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Really Managing Care and Costs

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By BRIAN KLEPPER

One of my favorite health care stories is about Jerry Reeves MD, who in 2004 took the helm of a 300,000 life health plan in Las Vegas, including about 110,000 union members, and drove so much waste out of that system – without reducing benefits and while improving quality – that the union gave its members a 60 cent/hour raise. There was no magic here. It was a straightforward and rigorously managed combination of proven approaches.

Dr. Reeves’ work betrayed the lie that tremendous health care costs are inevitable. To a large degree, the nation’s major health plans abetted this perception when they effectively stopped doing medical management in 1999. (Most have recently begun managing again in earnest.) The result was an explosion in cost – 4 times general inflation and 3.5 times workers earnings between 1999 and 2009 – that has priced a growing percentage of individual and corporate purchasers out of the health coverage market, dangerously destabilizing the health care marketplace and the larger US economy. In 2008, PriceWaterhouse Coopers published a scathing analysis suggesting that $1.2 trillion (55%) of the $2.2 trillion health care spend at that time was waste.Continue reading…

Who Is Don Berwick (and Why Is He Following Me?)

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By MAGGIE MAHAR

The rumors that I wrote about Friday are, in fact, true. President Obama will name Dr. Donald Berwick, president of the Institute for Health Care Improvement (IHI), to run Medicare and Medicaid. Berwick, who is a professor of pediatrics and healthcare policy at the Harvard Medical School and a professor of health policy and management at the Harvard School of Public Health, will have to be confirmed by the Senate Finance Committee.

Just how tough will the confirmation hearing be? I’m not worried. Berwick can handle himself.

Granted, yesterday the New York Times called Berwick “iconoclastic,” i.e., someone who “smashes sacred religious images” or “attacks cherished beliefs.”   But most who know him describe him a “visionary” and a “healer,” a man able to survey the fragments of a broken health care system and imagine how they could be made whole.  He’s a revolutionary, but he doesn’t rattle cages. He’s not arrogant, and he’s not advocating a government takeover of U.S. healthcare.

Berwick stands at the center of a healthcare movement that would reform the system from within. In 2005, Modern Healthcare, a leading industry publication, named him the third most powerful person in American health care. In contrast to others on the list, Berwick is “not powerful because of the position he holds,” Boston surgeon Atul Gawande noted at the time.  (Former Secretary of Health and Human Services ranked no. 1, while Thomas Scully, the head of Medicare and Medicaid services captured the second slot.) “Berwick is powerful,” Gawande explained, “because of how he thinks.”

Listen to some of the clips below, from the film Money-Driven Medicine, produced by Alex Gibney, and based on my book, and you’ll understand what Gawande means. Soft-spoken, and charismatic Berwick is as passionate as he is original. His style is colloquial, intimate, and ultimately absolutely riveting. He draws you into his vision, moving your mind from where it was to where it  could be.

Berwick isn’t just another ivory-tower philosopher. He’s “an extraordinary leader when it comes to inspiring people and creating the will to move forward,” Dartmouth’s Dr. Elliot Fisher told me in a phone conversation Friday. “And he can teach people how to do it. He has demonstrated his ability to teach people how to implement change in a complex system.”Continue reading…

Are The Attorneys General’s Constitutional Claims Bogus?

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By MARK HALL, Wake Forest University School of Law

6a00d8341c909d53ef012876544c5e970c-320wi Immediately after passage of health care reform, over a dozen state A.G.s sued to declare it unconstitutional, as violating states’ rights. The Florida complaint is here, and Virginia’s here. Reminiscent of southern governors in the 1960s blocking their state universities’ gates, these legal officers in effect are saying “not on our sovereign soil.” Since the constitutional issues have already been hashed through so thoroughly, what’s new to talk about?

First, the Florida complaint, which a dozen other states joined (AL, CO, ID, LA, MI, NE, PA,SC, SD, TX, UT, WA), focuses mainly on the financial burdens of expanding Medicaid. This is challenged under the “commandeering” principle, as requiring states to devote sovereign resources to achieve federal aims. But, as we know, states are free to withdraw from Medicaid, so the argument seems to fall entirely flat. The complaint makes a bait-and-switch type of estoppel argument , that states got into Medicaid without any expectation of this expansion, and now it’s too damaging for them to withdraw. So, in effect, states argue that the Constitution allows them to keep the federal carrot but refuse the federal stick. Good luck selling that to an appellate court.Continue reading…

Commentology: Dear Mr. Angry

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THCB reader CARISSA PILLOW, an RN, is one of many readers who objected to the tone of the satirical post “Let’s Pay Nurses Minimum Wage.” Carissa writes:

