Tuesday’s Health 2.0 Show with Indu & Matthew was (IMHO) the best we’ve done so far. For those of you who missed it, we had David Hale demoing talking about Pillbox—fascinating. Then Ted Eytan and Patient activist Regina Holliday discussed and showed her murals. Finally Marco Smit tells you a little about what is coming from Health 2.0 Advisors. But don’t take my word for it. Watch it all!
Above the Fold
Patrick Soon-Shiong – Role in a World of “Data Liberacion”
SUBTEXT: In the DC panel debate on the Role of “Data Liberacion” Executive Chairman of Abraxis Health, Patrick Soon-Shiong, commented on how coordination and exchange of health data can improve healthcare and have a direct impact on individuals. He also talked about how his “realizing of the American Dream” enabled him to contributes to this through the non-profit organization the Health Transformation Institute.
Pitfalls of PPACA – The Grandfathering Problem
Throughout his election campaign and his subsequent efforts to achieve passage of health care reform, President Obama assured Americans that anyone with existing coverage could keep that coverage. Consistent with the president’s promise, Democratic lawmakers worked to include language guaranteeing continuation of coverage in the reform legislation.
They may have been too successful.
Section 1251 of the Patient Protection and Affordable Care Act provides assurances that nothing in the Act requires that an individual terminate existing coverage, excludes many of the provisions of the Act from applying to existing coverage, and goes on to guarantee that existing coverage can be extended to new employees (in a group plan) and additional family members (if allowed by any plan).
On the one hand, these provisions counter some concerns about reform (at least for those who understand them). On the other hand, the grandfathering of existing coverage undermines much of the intent of other parts of PPACA. Grandfathered plans are exempt from each of the following reform requirements (and others):
- Elimination of cost-sharing for preventive care
- Elimination of annual limits (individual plans only)
- Elimination of preexisting condition exclusions (individual plans only)
- Provision to consumers of “plain language” plan information
- Availability of a standard appeals process
- Limitation on premium variations by age and other factors
- Guaranteed availability of coverage
- Guaranteed renewal of coverage
- Prohibition on discrimination based on health status
- Provision of comprehensive health care coverage
In other words, grandfathered plans will be able to continue most of the practices that have angered consumers—and discriminated against those most in need of coverage.
There’s another problem, too. In the small group market—and possibly also in the individual market in some states—the effect of grandfathering may be to reduce the diversity of the insurance exchange risk pools. Insurers will be eager to perpetuate their current plans and avoid most of the new regulatory requirements, while employers with younger and healthier employees will want to retain their prior lower-cost coverage, leaving older and sicker groups to migrate to the exchanges, with regulations and rates more favorable to them. The effect in states currently with high numbers of uninsured—and therefore potentially with the most exchange enrollees—may be minimal, but in others the result may be that premiums are higher for plans available through exchanges than for those outside, while many insurers may decide to focus on their present less-regulated business and simply avoid the exchanges.
Roger Collier was formerly CEO of a national health care consulting firm. His experience includes the design and implementation of innovative health care programs for HMOs, health insurers, and state and federal agencies. He is editor of Health Care REFORM UPDATE [reformupdate.blogspot.com].
Innovation: Curious Word
If
you follow the health IT media, you cannot escape the new and
obligatory word, Innovation. Every self-respecting article, blog post,
press release or casual comment on line is not complete unless some
reference is made to Innovation, its derivatives (innovators,
innovative, etc.) or compounds (foster innovation, disruptive
innovation, etc.). By now I am ready to add Innovation to the infamous
Do Not Use category, along with Synergy, Turn-Key and One-Stop-Shop, to
name a few.
According to Merriam Webster Dictionary Innovation means the introduction of something new or a new idea, method, or device. That’s probably a bit too vague for us. The Business Dictionary has a more interesting definition of Innovation: Process by which an idea or invention is translated into a good or service for which people will pay.
Since Health IT is a business, this definition makes more sense. It
turns out that there are various types of Innovation. From a user point
of view there is Evolutionary Innovation, which requires very little
learning from the end user and not much change to routine, and there is
Revolutionary Innovation which completely disrupts routine and requires
learning new ways of doing things.
