Kaiser Health News (KHN) debuted today and is a critically important addition to America's debate over health care reform.As the media has downsized in recent years, we have lost many reporters who were health care specialists. KHN
will provide news outlets across the country with an important
specialized source of solid reporting from an organization that has
come to be known as uniquely expert and unbiased.In their inaugural issue today, Julie Appleby has an interesting interview with Nancy Ann DeParle, the President's point person on reform.
Above the Fold
Death to Innovators – The Tragedy of Healthcare Innovation
Tragedy
- A disastrous event, especially one involving distressing loss or injury to life
- A tragic aspect or element.
- A drama or literary work in which the main character is brought to ruin or suffers extreme sorrow, especially as a consequence of a tragic flaw, moral weakness, or inability to cope with unfavorable circumstances.
The Advisory Board to the Health 2.0 Conference have been rehashing the recent conference in preparation for the fall program. We are continuing to try to push the boundaries of how to highlight bleeding edge innovations (dessert) and the new tools and technologies (eye-candy), but trying to be disciplined in challenging the community to put up their hard core case studies (nutritious tofu in the words of Esther Dyson) that demonstrate why this movement actually matters. This latter one requires thoughtful discipline, and hard data, from people trying to do very hard things (like obtain accurate personal health data from disparate sources, help consumers understand and optimize health value, and show how these new models of care actually lower cost). We look forward to producing a great program and I will keep you posted on these conversations.
The reason it is so hard to “do the right thing” in health care is that the current environment is a conspiracy of connundrums – no accountabilty, no transparency, rules/regulations, culture, binding contracts, third party payments, behavioral choices, lack of evidence, etc ad nauseaum. A real world example of how this plays out can be seen in the Vicious Cycle of Healthcare Innovation. This article highlights what happens when health care providers “do the right thing” but are rewarded with less money, which then kills off not only their desire but also their capability to do the right thing. Its a beautiful mechanism to ensure that the status quo never changes. This “Death to Innovators” concept has been highlighted by Intermountain Healthcare (pneumonia), Virginia Mason (back pain), and health innovators like Rushika Fernandopulle , MD at Reinnassance Health.
These tragedies have to be overcome. Given the grip of the medico-industrial complex, and their lobbying minions in DC, the only hope I have is that an entirely new system of health can begin to develop and emerge “off the grid” for the current non-consumers of healthcare. From this toehold, and from early and small efforts of the myriad groups seeking to change the financing of healthcare, I am hopeful that innovation can emerge that will align incentives, coordinate care delivery, improve outcomes, and be rewarded appropriately for these results. That is why I am involved in the various efforts to not only bring innovation to light but also demonstrate that these models can flourish.
CER Council requests public comment
The Federal Comparative Effectiveness Research Coordination Council has posted its draft definition of comparative effectiveness research and the draft criteria for research prioritization athttp://www.hhs.gov/recovery/programs/cer/draftdefinition.html for public review and comment.
Cool Technology of the Week
In my recent blog about the Red Flags rule, GreenLeaves commented that biometric checking would help reduce errors by establishing identity and uncovering fraud.
Using biometrics to verify identity seems like a good idea, so I met with Jim Sullivan from BIO-key, a leading provider of biometric solutions.
In
the past, I've been reluctant to adopt biometrics because of the
expense of buying fingerprint or Iris scanners for each of my 8000
client devices.
However, now that many laptops and hospital
ready tablets include embedded fingerprint swipe scanners and that the
price of USB fingerprint scanners has dropped significantly, it is
realistic to consider biometrics.
BIO-key has developed a
next-generation algorithm that reduces the fingerprint to set of
calculated unique identifiers. A person’s fingerprint graphic is not
the credential; their finger is. BIO-key ensures that only a real
finger is being scanned to produce these unique identifiers, making a
stolen fingerprint graphic useless to a potential imposter. It's the
computed values that are stored when the user's finger is scanned at
enrollment, and is later used for comparison with future scans. To me,
it's similar to the way NTLM authentication works – there is no need to
store or exchange the actual password, it's a mathematical hash of the
password that is compared to a stored mathematical hash of the original
password. BIO-key allows you to enroll and identify on most of the
different fingerprint scanners in the market, allowing an open,
heterogeneous fingerprint hardware environment.
Cal Blue Shield wins recision case, but it’s very, very strange
So Blue Shield of California wins the first case it’s fighting over the recission issue. But it’s in very strange circumstances. The plaintiffs (a couple trying to get coverage for a doctor they like that wasn't in their employer’s plan) changed their story and said that they had lied on their application.
Blue Shield’s lawyer even went after St. Lisa herself!
Blue Shield's lawyer, Jacobs, also complained about "unrelenting negative coverage in the Los Angeles Times." Despite that, he said, "we fought this lawsuit because we knew we had behaved properly and we were confident that the evidence would speak for itself. It has."
