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UPDATE from the FRESH-Thinking Capstone Conference

May 15, 2009• 2

By TEAL PENNEBAKER

In the same week that the Obama Administration has stated its commitment to overhauling the health care system, the FRESH-Thinking Capstone Conference adjourned yesterday morning to discuss next steps in health care reform. The event is a cross-section of health care experts—academics, practitioners, economists, industry insiders—devoted to fixing the health care system.

The morning began with Stanford Health Policy core faculty member Victor Fuchs welcoming the hundred plus attendees. Fuchs is co-director of the FRESH-Thinking Project with Ezekiel Emanuel. Emanuel stepped down from the Project to join the Obama Administration earlier this year. The Project has spent the past years considering all aspects of health care reform, and this conference is the capstone event of the group's findings. The morning talks look at the cost side of reform.

The first morning speaker was John B. Shoven, Director of the Stanford Institute for Economic Policy Research (SIEPR), who queried the crowd "is it possible to put health care on a diet?" Shoven's focus was on universal coverage and how it can be paid for. After discussing the logistics of who the uninsured are and the current taxation approach, he disavowed the crowd of two giant universal health care reform myths: shared responsibility and the middle class not having to shoulder health care costs. Shoven's take aways were "it's not necessarily that we should have new value added tax. It's that we should have a dedicated tax … We should not separate the benefits from the costs."

Should Health Care Standards be Open Source?

May 15, 2009• 10

By ALAN VIARS

Recently there has been some chatter on Twitter about health standards and open
source, so I thought I would write a little commentary on the topic.

Anyone who knows me well, knows that I am huge fan of Linux and open
source. This is perhaps why I get so frustrated with the US health
care industry and its general lack of interoperability. I could use
many standards as an example, however, for this discussion I’m using
the ASTM Continuity of Care Record (CCR) as an example. Now I’m not
picking on the CCR. The format is XML (good), and while there is always
room for improvement, I think the general structure is reasonable and
workable. I’d also point out that David Kibbe and Steven Waldren, two
keep champions for the CCR, have always been nice and helpful any time
I’ve asked a question on the list serve. I’m using the CCR as example
just because the barrier to access is so low ($100). Much of the
following is summarized from an inquiry I made to the CCR list serve
about a year ago.

The Chronic Pain Educational Educational Workshop in Berkeley, CA – July 19th, 2009

May 14, 2009

In the spirit of Health 2.0 and User Generated health Care we are proud to announce:

“The Chronic Pain Educational Educational Workshop"
July 19th, 2009 – 12:00P.M – 7:00P.M – Reception 7:00P.M – 8:00P.M

Chronic pain is the 21st century’s invisible handicap, a humanitarian crisis of epidemic proportions.

Chronic pain holds back individuals, families often whole communities from their full potential.

We believe effective chronic pain prevention and treatment is possible;
it comes through education and our goal is just to do that: to raise
awareness and educate on the issues related to chronic pain. That way
individuals and their families can make educated decisions on how to
manage their chronic pain, reclaim their lives and be able to
participate and contribute to their families and communities not longer
being devastated by daily burden of chronic pain.

The event is designed to educate and fundraise on issues related to
chronic pain and to benefit "The Chronic Pain Educational Documentary
Series."
During the event there will be informational booths with educational
material available to attendees, informational sessions and a silent
action. Food and beverages will be available.
Massage therapists will be available during the event for free chair massages.

Companies and individuals are welcome to sponsor and/or attend the event.
For more information or press releases please inquire via e-mai; at Ch******************@***il.com

Op-Ed: Leave it to Darwin?

May 14, 2009• 16

By ROGER COLLIER

I’ve been reading some of the testimony on delivery system reforms from the House Ways and Means Committee meeting earlier this month, in particular the lengthy statements from MedPAC Chairman Glenn Hackbarth and Urban Institute Senior Fellow Dr. Robert Berenson. Hackbarth and Berenson are each distinguished health care figures, and their remarks are worth careful study. Together, they paint an all too familiar gloomy picture of a system whose costs are out of control, in which quality is often poor, and where there is little correlation between expenditures and outcomes. Few would disagree with the causes that they identify: payment structures that reward volume, lack of coordination among providers, an overemphasis on specialty care, and a system that seems more often driven by supply than demand. The two sets of testimony include several very important recommendations, like more emphasis on public health, dissemination of comparative effectiveness information, and higher payments for primary care (although several years will elapse before this makes a real impact on physician career choices).

