Aneesh Chopra is the new and first CTO of the Federal Government, and he’s also going to be the keynote speaker for the Health 2.0 Conference (Oct 6-7,register here!). I caught up with him for a quick interview yesterday where he discussed his role, Health 2.0 and the new apps.gov site. Off camera we had a great chat and Aneesh both forced me to give a brain dump on exciting companies in Health 2.0 and showed that he knows plenty about the space and has really big ambitions. I can’t say more yet, but let’s say he’s very interested in using new sources of data to improve decisions. I think that it’s great that someone so committed to making technology work for people (and not vice versa) is in such a strong position to influence Federal policy. Here’s the interview
Above the Fold
“Reform” Means Higher Costs, Not Lower
A reader asks: “If the current bill passes are my health insurance costs likely to go up, down, or remain about the same?”
If the form that I believe most likely to pass actually passes (insurance reforms, individual mandate, weak or no public option or co-ops), I believe that they will continue to go up. There simply is nothing in the bill that would make things more affordable. In health care markets, for a convoluted nest of reasons, more competition causes prices to go up, not down.
Health Care Outlook Not Improving
Sen. Max Baucus (D-Mon) released his much-anticipated healthcare proposal Wednesday morning.
The next big test for a health care bill in 2009 (notice that I did not call it health care reform) will come in Senate Finance.
The
final vote in that committee will tell us a lot about whether the
Democrats have any chance for 60 votes in the full Senate. So far, it
does not look good.I have the greatest respect for Senators
Baucus and Grassley and their good faith efforts to find a bipartisan
health care solution. But I also think their efforts were fatally
flawed from the beginning.I think the problem is that Baucus
and Grassley were trying to bridge the wide chasm between liberal and
conservative ideas. Finding the fine balance necessary has created an
unwieldy compromise—no one is happy. Most striking, the compromise
reached between cost and premium subsidies has yielded an $880 billion
bill that requires middle class people to buy health insurance they will in no way will be able to afford. On top of that, the policies have big deductibles and out-of-pocket costs.
Limited English Proficiency Shouldn’t Mean Limited Health Care
It’s impossible to know exactly what shape healthcare will take for Americans as Congress and President Obama struggle with reform measures in the coming months. But one thing is certain: Those who have limited English proficiency will continue to have more health care services they can understand. Though the U.S. has prohibited discrimination, including language access for limited English proficient persons, since the passage of the Civil Rights Act of 1964, the reality in the healthcare industry is very different. Whether insured or not, those who don’t speak or read English “very well” tend to have care that’s not as good as those who do. The Agency for Healthcare Research and Quality (AHRQ) reported that in 2005 only 54 percent of Latinos experiencing an injury or illness had timely access to healthcare, compared to 65 percent of whites. And if uninsured, Latinos got care in only 27 percent of cases.
Commentology: Government vs. Corporate Bureaucrats
Bob Bourque of Los Alamos writes:
Do I want government bureaucrats deciding on my health care? You bet I do! Because the other choice is to have corporate
bureaucrats deciding on my health care. I have some control over the
government bureaucrats: I can vote out their bosses who tell them what
to do. I have no control over the corporate bureaucrats. They can do
what they please, and pay off politicians to stay out of the way.Government bureaucrats will charge a few percent for the administrative
work they would do, which is like what they do for Social Security and
Medicare. Corporate bureaucrats now charge 30% to pay their CEOs
hundreds of millions of dollars and billions to their investors.
Medical Students Want You to Know
By
How many of us can remember a world without cell phones? Today’s medical students would undoubtedly be among that group. So it is no wonder these future physicians rely heavily on technology as they embark on their career path. We surveyed more than 1,000 medical students who are Epocrates subscribers about technology (software, hardware and EMRs) and other pressing industry topics.