So four burning questions remain.
1. Why did the couple who’ve been fighting this all the way, suddenly capitulate when not significantly different circumstances in the only other case to go to arbitration (the Healthnet case) led to a $9m verdict? Something happened here and in the interests of transparency Blue Shield had better tell, or suspicions will be raised.
2. If it’s so sure that it’s legally in the right, why did Blue Shield settle with the state insurance commissioner earlier this year (albeit on pretty favorable terms) and pay the out of pocket expenses and offer insurance to the 678 people with claims against it? If you’re in the right (and legally I think they may be in many of those cases), why be expedient?
Calendar: Tufts Summer Institute on Web Strategies for Health Communication
What do millions of people do online and why does this matter to
healthcare? That question, and many related ones about how to take
advantage of the Web for health communication, will be answered in a
new course offered by Tufts University School of Medicine on Web
Strategy for Health Communication, http://webstrategiesforhealth.com.
This one-week intensive course will be offered July 19-24 to help heath
communication professionals develop, justify, and implement a coherent
Web strategy for their organization.
healthcare? That question, and many related ones about how to take
advantage of the Web for health communication, will be answered in a
new course offered by Tufts University School of Medicine on Web
Strategy for Health Communication, http://webstrategiesforhealth.com.
This one-week intensive course will be offered July 19-24 to help heath
communication professionals develop, justify, and implement a coherent
Web strategy for their organization.
Students will learn from Tufts faculty and industry experts, including:
- Bill Tancer, author of "Click: What Millions of People Do Online and Why It Matters" and general manager of global research at Hitwise
- Tara Montgomery, Publishing Director at Consumer Reports Health
- Gilles Frydman, founder of Association of Cancer Online Resources (ACOR)and blogger at e-patients.net
- Dan Childs, Health Page producer for ABCNews.com
- Diane Aronson, Past-President of the Road Back Foundation
- Aviva Must, Dean of Public Health and Professional Degree Programs, Tufts University School of Medicine
- Lisa Gualtieri, Adjunct Clinical Professor, Health Communication Program, Tufts University School of Medicine
Students
will learn best practices through case studies from leading healthcare
organizations. For some organizations, including Consumer Reports
Health, they will conduct Web strategy "makeovers". "Our challenge is
how to leverage our trusted brand to engage consumers online, explain
the scientific evidence behind their healthcare options, and ultimately
empower them to change their behavior so that they can live healthier
lives," said Tara Montgomery, who will be presented with the results
from student teams.
will learn best practices through case studies from leading healthcare
organizations. For some organizations, including Consumer Reports
Health, they will conduct Web strategy "makeovers". "Our challenge is
how to leverage our trusted brand to engage consumers online, explain
the scientific evidence behind their healthcare options, and ultimately
empower them to change their behavior so that they can live healthier
lives," said Tara Montgomery, who will be presented with the results
from student teams.
Another case study is Families for Depression Awareness.
“We started a Facebook page hoping it would bring more people to our
Web site but we don’t think it’s working,” Ritu Gill, Staff Member.
They also use twitter
but have one person they are following (moi), two tweets, and three
followers. Given limited staff and budget, how can they best use their
resources to help patients?
Other case studies are from the Road
Back Foundation, Memorial Sloan-Kettering Cancer Center, CureTogether,
Weight Watchers, and TuDiabetes.com. While the organizations differ in
many respects, they share the goal of how to best leverage Web
technologies today and in the future.
For more information go to: http://webstrategiesforhealth.com
Helping Each Other Take Care of Each Other
- How many billions of dollars in volunteer health care services are donated in this country?
- How can HIT stimulus dollars help to provide development of businesses or business models that provide an economic multiplier effect to the value of volunteer health services work?
- How can volunteer health care services be attached to the coordinated care team? (Clinicians, family, friends, volunteers)
I attended a “Health Fair” today. I confess that it is the first one I have experienced. While I have been working in health care information technology longer than I will admit, I have been aware of “health fairs” but never actually participated. I have always been able to afford health insurance throughout my adult life and in my childhood my parents had access to employer sponsored health coverage. When I am due for a check up or need other attention to my aging body, I have been quite fortunate to have very talented and dedicated physicians and other providers who accommodate me and take care of me.
