to its sites on a monthly basis, Jeremy has some knowledge about the NewPatient, too.

What makes an engaged patient, he has learned, isn’t based on a demographic such as age or gender or socioeconomic status, per se; what makes an engaged patient is a desire to understand her situation and a driving curiosity – in sum, a “need for cognition and understanding,” Jeremy contends.

Jeremy notes that the average search on health has grown from 4 words just a couple of years ago to 6.5 words today — a longer tail – because people are describing their unique situation and they want an answer to their own needs.

Healthy Eats For Data-Hungry Doctors

Oct 10, 2010• 5

By DAVID C. KIBBE, MD, and BRIAN KLEPPER, PhD

Imagine that an innovative health plan – aware that half or more of health care cost is waste and that physician costs to obtain the identical outcome can vary by as much as eight fold – hopes to sweep market share by producing better quality health care for a dramatically lower cost. So it begins to evaluate its vast data stores. It’s goal is to identify the specialists, outpatient services and hospitals within each market that, for episodes of specific high-frequency or high value conditions, consistently produce the best outcomes at the lowest cost. Imagine that, because higher quality is typically produced at lower costs – there are generally fewer complications and lower incidences of revisiting treatment – the health plan will pay high performers more than low performers. Just as importantly, it will limit the network, steering more patients to high performers and away from low performers.

Suddenly, it will become very important for physicians and other providers to understand, in detail, how they compare to their peers within specialty, and how to provide the best care possible. And if they find the results aren’t so positive, they may want to figure out where their deficiencies lie, and how they can improve.

Now imagine that clinicians could easily view data about their patients and themselves.

Basic demographics: e.g. age, gender, length of time since last visit.
A problem list based on diagnoses within the past year.
A list of medications prescribed, including ordering physician, dates and fulfillment information.
A list of lab tests ordered, by physician and date.
A list of immunizations.

Suppose the clinician could review, revise or copy this information to create a lasting “patient profile,” saving it online and retrieving it for use at each subsequent visit as appropriate.

The Health 2.0 Connection

Oct 10, 2010• 1

Regina Holliday paints at Health 2.0 while Aneesh Chopra talks. (Photo from Gilles Frydman)

Calling Dr. Berwick

Oct 10, 2010• 8

By MARGALIT GUR-ARIE

On April 27, 2004, President George Bush signed Executive Order 13335 establishing the position of the National Health Information Technology Coordinator. Six years, a recession, a change of administration, a couple of major legislations and a multitude of billions of dollars later, the Office of the National Coordinator for Health Information Technology (ONCHIT) is finally on the road to delivering on the original vision behind that executive order.

The stated mission of ONCHIT, as reiterated in the HITECH Act, was the creation of a nationwide interoperable health information technology infrastructure that makes pertinent information available at the point of care, improves health care quality and coordination, reduces health care costs and disparities and does all that while protecting privacy and security.

While the 2004 executive order did not go into much operational detail, the HITECH Act provided instruction on the structure and strategy for building the HIT infrastructure. It is interesting to note that the HITECH Act is comprised of two Titles; Title XIII in Division A which outlines the activities expected from ONCHIT and Title IV in Division B which creates the Medicare & Medicaid stimulus incentives to eligible providers. The notorious “Meaningful Use” term appears only in Title IV and only as a prerequisite for stimulus incentives from CMS and is loosely defined by certified technology, electronic prescribing, information exchange and reporting on clinical quality measures.

Additional guidance is provided on the selection of clinical quality measures to be in accordance with Section 1890(a) of the Social Security Act, which awards CMS $10 million every year for contracting development of such measures. Meaningful Use seems a rather benign litmus test for CMS to administer prior to dispersing any stimulus incentives. So why is it that “Meaningful Use” became the defining substance of the ONCHIT mission?

Too Many Promises

Oct 10, 2010• 2

By JOHN GOODMAN, PhD

I don’t know what it is about public officials and Ponzi schemes, but the former finds the latter irresistibly attractive almost everywhere. Maybe it’s the fact that the law lets them get away with it. They get off scott-free when they do the very same thing that landed Bernie Madoff in the hoosegow.

Although national attention tends to focus on Social Security, Medicare and other unfunded federal obligations, many state and local governments are in far worse shape. As I explained at my blog the other day, post-retirement health care promises are the fastest growing component. I believe we are on the cusp of a spate of local bankruptcies. Although states cannot declare bankruptcy, they can default on their debt. In California, this seems almost inevitable.