So are we Evolutionary or Revolutionary in Health IT? If you ask
physicians, they will probably say that EHR is revolutionary, since it
forces them to change their workflow and the learning curve is very
steep. If, on the other hand, you take a step back, it is clear that
workflow hasn’t changed much. Patients still make appointments, show up
at the front desk, wait in waiting rooms, have nurses bring them to the
exam room, vitals are taken, doctor steps in and out and it all ends
with a claim to the insurance company. The only change is that paper
has been replaced by a computer, and computers are ubiquitous in
everyday life. All the talk about workflow redesign boils down to minor
simplifications due to the fact that the chart is available to all
simultaneously. EHRs are only incremental evolutionary innovations.
Well then, maybe we need a more Revolutionary Innovation, one for which
doctors will be willing to pay. This is definitely the prescription
from new entrants, or hopeful entrants, to the EHR market: the legacy
EHR incumbents have failed and we need a slew of low priced new
products, preferably fragmented into sub products, so that physicians
can pick and choose from an ever increasing array of choices. We
currently have several hundred EHRs to choose from. Maybe if we had
several thousand modular choices, every doctor will be able to find a
combination that fits his specific needs. It’s all about choices, or is
it? There are numerous studies
showing that over a certain threshold, more choices only slow down
purchase rates and actually make shoppers disenchanted with their
purchase. Maybe if we had just a handful of EHRs, things would be
different. Maybe too much of this type of innovation is detrimental to
an industry as a whole.
More recently our hopes have turned to Democratizing Innovation
and hoping that Innovation will come from consumers armed with medical
records. It is very likely that a healthy crop of consumer applications
will be created to analyze all those medical records, provide advice,
second opinions and even therapies outside the established medical
settings. Some will be good and some will be harmful. Caveat emptor, as
always, will be the rule and we still need to find out if this idea can
be translated into a good or service for which people will pay. Yes, pay, either by hard cash or by bartering their private information for services.
To judge by current developments in Health IT, we will be witnessing
both Revolutionary Innovations mentioned above, in a few short years.
Will they revolutionize Medicine and Health Care? Not very likely. The
most likely revolution will come from administrative simplifications,
payment reform, creation of Medical Homes, education, medical research
and eventually, technology inventions similar in magnitude to the
silicon chip. To be sure, Health IT has a major role in all these
upcoming changes, and Health IT will have to incrementally create a
standardized Clinical Information Highway on the Internet to support
change and improvement, but we will not be revolutionizing health care,
anymore than desktop publishing has revolutionized literature or
financial IT has revolutionized Wall Street.
Tomorrow’s Webcast–The CHDI Forum
The Health 2.0 crew is heading to DC immediately after today’s webinar. It’s still not too late to sign up for the 10am webinar.
Then tomorrow, it’s the Community Health Data Initiative Forum
Aman Bhandari who works with Aneesh Chopra in the Executive Office of Science & Technology Policy asked us to publicize the Forum. We’ll be there, but if you can’t be, here are the details as to how to follow it remotely below. This is a major event around innovation and health data, with remarks from Secretary Sebelius, HHS CTO Todd Park and White House CTO Aneesh Chopra. There will be major tech companies doing public launches of their work using HHS data.
1.The webcast will be hosted in 2 spots: http://www.hhs.gov/open/ or http://videocast.nih.gov/summary.asp?live=9347
2. Meeting information: http://www.iom.edu/communityhealthdata
3. HHS Blog Post: http://www.hhs.gov/open/discussion/chdi.html
4. RWJF Blog Post: http://rwjfblogs.typepad.com/pioneer/2010/05/introducing-data.html
5. Twitter hashtag: #healthapps
And you can look for a very special announcement about Health 2.0’s role during Aneesh Chopra’s remarks.
The Evidentiary Basis for a Clinically Meaningful Benefit
By NORTIN M. HADLER, MD and ROBERT McNUTT, MD
We entered the 21st century awash in “evidence” and determined to anchor the practice of medicine on the evidentiary basis for benefit. There is the sense of triumph; in one generation we had displaced the dominance of theory, conviction and hubris at the bedside. The task now is to make certain that evidence serves no agenda other than the best interests of the patient.