“Dear Mr. Angry, I just wanted to take a moment to express my sincere disappointment. Yep, I’m a nurse. Yep, I got it, you were trying to be funny, with some witty satire. Yep, I see that you were trying to point out how backwards it is to pass legislation “outsourcing” nursing. But, by making a funny funny post, what you did was perpetuate the ongoing misconception of what a nurse does. You describe nurses as a group of butt wiping, overpaid babysitters with skills the equivalent of retail clerks. And while yes, in my 13 years of nursing experience I have done my fair share of butt wiping and babysitting, my daily work involves so very much more than the public understands. So let me clarify my job description for you and for the American public that you have misinformed. In my career I have: Sat by a patient as the only person in the room while they met their maker, and provided dignified post mortem care for them; Given a 40 year old wife the news that her husband had suffered a massive heart attack and was recovering from a cardiac cath procedure that saved his life for the third time; Told a hospitalist the orders that she needed to write for a patient suffering from Diabetic Ketoacidosis; Helped countless doctors sort through the diagnostics on their patients and helped make critical decisions in their patients’ care; Provided critical information to doctors during their patients’ sudden onset of cardiac dysrhythmias; Run countless codes; Prayed with families and patients prior to some very frightening surgeries; Packed countless gaping abdomenal wounds; Given countless doses of Morphine, Zofran and Insulin; Spotted critical errors and omissions in care and brought them to the attention of the doctor responsible for immediate correction; Informed families of impending brain death of their loved ones; Continue reading…

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Health 2.0 Webinar on EMRs, meaningful use & clinical groupware

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By MATTHEW HOLT

The Health 2.0 crew is in Paris—yes Health 2.0 Europe is next week (April 6 & 7) but the Health 2.0 clock is still running in the US with conferences in Florida for physicians on April 24, and in Washington DC on June 7.

We have a special conference for physicians at the Sawgrass Marriott, Ponte Verde, FL on April 24. Health 2.0 in the Doctor’s Office is going to focus on EMRs, the ARRA & meaningful use requirements, and the emerging space of clinical groupware—modular SaaS based applications that help physician workflow, help make practices more efficient, and help physicians communicate better with patients.

In order to give a taster of what will be happening in Florida, tomorrow Tuesday 30 March at 10 am PST, 1pm EST (and yes for us 7pm Europe time), we’re going to have a version of The Health 2.0 Show with Indu & Matthew, that will focus on EMRs and clinical groupware.

The webinar will feature a discussion with three iconoclasts in the EMR world. They are:

These three have very strong opinions about physicians, their EMR use, and clinical groupware—it’s sure to be a fascinating discussion.

And the webinar is (as always) free. You can sign up here

Interview with Alex Savic, CEO of Alensa Next Widgets

By INDU SUBAIYA

Alex Savic is CEO of Alensa NextWidgets, based in Zurich, Switzerland. Alex is a repeat presenter at Health 2.0 and will be presenting an update on the NextWidgets platform at Health 2.0 Europe in Paris April 6-7, 2010. NextWidgets allows pharmacies to sell their products online directly to consumers through widgets placed on relevant content publisher websites.

Indu Subaiya: Alex, tell us a bit about yourself and our background, and what Alensa is all about.

Alex Savic: I’ve been working in the generics industry since 2000, traveling a lot to India and Eastern Europe to meet with manufacturers and inspect manufacturing facilities. Alensa was mostly in the API and finished formulations business then. So to branch out, in 2006 we started working on an e-commerce platform for pharmacies which has since evolved into the NextWidgets platform.Continue reading…

Physicians–grumpy and getting grumpier

By MATTHEW HOLT

As the careful THCB reader may have noted, we like to feature Daniel Palestrant (CEO of Sermo) and Jonathan Bush (CEO of athenahealth) relatively frequently because a) they’re both very entertaining and b) their companies are providing new types of services that aggregate both the opinions and the clinical activities of physicians. Given that physicians are very important in health care, and that I (and my Health 2.0 colleagues) think new clinical and business processes are a must, it’s well worth considering what physicians are thinking.

My impressions from observing what’s happening in Sermo is that physicians are grumpy. Grumpy with insurers, grumpy with the AMA, and grumpy with government. My sense is that about 2/3s of commenters on Sermo wish they can go to some kind of cash-only direct patient pay system, and the rest would want to go to some kind of protected salary system. Continue reading…

Healthcare’s Privacy Problem (Hint: It’s Not What You Think It Is )

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By LYGEIA RICCARDI

Picture 27 I recently applied for life insurance. The broker, whom I’ve never met, asked about my health history. “So you’ve just had a baby,” he began. I asked him how he knew. “You’re on Twitter.”

In the last couple of years concerns about the privacy of online health information have grown, as health care finally catches up to other sectors in its use of information technology (IT). The Stimulus package will pump $19.2 billion into healthcare IT, especially electronic medical records for doctors.

While technology can make your medical records safer in some ways than they’d be in a paper chart (using encryption, fire walls, audit trails, etc.), the fact is, no system is totally fail-safe. And when screw-ups happen, technology tends to super-size them. Continue reading…

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