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Pop the Cost Bubble: Unallot Medicare

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Victor Sandler

Here’s a dirty little secret: Cutting health care costs is not that difficult, nor will it harm patients. That’s because it only involves giving up unnecessary medical care—tests and treatments patients may want but really don’t need because they don’t benefit their health.

How is this supposed to happen? In Minnesota we call it “unallotment.” When the state had to reconcile a projected multibillion dollar budget deficit this year, and the Republican governor and Democratic lawmakers couldn’t agree on how to do it, the governor simply “unalloted” billions of dollars of planned expenditures.

Medicare should do the same. All Congress has to do is pass the MedPAC Reform Act of 2009 (SF 1110) and give it teeth. We can then unallot the 30 percent of Medicare expenses that most health care experts believe are unnecessary. That’s the 30 percent that goes for tests, drugs, and devices that don’t have any proven benefit but sell like hotcakes anyway.

When Gov. Tim Pawlenty decided to cut medical expenditures during the unallotment process, he took no prisoners. More than 30,000 indigent adults will simply have their medical insurance eliminated starting next March. Medicare would take a higher road, eliminating unnecessary care and costs, not “unnecessary” people.Continue reading…

Let’s Not Lose Sight of the Goals

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By BILL KRAMER

Picture 4

I love Daniel Schorr.  I’ve never met him in person, but I love his voice and his insights about politics on NPR’s Weekend Edition.  But this morning I was disappointed.  After listening to his comments on the Olympics and Iran, I looked forward with anticipation to his thoughts about the Senate Finance Committee’s accomplishments earlier this week on health reform legislation.  When asked whether a “real health care bill” is likely to pass later this year, he said, “Well, it begins to look more [likely] . . . that there will be a bill.  The question is not whether there will be a bill . . . but what will be left in the bill, because so many things have been taken out.”  I could almost hear him sigh.  He went on to talk about the fact that the public option is not a part of the Senate Finance bill, although it might be restored in full or part (through a trigger mechanism or health cooperatives) as the bill moves through Congress. Let’s step back for a minute.  (This is what I usually rely on Schorr to do for us.)  Where were we a year ago?  Although advocates of health reform were encouraged that the health care crisis was getting a lot of attention in the Presidential election campaign, the outlook was not rosy. Obama and McCain were neck and neck, and McCain’s reform proposal was so weak as to be laughable.  The pundits and pollsters were predicting that the Democrats would get about 56 seats in the Senate – not enough to overcome a filibuster.  And there was serious concern that even if Obama were elected, health reform would be crowded out by other major crises – the threat of a serious economic depression, the banking collapse, Iraq/Afghanistan/Iran, energy and global climate change, and who knows what else.  In October 2008, the likelihood of serious comprehensive health reform was probably about 25%.

Continue reading…

Olberman, hysterical hypocrisy expose

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By Matthew Holt

A really fun piece from Keith Olbermann as he shows how the entire Gang of Six and more voted for fully socialized flood insurance and yet seem to have a problem with an independent government run public option.  

Of course, now that a bill has finally left Baucus committee, our meandering towards a relatively inconsequential tinkering at the edges of the health insurance market is a little further down the path. But can we somehow arrange it that the bozos at the NY Times (yes I’m talking about Robert Pear and David Herzenhorn) please stop saying things this dumb:

the Democrats are trying to restructure one-sixth of the economy, writing a bill that will affect almost every American, every business and every doctor and hospital in the country.

The level of exaggeration in that statement is simply unworthy of the paper of record. Would that it were true.

JSK (national treasure) on data liquidity, and how it fits into Health 2.0

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By Matthew Holt

Given that she taught me most of what I know about health IT I don’t know why I ever need reminding about how great Jane Sarasohn-Kahn is at keeping her finger on the pulse of health care, and how consistently good is her one daily post on Health Populi.

Yesterday was no different. She gave a great overview of a new PWC study on data liquidity. You’re going to hear lots from me and others in the coming days about data liquidity, substitutability, intermingling of applications, and unplatforms. But what’s happening on the edges of health care IT in the Health 2.0 movement is a combination of tools, content and transaction data beginning to flow between applications. More and more this is both enabling better management of the consumer (and clinicians) workflow experience and better ways to aggregate these new data sources for clinical decisions and research.

On day Two of the Health 2.0 Conference next week we’ll be showing this both in our panel on Data Drives Decisions, but also on the Tools panel which will feature a series of inter-operable applications sharing data. And we’ll also be showing the big players (Google, Microsoft & WebMD) as they move their offerings to a world where other service providers can use their platform.

Truly exciting times, but Jane points out that there are lots of barriers. She calls the PWC report

a sober analysis of what stands between transactions and raw data, and the ultimate goal of using that information: clinical transformation that benefits people.

And those barriers all center around the workflow, payment structure and institutional inertia of our current health care establishment.

 the health industry en masse needs to shift the focus of data from transactions to quality and outcomes. This will require – surprise, surprise – incentives to, as PwC puts it, “induce all stakeholders to collect, report and use the data.”

Two big deals in Health 2.0

By Matthew Holt

John Halamka writes about the small but important meeting this week at Harvard Medical School hosted by Zak Kohane and Ken Mandl. Because of the impending arrival of about 1,000 of my best friends next week at Health 2.0, I couldn’t go to that meeting. But it may be very important in putting the “cats and dogs” together to think about ways for new platforms with players like Halamka and David Kibbe (who have not been on the same side of these issues) both taking part.

