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Above the Fold

American Well world domination plan on course

Jun 10, 2010• 16

By MATTHEW HOLT

They may have started with a Blues plan in a small state (Hawaii) and been moving deceptively slowly for a while, but having got Optum (part of United Healthgroup) on board last year, today American Well announced the landing of the other big Kahuna. Wellpoint will be rolling out American Well’s online care program in “certain markets” in Q4 this year.

If California isn’t one of those markets, expect some bitching and whining from at least one Wellpoint member in San Francisco! More seriously, as I’ve been saying for a while, Wellpoint’s online services for its members are a mess, and I’m looking forward to what the integration with online care looks like from the user end.

More from American Well to come, as I’ll be popping by their session at AHIP this morning (yes, it’s a slow recovery from last night in Vegas).

Full Disclosure: American Well is a corporate supporter of both THCB and Health 2.0.

Health 2.0 Came to Washington—And Now it Needs to Stay

Jun 10, 2010• 1

By LYGEIA RICCIARDI

This week’s Health 2.0 conference was held for the first time in Washington, DC, plunging Health 2.0’s community of IT geeks into the heart of the land of policy wonks. The feds’ Chief Technology Officer, Aneesh Chopra, joked about the gap between the two cultures: where the Health 2.0 crowd says “there’s an app for that,” the government says “there’s a form for that.”

Chopra and officials from the Department of Health and Human Services outlined their goals and plans related to health IT and extended an invitation for the two communities to work together more closely. The feds described a transformation of the economy and an improvement in the lives of Americans, and gave examples of initiatives that open access to health data and/or provide incentives for innovative uses of it, including:

The Blue Button Initiative – A CMidentifying S and VA initiative that lets consumers download data for use in a personal health record (PHR)
Pillbox An NLM and FDA program releasing data that helps in pills
VAi2 — An $80 million VA innovation competition focused on areas including telehealth and adverse drug events
Community Health Data Initiative — An HHS and IOM initiative that releases data sets about communities (and which provides the data for the Health 2.0 Developer Challenge).
Apps for Healthy Kids A White House competition to create software tools and games toimporve kids’ health

As the Department of Health’s Farzad Mostashari said to the crowd, “We’re watching. We want to learn. Show us what is possible.”

But not everyone was impressed. Jamie Heywood of the online health community PatientsLikeMe bristled at the idea that technology entrepreneurs should step up and fix problems that rightly belong to government, such as collecting and analyzing better population health data. “Don’t look to us to save you,” he said, arguing that the feds need to build better markets for innovation. He has said, for example, that government could offer to buy data generated by the private sector that furthers public health goals.

Health 2.0 DC: Passion and Execution at Scale

Jun 10, 2010• 1

By SUSANNAH FOX
I think conferences are deeply affected by the spirit of their host city. San Francisco has its hackers and dreamers, Boston has its entrepreneurs and ivy, Paris has its pomp and worldliness. At Health 2.0 DC yesterday, my city showed that it has passion and execution — at scale.

Leave it to others to point out this city’s shortcomings. The Washington, DC, I know draws in the best & brightest, engages in debate, and gets things done.

Tim O’Reilly recently said that within the federal government he has found “an intense passion among people trying to make change.” Todd Park, CTO of HHS, expanded on that theme yesterday as he described his federal co-workers as just as smart, just as creative, and just as entrepreneurial as anyone he worked with in the business world.

Tufts Summer Institute on Web Strategies for Health Communication, July 18-23, 2010

Jun 10, 2010• 3

Many healthcare organizations who are trying to reach healthcare consumers share these problems: “our website hasn’t been updated in three years”; “we set up a Facebook page but don’t know what to do with it”; and “what exactly is Twitter and how do we use it?” With 61% of American adults looking online for health information [Pew, 2009], healthcare organizations need a Web strategy and healthcare professionals need to understand the latest technologies to plan and execute health communication initiatives. There can be a risk in not embracing the Web if other health organizations are and if healthcare consumers expect it.

Yet it is difficult to decide which of the rapidly evolving Web technologies to select and how to use them to provide effective health communication, especially as part of a coherent Web strategy. This course covers how to develop and implement a Web strategy to drive a health organization’s online presence, specifically the processes for selecting, using, managing, and evaluating the effectiveness of Web technologies for health communication. The course will use case studies from organizations to illustrate initiatives with a discussion of what worked and the recommended improvements and will work in small teams on a Web strategy redesign for Harvard Health Publications.

The Axis of Evil

Jun 9, 2010• 15

By ROB LAMBERTS, MD
My recent post about Medicare allowing patients to use drug vouchers was met by a rousing reception.