Workers Ungrateful for Empowerment to Pay More
American workers sure are ungrateful.A new report by the National Business Group on Health (NBGH) says that 27 percent of insured workers are skipping health care treatments to avoid co-payments, 20 percent of employees are not taking their prescriptions as advised by their doctors, and 17 percent of employees are cutting their pills in half to make them last longer.Yet rather than expressing gratitude for the opportunity to express their consumer-driven preferences, and rather than praising the benefits consultants and conservative think-tank talkers who have given them the chance to have “skin in the game,” 58 percent of those surveyed said they “continue to be surprised” at their out-of-pocket costs. Obviously, they haven’t been attending conferences of HR execs, or they’d know that one man’s “cost shifting” is another man’s “empowerment of my employees.”It turns out that shopping for health care is not like shopping for a refrigerator and that changing co-pays and deductibles has to be undertaken with a great deal of care. Workers, hard-pressed financially by a deep recession, workers are not craftily eliminating unnecessary and non-evidence-based care. Instead, they’re pill splitting or skipping the pills entirely. This is precisely what the landmark RAND Health Insurance Experiment research on copayments and deductibles predicted more than two decades ago, which would be no surprise had the study consistently been quoted honestly by all proponents of the so-called consumer-driven health plans.
Of course, what goes around, comes around. Since 68 percent of employees say that having access to health benefits is a key reason for staying with their employer, it will be that same employer who picks up the tab for the consumer-driven diabetic who has to drive her consumer self to the emergency room because she couldn’t afford her medication. However, the good news is that a majority of workers polled said financial incentives from their employers have motivated them to try to lead a healthier lifestyle.In fact, about half of workers now agree that fat people and smokers ought to pay higher premiums. That’s only fair. And I think guys who have personal trainers and executive physicals should pay less, too, don’t you? Oh, wait. That wasn’t on the questionnaire.Why not just eliminate health insurance altogether and instead give every worker a shiny apple a day? (To keep the doctor away, of course.) If any HR execs, benefits consultants or conservative policy wonks out there would like to adopt this proposal, you can call it One More Fruity Idea for Health Care.
The Great $2 Billion Cost Cut “Promise” Meets Another Obstacle
By ROGER COLLIER
It turns out that the hospital, insurance and pharmaceutical organizations who announced with great fanfare a couple of weeks ago their plan to cut/maybe think about cutting* $2 trillion/maybe nothing* from their costs may have been even more devious/disingenuous/stupid* than was apparent at the time. [*choose one]
The New York Times pointed out yesterday that any such organized effort to reduce prices could face antitrust charges. In the Times’ words: “Antitrust lawyers say doctors, hospitals, insurance companies and drug makers will be running huge legal risks if they get together and agree on a strategy to hold down prices and reduce the growth of health spending.”
The drug manufacturer lobbyists who so eagerly participated in the May 11 meeting with President Obama should have been especially aware of the issue. Back in 1993, it was their trade group that, in an effort to soften the threat of Clintoncare, offered to limit pharmaceutical price increases to the CPI rate, then were told by the Justice Department that this would violate antitrust laws.
And, again according to the Times, it was the AHA who complained recently to the Federal Trade Commission that antitrust laws make it difficult for providers to collaborate and lower costs.
So, first these organizations promise to cut costs by $2 trillion, then they say they didn’t really mean it, and now it turns out that it would probably be illegal (which they should have been fully aware of, anyway). Who’s trying to fool whom?
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].
Raising Legitimate Questions and Concerns About Health IT Certification, Without Getting Personal
By DAVID C. KIBBE
In a recent blog post on THCB, Mark Leavitt wrote this about me: “[Dr. Kibbe’s] repeated use of falsehoods and innuendo to attack CCHIT have found an audience in the national media, reaching a level that can no longer be ignored. By implication, he demeans the integrity of everyone who has contributed to that work – and I must rise to their defense.”
The truth is that I respect both Dr. Leavitt and, equally important, the many fine people who have contributed to CCHIT work. I regret that he has made me the target of his anger about investigative reporting in the Washington Post, which I certainly did not initiate.
To clarify what I actually said, after a brief interview, quoted in the second of two articles in the Washington Post by Robert O’Harrow, Jr, a Pulitzer Prize finalist :
“One has to question whether or not a vendor-founded, -funded and -driven organization should have the exclusive right to determine what software will be bought by federal taxpayer dollars,” Kibbe said. “It’s important that the people who determine how this money is spent are disinterested and unbiased . . . Even the appearance of a conflict of interest could poison the whole process.”
Raising questions and concerns like these does not reach the level of “falsehoods and innuendo.” In my opinion, it is entirely appropriate to ask tough questions about whose interests are being served when $36 Billion of tax payers’ money is involved, and the future of health IT in the U.S. will be the result of certification.”
I am not the only one with these concerns. Many other health care and health IT professionals have raised legitimate questions about CCHIT and its practices, its relationship with HIMSS, and yet to date these have not been resolved. A response that attacks me personally and labels me a liar is far from adequate, and so the questions will remain.
The stakes are too high to simply look the other way.
David C. Kibbe MD MBA is a Family Physician and Senior Advisor to the American Academy of Family Physicians who consults on healthcare professional and consumer technologies.
