On June 7, 2010 senior advisor at the Office of the National Coordinator, Farzad Mosashari, gave an interview at the Health 2.0 Goes to Washington conference. These are his thoughts on the conference, meaningful use and the focus his office has on watching out for the little guy.
Above the Fold
Beacon Communities: Webinar with EVERYTHING You Ever Wanted to Know!
HIE, SHARP, RECs, and now… Beacons?
What does it all mean?
With the passage of HITECH in 2009, we’ve seen a series of coordinated grant programs from HHS – and if you’re not confused with all of the acronyms, you’re probably not paying attention. But never fear, in the latest of our series of FREE webinars, Health 2.0 has teamed up with the Health 2.0 Accelerator to bring you a conversation with Aaron McKethan, Program Director for the Beacon Communities Program in ONC to explain what the Beacon communities are, give some details about the types of programs and opportunities that they are providing, and to help answer all of your questions!
Wednesday, July 21, 2010
1pm ET / 10am PT
Register today at: http://www.health2con.com/webinars!
Checking in with BenefitFocus
It's been a little while since I checked in with the folks at BenefitFocus. They essentially create a system that allows employees to sign up for benefits all at once. They market it via a lead health plan in each area, and then give the employer HR department the ability to glom their other benefits plans onto it, saving lots of time and trees during open enrollment and for new employee hires. (The really old reader may remember that this was the very first business model of Healtheon in 1996 and funnily enough Healtheon's first "client" for that version of their business model, Blue Shield of California, is a decade and a half later using BenefitFocus for the same thing).
They also have an interesting side business making videos and selling that service to HR departments for internal education, and have a public side to their video business, a sort of Youtube for health called ICYOU, who of course come to every Health 2.0 Conference (Hi, Nina & crew!)
Last week I caught up with Shawn Jenkins, the CEO of BenefitFocus. This is a guy who started a business in the middle of the dotcom bust in the technology backwater of South Carolina (cue abusive emails!), and now has 500 employees, lots of clients and a very profitable company. And of course they are well positioned to be at the hub of the forthcoming exchanges–the state of Maryland has already signed on the dotted line. And now they're moving into analytics.
Interested in what they're up to? Listen in.
Kenneth Buetow and caBIG
SUBTEXTAt Health 2.0 Goes to Washington on June 7, 2010, Kenneth
Buetow, Associate Director of BioInformatics for the National
Cancer
Institute and Founder of caBIG, talked about the launching of a large
scale effort called Cancer Biomedical Informatics Grid (caBIG).
Open access scheduling at the doctor’s office
By
I’m quoted in the Boston Globe today (A new practice: The doctor will see you today) on open access scheduling. (I’m all the way down at the bottom of the article.)
Open access is one of my favorite innovations because it improves customer service and quality levels. As we add patients to the system open access provides a way to preserve or improve access to the physician. It’s better—in my view—than other solutions such as using more mid-level practitioners and trying to boost the total number of doctors.
Open access means seeing today’s patients today rather than forcing them into a slot far in the future or trying to squeeze them in to a crammed schedule. The example given in the Globe article is a more extreme version than what I’m used to. I’m not sure such a radical shift to open access is optimal. It might be best to preserve a lower percentage of slots for same-day access rather than forcing folks in today who’d prefer to wait a bit!
What’s required to make open access work?
- Working overtime to chip away at the existing backlog (otherwise there’s no free time to offer up)
- Varying number of hours worked per day to accommodate fluctuating demand
- Having the right sized patient panel—something that’s somewhat hard to assess in advance, since the true demand is unknown (offices usually just know how far out they are scheduling)
Why does it work?
- There’s a high no-show rate from appointments made weeks or months in advance
David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma, biotech, and medical devices. Formerly with BCG and LEK. He blogs regularly at Health Business Blog, where this post first appeared.
A Reply to the Cato Institute
This week, the Cato Institute released a 52-page report on health care reform titled: Bad Medicine: A Guide to the Real Costs and Consequences of the New Health Care Law.
The tract was written by Michael Tanner, a senior fellow at the Institute, and it rests on the thesis that the Patient Protection and Affordable Care Act (ACA) is both Unaffordable and Unfair. Inevitably, Tanner’s claims about affordability are shaky; in truth no one can project how much reform will cost over ten years—and how much it will save. There are too many variables involved. Nevertheless, Tanner seems sure: the legislation will add to the deficit, he asserts, and force insurance premiums higher. Moreover, he stamps the legislation “unjust”: it would turn private insurance companies into regulated “public utilities,” forcing them to insure sick people, while “redistributing income” from families earning “over $348,000” to families earning “$18,000 to $55,000.” Ultimately, he argues, reform represents yet another step toward turning the U.S. into a “Nanny State.”