By crickets.

It seems that some saw me as one who (gasp) trusted the pharmaceutical companies to do something good. Has Dr. Rob lost (what’s left of) his mind?? Drug companies do everythingwith themselves in mind, and there are alwaysstrings attached. They can’t be trusted. They are evil. Doesn’t Dr. Rob realize that?

I have heard the same thing about insurance companies. I had a patient a few days ago use the word evil when describing the insurance industry. I myself have called them rabid wolves, have decried the outlandish CEO salaries, and have declared that they do a whole lot of things that hurt patients and make my life difficult.Continue reading…

Allscripts buys Eclipsys: Does it make sense?

Jun 9, 2010• 8

By Matthew Holt

Queen of shoes Inga at HISTalk got ahead of the news (she tweeted about 2 hours before the announcement—not sure if that led to the news being moved up—but the Eclipsys stock showed no sign of word getting out in advance and the website they’ve put up looks very thrown together!). Inga also has the best summary.

The deal is that Allscripts is going to buy out Misys (which owned a majority stake following Allscripts buying the former Medic practice management system but was always trying to get out of the US HIT business) at about it’s rough current market price, and pay it a spiff on top of over $117m. I’m up with insomnia, so the US market isn’t open and we can’t know how it’ll like it. But the UK is open and Misys is trading 20% higher. So my guess is that Allscripts will take a hit for that. Meanwhile it’s paying about a 20% premium for Eclipsys. In the end Eclipsys shareholders will have 37% of the combined entity, Misys will keep a chunk of about 10% that Allscripts can buy out post closing. Allscripts CEO Glen Tullman will stay CEO, and Eclipsys’ CEO Phil Pead will be Chairman with a list of tasks that suggests that he’ll have more time on the golf course than Glen.

Does it make sense? Other than the financial deal, this is a moderate size bet from Allscripts, which is about double the market cap of Eclipsys. The bet is that there are enough hospitals who (like it’s star client North Shore-Long Island Jewish) will buy both an inpatient system and an integrated outpatient system for their affiliated physicians. They claim that it’s about 35% of the market.

But that remains to be seen. Most of the hospitals who are big enough to be “hubs” have already made a bet on an inpatient vendor, and in general that hasn’t been Eclipsys. (Calling them a “leader” in hospital IT is somewhat redefining the term) Whether enough of them are reconsidering their whole approach I doubt. But on the other hand Allscripts has shown that it can integrate diverse product lines with several of its acquisitions and make good business decisions about it (although not always thrilling customers who thought they were buying an ongoing product). And Eclipsys is profitable, so the downside risk doesn’t seem too high.

I guess the only real question is raised in a separate NY Times article yesterday which suggested that meaningful use criteria were so impossible that no one could possibly get the government’s money. Of course the expectation that EMR use will dramatically grow is the main justification behind Allscripts’ merger driven growth the last few years.

BTW checkout slide 21 on the slide deck of the announcement. Glen still can’t resist taking a crack at a certain CEO in Madison, Wisconsin.

CORRECTION, APOLOGY & CLARIFICATION about “You Want To Have It Both Ways”

Jun 8, 2010• 17

At THCB we regularly repost content from other blogs and we delight in giving those authors access to a different audience as well as giving our audience access to other viewpoints that I and the team here frequently don’t agree with. However, sometimes we make mistakes and this post represents one of those times. This post originally was published on the Sermo blog as an example of a community post–one that non-MDs cannot access–which stirred a lot of controversy on Sermo. This post attracted more than 200 comments on Sermo, and they highlighted it on the Sermo blog from which we syndicated it.

But unlike how we originally bylined and presented it on THCB, this post was not written by Daniel Palestrant MD, CEO of Sermo, and does not represent Sermo’s corporate opinion, and I can assure you definitely does not represent Daniel’s personal opinion.

The first 19 comments on THCB come from people who we misled by our error into thinking this was Daniel’s post. We’d like to apologize to Daniel, Sermo, drspuds and our readers.

But as this post (like it or not) does represent the view of at least one physician and maybe rather more, we’re going to keep it up on THCB-–Matthew Holt

* * *

Dear Mr. and Mrs. America, by Sermo member “drspuds”

You live in one of the greatest countries on earth, one of the
richest ones, yet arguably not one of the best for medicine.
You may question why that is. I think I may have some
answers. Essentially, you want to have your cake and eat it too.

When you are sick or injured, you want the best healthcare money
can buy. But you want someone else to pay for it. You
feel should not be made to pay for things that are not your fault,
as you perceive it.