The survey found 45% of respondents currently use an iPhone or iPod touch, followed by Palm and BlackBerry devices. Even prior to the launch of the iPhone, Apple has connected with this younger generation and continues to play to its strengths. Our survey did not address carrier preference, but it appears students may be more device focused; nearly 60% of non-smartphone users planning to purchase an iPhone within the next year. It is also worth noting that students may be looking at what device residents or attending physicians are using as well. In the first year of availability, over 100,000 physicians are actively using Epocrates software on an iPhone/iPod touch. We still see a significant number of physicians using BlackBerry and Palm devices, so we expect those respective populations to grow as well.Continue reading…
Obama’s Medicare Half-Truth
Obama was called a liar during his recent address to a joint session of Congress. Actually, he was not fully truthful about the implications of cuts to Medicare. Obama repeated that his health reform plan includes payment cuts for private Medicare Advantage (MA) health plans:
The only thing this plan would eliminate is the
hundreds of billions of dollars in waste and fraud, as well as
unwarranted subsidies in Medicare that go to insurance companies —
subsidies that do everything to pad their profits and nothing to
improve your care. … So don’t pay attention to those scary stories
about how your benefits will be cut… That will never happen on my
watch. I will protect Medicare.
Obama’s claim that the cuts will trim insurer profits but not Medicare benefits was meant to calm nervous seniors. As I and others have pointed out the proposed cuts will in fact reduce benefits to some degree, contrary to the President’s assertion. But seniors, in general, should not be concerned. First, only about 23% of Medicare beneficiaries are enrolled in an MA plan.
Balancing Consistency and Innovation in Healthcare
Our healthcare system is now facing a problem that has plagued 
business leaders for years: how do you balance consistency and innovation?
The drive for consistency in healthcare is based upon the fundamental observation that physicians across the country treat similar medical conditions in dramatically different fashions. Sometimes, these different approaches are costly, such as using a more expensive treatment when a less expensive approach might be as effective. In other cases, these practice variations are dangerous – failing to provide patients with treatment the evidence suggests is best.
Standardizing the delivery of care — identifying “best practices,” and then insisting physicians follow these guidelines – could, in theory, save money while improving quality, and is the basis of Obama’s healthcare proposal.Continue reading…
What if I Had To Do HIT All Over Again?
By MARGALIT GUR-ARIE
This post is aimed at serving as an interlude to the “public option/death panels” discussions. No matter what healthcare reform bill, if any, is passed this fall, HIT will be part of the program. Four short years ago I was involved in the creation of a comprehensive, some would say monolithic, EMR/Practice Management/Billing system. This new product was built in reaction to the very large, very expensive and very clunky systems already on the market.
Remembrance of Things Past – The driving design considerations four years ago
- The problem – Paper charts are causing inefficient workflows in physician offices. It is hard to find pertinent information in a big chart and it is hard to analyze that information. Charts can only be accessed by one person at a time and cannot be accessed from outside the office. Charts are sometimes misplaced and may be lost during a fire or natural disaster. Every new chart costs money to create, store, pull and maintain.
- The solution – Application software that provides a computerized version of the paper chart – an Electronic Medical Record. Computers are great at storing and arranging data in all sorts of ways and formats. Computers can analyze, graph and report on enormous amounts of data. The software should be web based so it can be easily accessed from anywhere by multiple users simultaneously. No more misplaced charts and no more wasted office space and a SaaS solution would make sure the records are disaster proof.Continue reading…
A little ain’t enough, or is it?
I've been so buried in the run up to Health 2.0 that I haven’t had a chance to add to the deluge of electrons about the bills in Congress, Obama’s speech, the several hundred amendments to Baucus’ bill in mark-up, etc, etc. And my colleagues on THCB and elsewhere are taking good care of you in the details.
But I thought that I’d quickly respond to today’s WaPo article in which Erza Klein connects two themes that matter, while leaving out two that matter more. The first of the two he identifies is that most Americans don’t see the cost of health care. If we made them all write a check for $13,000 a year, and they’d seen that number go from $8,000 a decade ago and realized that it will be $25,000 in another decade, then the cost problem would be much more real. It would also get associated with the access problem as people realize that as the cost goes up, they (and their employer) can afford less. At the moment those problems are disconnected.
The ignorance here remains palpable. An HR exec I know did an exit
interview last week with an employee who was astonished to find out
that now he was on his own he could buy family health insurance in
California for under $500 a month which was less than his contribution
to the company plan. The concepts of risk pooling, risk selection,
varying benefit levels et al were clearly foreign to him. And of course
had his family had a pre-existing condition that policy might have cost $3,000 a month or more.