Why a 52-page report on health care reform now? Tanner makes his purpose clear in the Introduction where he suggests that conservatives will make the new health care legislation the “centerpiece of Republican campaigns this fall,” as they lobby for repealing the Affordable Care Act, or at the very least, replacing it. Bad Medicine is meant to serve as a playbook for those who hope to kill reform.
With that in mind, The Century Foundation decided that the document deserves scrutiny. In the weeks ahead, I will be analyzing and rebutting the report’s many arguments against individual and employer mandates, insurance regulation, subsidies, reductions in Medicare spending, and the CLASS Act, a much-needed national long-term care program.Continue reading…
So I’m on TV, unfortunately in piece of crappy reporting
So last month the nice people from KTVU (the local Fox affiliate in SF) came by to interview me and last night it aired. They’d been over at web-based EMR vendor Practice Fusion and had found out about EMRs. Then they came to interview me. I should probably have got the hint when reporter John Fowler kept on asking me about privacy concerns. I spent 20 minutes giving a balanced nuanced view about the advantages and problems of adopting medical records which is not exactly represented by the 6 second soundbite I get.
Unfortunately—despite the producer’s stated desire to use Bay Area people—Texan nut job Deborah Peel gets almost half the piece including almost all the interview content. (Apparently Deven McGraw couldn’t be tracked down? Maybe DC is too far away) And what does Deb Peel say? Well you know what she says…
How to Ration Health Care
By JOHN C. GOODMAN, PhD
Suppose you were in a triage situation and you had to choose between two patients, deciding who lives and who dies. Are there any principles you could rely on to make your choice?
Alex Tabarrok had an interesting post the other day at Marginal Revolution in which he asked readers to imagine standing behind a Rawlsian veil of ignorance. This is a thought experiment in which you are about to be born into a world, but you don’t know which person in that world you will be (e.g., you could be born smart, dumb; rich, poor; black, white; etc.). You can decide the rules governing the world you are about to be born into, but you must make your choice “position blind.”
What decision rules would you choose?
For his part, Tabarrok focuses on how to allocate kidneys among transplant prospects and his own solution is: allocate scarce organs so as to maximize remaining years of life:
In the current system, a 60-year-old patient can be given a 20-year-old kidney — that’s a waste because the life expectancy of the kidney is longer than that of the patient; it’s like putting a new clutch in a car that is rusting away. If we had 20-year-old kidneys to spare, this wouldn’t be a big problem. But we don’t have 20-year-old kidneys to spare, so we also give 20-year-old patients 60-year-old kidneys which means the kidney is likely to die early, taking the patient along with it. If we want to maximize total life expectancy, younger people should get younger kidneys.
Fantastic job: HHS ONC subject matter expert on consumer e-health
Josh Seidman has written from ONC telling us about a fantastic job opportunity. You get to work with the brilliant folks at ONC on fun stuff regarding consumer e-Health. What does that mean? From the posting.
- Forge alliances with consumer organizations, technology and care delivery innovators and consumer advocates to further the consumer e-health agenda.
- Develop consumer oriented strategies across the Office of the National Coordinator for Health Information Technology (ONC).
- Serve as Project Officer providing project management oversight for contracts, including designing, developing and coordinating project management plans for policy initiatives in conjunction with the Division Director and the Office of Policy and Planning Director.
We’ve been very impressed by everything we’ve seen about ONC’s commitment to patient communication—not least the “sneaking-in” to the meaningful use requirements in Phase 1 of patient education materials (what Don Kemper calls Christmas in July). I can’t think of a more fascinating job for anyone who cares about online health.
So if you’re interested here’s the link to apply.
Christmas in July: Meaningful Use as a Gift for the Consumer
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Everyone was expecting the new meaningful use rules to include some important, but relatively basic advances for the consumer—and it did. However few of us expected meaningful use would include a real consumer gift: the requirement that EMRs help doctors deliver information prescriptions to each patient. That addition is a game changer for advancing the patient’s role in a patient-centered health care system.
Page 225 of the rules includes this Stage I Measure for demonstrating the “meaningful use” needed to qualify for the federal subsidy for EMR investments:
More than 10% of all unique patients seen by the provider are provided patient-specific education resources.
That simple requirement represents a sea-change in use of the EMR as a tool to advance the role of the patient. It will bring into mainstream American medicine a recognition that medical care is of high quality only if it includes relevant information to help the patient do appropriate self-care and better participate in treatment decisions.
The requirement gives mainstream life to the decade-old concept called “information therapy” or Ix for short. Ix promotes the need to prescribe the right information to the right patient at the right time as part of the process of care. The new rule promotes the exact same thing.