Evidence-based medicine is the conscientious and judicious use of current best evidence from clinical care research in the management of individual patients”. [1,2]
But, what does “judicious” mean? What does “current best” mean? If the evidence is tenuous, should it hold sway because it is currently the best we have? Or should we consider the result “negative” pending a more robust demonstration of benefit? Ambiguity is intolerable when defining evidence because of the propensity of people to decide to do something rather than nothing. [3] Can we and our patients make “informed” medical decisions on thin evidentiary ice? How thin? Does tenuous evidence mean that no one is benefited or that the occasional individual may be benefited or that many may be benefited but only a very little bit?Continue reading…
Why do the uninsured want to stay uninsured? They won’t say
Two uninsured people who insist on their right to remain uninsured have joined 20 states and the National Federation of Independent Business in suing to overturn the new federal law requiring all Americans to obtain health insurance or else pay a tax penalty.
The lawsuit, filed in U.S. District Court in Pensacola, Fla., claims the government is exceeding its constitutional authority to regulate interstate commerce.
The states added the two individuals as plaintiffs because the government is likely to argue that the states lack legal standing to challenge the individual insurance mandate, given that it only affects individuals, not the states.
But the public can’t find out why the two new individual plaintiffs — an auto repair shop owner in Panama City, Fla. and a retired lawyer/Wall Street banker living in Port Angeles, Wa. – oppose the insurance requirement because the lawyer spearheading the suit says they aren’t speaking to the news media.
I particularly wanted to know how these two uninsured people have paid for health care for themselves and their families in the past and how they plan to pay for it in the future. So I asked David Rivkin, a partner at Baker Hostetler in Washington, D.C., who is representing them and the NFIB and serves as outside counsel for the states, if he could put me in touch with them.
Chaim Indig, Phreesia, on how to spend $16m
By
Chaim Indig has been steadily turning Phreesia from an ad-supported patient check-in service to a front end for physician’s offices to manage their relationships with patients, and collect co-pays. As such Phreesia is turning from a content company to a transaction company. Last week they raised a further $16m in venture capital, with new investor Ascension Health Ventures leading the round. Chaim dropped by the Health 2.0 world HQ to meet Charley the dog and to tell us about Phreesia’s next steps.
The Times Hits the Right Notes on Hospitalists
By BOB WACHTER, MD
You probably saw yesterday’s hospitalist piece in the New York Times, arguably the best lay article on the movement to date. It hit all the right notes, and did so with uncommon grace and fairness.
The piece, written by the Times’ Jane Gross, profiled Dr. Subha Airan-Javia, a young hospitalist at the Hospital of the University of Pennsylvania. While Dr. Airan-Javia spends about half of her time in administrative, largely IT-related roles (like many of my faculty), the article (and an accompanying profile) gave us a day in her life on the wards:
seeing patients, collaborating with consultants, talking to families, and orchestrating discharges. The fundamental advantages of the hospitalist model – tremendous availability, markedly improved efficiency, and a unique focus on systems improvement – came through unambiguously. For example, regarding availability, there was this:
Because she was on the floor all day, [she] was able to schedule a long meeting with a man who held power of attorney for a patient who was close to death and incompetent to make decisions… Expansive and gentle, the doctor discussed why she would recommend a transfusion but not a feeding tube.
As for efficiency, Gross cited my 2002 JAMA review, which found that hospitalist care was associated with an approximately 15% reduction in hospital costs and length of stay.
Yahoo: The sleeping giant awakes?
By
While Yahoo!’s most recent notable public moment has been its CEO telling some (other) ex-pat British blogger to “Fuck Off”, this British ex-pat blogger has been waiting for a long time for Yahoo! to re-emerge in health care. And finally after a big false start in 2008, they’re baaack.
As of late this week, the new Yahoo Health is now up and running and showing a good deal of (as you’d expect) Healthline’s fingerprints. Here’s my interview with Healthline’s West Shell about them winning the contract to essentially take over the Yahoo site and more.
So pretty close to the surface are Healthline products such as Symptom Checker, Doctor Search, & Treatment Search. It’s a very good first step, and clearly a big improvement.
What’s not in this iteration is any integration with Yahoo Groups which has over 100,000 groups in its Health & Wellness category. There are over 25,000 alone about “Drugs & Medication”, 56,000 in Men’s Health, 9,300 in Reproductive Health, etc, etc. Figuring out what’s in those groups and making them much more user friendly is (I vote) the next job at Yahoo!
The giant is awake, out of bed and stumbling around the cave, but it hasn’t yet come out to frighten the villagers. Let’s hope it keeps moving!