Meanwhile, yesterday Microsoft released My Health Info. I got a quick preview and it’s essentially a layer over HealthVault that allows both Microsoft and others to build widgets that can be arranged on sites like MSN Health (and presumably many more to come) which directly connect with the individual’s data in HealthVault. It essentially is the cool user interface that HealthVault has been missing and it’s more evidence of Microsoft’s serious intentions in consumer health care.

If you’re at Health 2.0 next week you’ll see Microsoft’s My Health Info and hear much, much more about what David Kibbe is calling Clinical Groupware, and also many demonstrations about we’re starting to call “unplatforms”.

While health reform is arguing about multiple amendments in Baucus’ committee and making some of us despair, the tech world is showing some real promise.

Money-Driven Medicine film now downloadable

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By Matthew Holt

If you want to watch the documentary Money Driven Medicine based on Maggie Mahar’s book, it’s now available for free download at moneydrivenmedicine.org (the DVD is also available for purchase). The free download is part of an ongoing “Watch-In! For America’s Health” — a national viewing party organized in conjunction with the Consumers Union.

Carrot or Stick? Should Patient Decision Aids Be Rewarded or Required?

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By DON KEMPER

Don kemper

  1. Should we incent or require providers to prescribe patient decision aids?
  2. Should we incent or require consumers to use patient decision aids?

Over-treatment is the most celebrated cause of runaway health care costs, but we shouldn’t blame the doctors. The fee-for-service system sets them up for over-treatment. First, they have been taught that offering all possible cures to every patient is good medicine. Second, malpractice law pushes them toward offering more testing and services, not less. And third, they generally get paid more when they do more. It’s hard to buck a triple-threat system like that without a little help from the patient. Fortunately, it’s not that hard for patients to provide that difference.Continue reading…

Can Social Media Save Healthcare Reform?

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By DANIEL PALESTRANT, MD

Daniel Palestrant is the Founder & CEO of Sermo, the largest online physician community, and a friend of THCB’s from the Health 2.0 world. Lately Dan has been seen on cable TV representing the 110K+ Sermo members in the health reform debate—including a very public break-up with Sermo’s former partners at the AMA, which has endorsed the House 3200 bill. I’ve been asking Dan, if his members’ don’t want the House bill, what do they want? This is the piece he sent me in reply—Matthew Holt

Daniel Palestrant Speaking at Fortune’s Brainstorm Technology Conference last month, longtime healthcare reform advocate, Howard Dean pointed out that the “dirty secret” of social media is that it can put a whole lot of politicians out of business because it allows the truth to bubble up. For the sake of healthcare reform, let’s hope he is right.

True healthcare reform has no chance of occurring with the current political topography. As the general public tries to make sense of the 1,000+ page version of the bill and President Obama distances himself from Howard Dean’s raison d’etre, the public option, two things are becoming increasingly clear:

1. There is very little actual healthcare reform going on.

2 The insurance companies look like they will win, no matter what, especially if you believe the cover of the most recent Business Week “The Health Insurers Have Already Won”.

At Sermo.com we seem to be seeing Governor Dean’s prediction come true.

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The Health 2.0 Accelerator is really gunning it…

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By MATTHEW HOLT


The Health 2.0 Accelerator was a glimmer in the eye of Commerce.net’s Marty Tenenbaum late in 2007. But under the dedicated leadership of Julie Murchinson and Aaron Apodaca, something quite remarkable is happening. The Accelerator is an industry consortium, mostly made up of very small Health 2.0 companies who are just getting started in their own young lives. But working together they’re integrating data and services in a way that’s going to make consumers’ use of online health tools very different from the patchwork we see today.

And the effort is getting attention. Today Kaiser Permanente announced that it was joining the Accelerator, moving alongside Sage and Catholic Healthcare West as corporate members. And in the wings is a major health care data player, who’s going to be adding their seal of approval next week.

What’s happening here is the evolution of an ecosystem—an ecosystem where innovation on the web and in mobile Health 2.0 is now finding ways to present itself to consumers and healthcare organizations in new ways.

I don’t want to let the cat out of the bag completely, but I think that anyone who’s interested in seeing the evolution of Health 2.0 and the evolution of health care consumer technology will be fascinated by what around a dozen Health 2.0 Accelerator members are going to show—together—at the tools panel at the Health 2.0 Conference next week.

In the meanwhile kudos to Julie and Aaron, to Erick & Linda von Schweber from PHARMASurveyor who’ve been founding board members and have driven the technical process, to the folks from Sage who were great early supporters and to the more than 100 people and companies who’ve been supporting the Accelerator.

They’ve all made a real difference. And it’s just beginning.

I was largely in favor of Swiss-style health care…

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By Matthew Holt

until I found out that the people who the NY Times says are really in favor of it are Bill O’Reilly and Regina Herzlinger…

Actually I’m kidding. I knew Regi says she likes it, and Maggie Mahar ripped her position—(Herzlinger’s position being that she espouses a version of the Swiss system for the US)—to shreds a while back. But would Herzlinger really want to live in a world where there was no easy money to be made trading in the stock of health insurers who are defrauding state governments? But I’ve got to say that Herzlinger and O’Reilly make a interesting couple.…pass the falafel.