When you do not feel you have gotten the best healthcare someone
else’s money can buy, you scream, yell, threaten and generally act
like a child. Then you demand to be respected as an adult.
You take the same approach to “free” care, such as telephone calls,
disability paperwork and public aid.

When your treatment does not go as you planned, you want to keep the legal option to sue a doctor for “everything he’s got”, but want to keep “good” doctors in your community so you don’t have to drive 6 hours to get your brain tumor operated on.

You want to be able to drink and smoke as much as you want, and then when years of beating the crap out of yourself makes its presence known, you want us to rescue you. We told you 40 years ago not to smoke. Now you want us to save your life from the CAD, emphysema and lung cancer you caused.

You want to drive a car at 90 mph while drunk, “because I’m having fun” but want us to put all the pieces back together when the inevitable happens.

You want a single-dose pill to take care of anything that ails you, aka the “magic pill.” But you complain about the realistic medications you will need to take every day for the rest of your life. 20 years ago, these pills did not exist and you would have had only a few years left to live. Now we can keep you around for many more years for you to keep complaining about the pills you have to take.

Three ways to set payment rates

Jun 8, 2010• 25

By PAUL LEVY

My suggestion last year that Massachusetts move away from the “free market” approach it uses to set hospital reimbursement* rates was not well received by the hospital world. But, this year, as people notice that their rates are being set by insurance companies in an unaccountable and unreviewable fashion (see this letter to the editor), more and more are saying, “Well, maybe. What would it look like?”

There is a range of options. Let me lay out some of them in summary fashion here, recognizing that a presentation in this forum is inherently simplistic. I would love to see a public forum in which these are debated.

One approach is that used by Maryland, with full determination of ratesfor each hospital by a rate-setting commission. Like public utility rate-setting, this involves lots of reviews and administrative procedures.

A variant of this is that we could have a state agency produce default rates (both fee-for-service and capitated) that serve as a state-wide rebuttal presumption. There could be prescribed (i.e., formulistic) add-on’s for geographic cost-of-living differences, teaching obligations, other government requirements, and the like. In this scenario, unless either the insurer or the provider made an evidentiary case for different rates in front of an administrative body, the agency’s presumed rates would apply.

The Online Future of Patient Communication

Jun 8, 2010• 4

By PAULA MORO

An array of online communication tools, including email and beyond, can
enhance the physician-patient relationship and save you both time. But
for a variety of reasons, many physicians haven’t adopted online tools.
Matthew Holt, healthcare futurist, co-founder of the Health 2.0
Conference and founder of THCB
says that the day is coming fast when most physicians will communicate
this way with their patients. Are you already one of them?

Listen to the ReachMD broadcast or podcast — Then it’s your turn.

Participate in the ReachMD Poll.

www.neomyz.com/poll
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the poll will not be displayed.

Tweet us
Post on Facebook
Or call the ReachMD Listener Line at 888-639-6157 to record your comments (portions of which may air).

Po**@*****MD.com

PITFALLS OF PPACA #3 – Insurance Exchange Issues

Jun 8, 2010• 2

By ROGER COLLIER

Although the Patient Protection and Affordable Care Act incorporates numerous health care system fixes, including new regulations to protect consumers, new rules for insurers, expansions of existing programs, new payment incentives and subsidies, and penalties for non-coverage, it mandates almost no structural changes, with one big exception: establishment of insurance exchanges in each state.

Insurance exchanges, designed to facilitate enrollees’ coverage choices within a competitive market, are not new. Exchange mechanisms have been used for several years for employee coverage selection by the federal government and by many states. And, since 2007, Massachusetts has operated what is probably closest in design to the PPACA concept—the Connector.

What’s been the experience so far?

The Federal Employees Health Benefit program provides by far the largest existing exchange, used by eight million government employees and retirees. Although employee surveys show that the FEHBP model works well in facilitating coverage choice, its market competition effect is limited. With no standard benefit package, apples-to-apples comparisons of coverage value are impossible, while with the government picking up some three-quarters of premium costs, employees may be relatively insensitive to price differences. While FEHBP presumably gains the lower premium advantages of large groups, the rate of premium increases has been close to that of the non-exchange private sector, according to a 2006 GAO report. (Premiums for California’s CalPERS, the largest state exchange, rose slightly faster than the private sector’s, according to the same report.)

Efforts have also been made by states and business groups to create exchanges for private sector employee coverage but, almost without exception, these have failed. In most cases, the primary problem was adverse selection: insurers marketing outside the exchange cherry-picked the best risks, leaving older and sicker groups to seek coverage via the exchange, which inevitably found itself in a death spiral as premiums rose and the better risks found coverage elsewhere.