Did you know that the average state has unfunded retiree benefits equal to more than one-fifth (22%) of the income of its residents? Seven states (Alaska, Ohio, Hawaii, New Jersey, New Mexico, Illinois and Kentucky) have unfunded obligations in excess of one-third of their states’ annual income. In Alaska, it’s about half (48%). Take Ohio, for example. The state needs 41% of one year’s income of its citizens right now — in the bank, earning interest — in order to fund its future obligations. And if it doesn’t do that this year, next year it will need even more.

Health 2.0 Conference 2010: Day 2

Oct 8, 2010• 1

By HENRY LI

Day 2 of the fourth annual Health 2.0 Conference started bright and early with three conversations with CEOs: John de Souza of MedHelp, Giovanni Collella of Castlight, and Jeff Arnold of Sharecare (which we saw demoed yesterday). The CEOs gave their takes on where their products stood in the changing healthcare world, and what they saw as challenges going forward—both for themselves and for others.

Two strong sessions about Tools and Unplatforms followed, highlighting and expanding on topics Indu and Matt had touched upon yesterday. “The Data Utility Layer” brought us a panel of heavy-hitters from the likes of Google, Kaiser, Microsoft and WebMD, while a series of demos showed off a variety of middleware services and products that promised powerful platforms for connecting data and services. “The Emerging Consumer Ecosystem” included an amusing (if occasionally awkward) play that showcased the interoperative power of apps from members of the Health 2.0 Accelerator. Unfortunately, although the concepts were impressive, both sessions seemed to feature products and presentations that didn’t quite live up to the spirit of Health 2.0—they lacked the compelling, human stories we saw yesterday, and suffered from a lack of attention to UI, language, and design.

Lunchtime brought the ever-popular Launch! session, which showcased ten brand new products from companies large and small: Axial Exchange exchange.com, Bill-Doctor.com, Breath Research, Castlight Health, HealthPrize, Mytrus, Univita, TeleThrive, Traitwise, and Trigeminal Solutions. The rapid-fire format gave us a look at some truly interesting new ideas across a wide spectrum of uses and users. At the end, the audience selected their choice for best product, which ended up being the previously-highlighted Castlight.

Health 2.0 Conference 2010: Day 1

Oct 8, 2010• 4

By HENRY LI

The 2010 Health 2.0 Conference kicked off this morning in San Francisco with a slew of exciting announcements, panels, and demos. This year, the conference anchors Health Innovation Week, which included the Health 2.0 Developer Challenge Code-a-thon, HIPAA Summit, HealthCampSFBay, Patients 2.0, and more.

Matthew Holt and Indu Subaiya, founders of the conference, opened by discussing the current landscape of Health 2.0 and how it had changed in the past year. The keynote speeches, given by Jeff Goldsmith of Health Futures and Tim O’Reilly of O’Reilly Media, then helped set the tone for the day. Both Goldsmith and O’Reilly spoke of the rising, disruptive forces in the health care sector and expressed hope that they were signs of positive change to come.

A major theme today has been the continued push for patient empowerment—allowing patients to access and use their own data, helping patients effect behavior changes through social networks and games, reaching out to patients wherever and however possible, or connecting them with other patients and harvesting stories to drive discussion and research. This was raised on multiple occasions in panel discussions and presentations, which covered a wide range of upcoming trends and products from both public and private enterprises.

Several companies also took advantage of the conference to announce the launch of new sites and services. ShareCare was easily the largest and most imposing newcomer: created by Jeff Arnold, founder of WebMD and former CEO of HowStuffWorks, it operates as a massive next-generation search engine for users to find answers to health questions. Content on the site, which covers an enormous array of knowledge, comes from a large roster of experts, organizations, and advertisers, ranging from Dr. Mehmet Oz to Johns Hopkins Medicine to AARP to Pfizer. Gideon Mantel of First Life Research showed off a new and powerful tool for tracking drugs, side effects, and more by essentially mining the entire Internet for consumer-generated content. A host of smaller startups, such as Qpid.me and TweetWhatYouEat, as well as the winners of the developer challenges, rounded out the group of presenting innovators.

It’s all an exciting reminder that major changes are afoot, and smart people (the “alpha geeks”, as O’Reilly calls them) are leading the charge. We’re looking forward to Day 2.

Henry Li is Associate Editor at THCB. He is a master’s student at the Johns Hopkins School of Medicine, where he studies in the Division of Health Sciences Informatics and performs clinical software research as well as cost-effectiveness analyses.