Other testimony proposals, however, especially those focused on
Medicare, carry the risk of distracting us from more important changes.
Chronic care coordination (including the medical home model) has not
yet convincingly been demonstrated to cut costs. Accountable care
organizations (this year’s buzz-phrase) require more willingness to
cooperate than many providers have so far shown. Bundled
hospitalization payments make good sense but require the same kind of
willingness to cooperate. Tying payments to quality introduces
questions of data interpretation and validity of guidelines.

Connecting value to coverage: a first glimpse

May 14, 2009• 2

By MICHAEL PAINTER

Would you take a virtual walk with me across the Dartmouth Atlas map on RWJF's web site? Just follow the link. Now, move your cursor first over, say, anywhere in Minnesota. There, you'll see that 2006 Medicare reimbursements were roughly $6,700 per beneficiary. Now, move your cursor across the country, way over to Massachusetts–specifically, Boston, for instance. There, 2006 Medicare reimbursements were almost a whopping $3,000 per beneficiary higher. You'd sure think that the quality of care in Massachusetts must be extraordinarily better for that extra $3,000 per person–but, guess what? It's not–it's roughly the same–maybe even worse in some cases. Plus, Massachusetts has embarked on its own universal coverage experiment. First in its class, Massachusetts is providing the rest of us with a real-world unfolding example demonstrating how health care cost, quality, value, and coverage intersect. If Massachusetts could figure out how to pay for high-quality care at the level of, say, Minnesota, their coverage experiment might just get exponentially easier.

So, are our national leaders taking this unfolding lesson to heart? We're beginning to learn. Last week the Senate Finance Committee released a set of policy options on transforming the health care delivery system. Their statement is really the first glimpse we've had at how our national leaders might (or might not) be linking value and coverage.

The Two Trillion Dollar Promise: Can We Trust It?

May 13, 2009• 6

By BILL KRAMER

President Obama described it as a “watershed” in the journey toward comprehensive health reform – and it might very well be. But many people are suspicious of the health industry leaders who promised to slow the trend in health care costs and save $2 trillion over the next ten years. Should we be hopeful or skeptical? The answer is both.

The joint statement by health insurers, hospitals, physicians, drug and medical device manufacturers on May 11 was very encouraging. At no time in recent history has this group agreed on a savings target and specific steps to achieve it. In the 1990’s, most of these industry groups made the cold, rational decision that they were better off with the status quo than under a Clinton-style reform plan. Now, all of them know that the current path is unsustainable, and they believe that the mainstream reform proposals by President Obama and Sen. Baucus are much better for them than the other options (do nothing or single payer). They also know that these savings are achievable; for the last 15+ years, academic experts and consultants have been pointing out opportunities for improvements in affordability and quality. There is plenty of “low hanging fruit”.

But there are plenty of reasons to be skeptical. In the past, no one ever lost a bet that health care costs would continue to increase rapidly. The title of Altman & Levitt’s 2002 article in Health Affair says it all: The Sad History of Health Care Cost Containment as Told in One Chart.

Vaccine refusal, or Jenny McCarthy, better with fewer clothes on

May 13, 2009• 5

By Matthew Holt

Kaiser Permanente has released a study from its EMR database looking at use of vaccines in its Colorado region. KP in Colorado has data on about 480,000 members dating back to the mid-1990s from when they started implementing the first EMR. After that system was retired and they moved to Epic the old data is in PDF format for current records, but is also in a database for research use. I spoke to the researchers Jason Glanz & Ted Palen from the KP Colorado Institute for Health Research late last week.

Essentially the problem is that several studies have shown vaccines to be safe but some parents are really concerned, prompted in large part by certain celebrities (with former Playboy model Jenny McCarthy being among the most vociferous claiming that vaccines cause autism), and partly because they don't believe the diseases the vaccine prevents are serious.

TV stardom (well, sorta…)

May 13, 2009• 3

By Matthew Holt

It’s just possible that you weren’t glued to the France24 cable channel (yes there is a French 24 hour news & chat channel broadcast in English). Well yesterday they had a “debate” about healthcare hosted by the very smooth Francois Picard.

Jean-Jacques Zambrowski, a professor at Paris Descartes University got to talk about Bismarkcian and Beveridge-type systems (and why Michael Moore was wrong to call French & UK care as being the same). I was sitting in a dark studio in front of a DVD showing the Golden Gate Bridge. On the phone was Tevi Troy from the Hudson Institute (yes those right wingers) who basically spent most of his time agreeing with me—which I found pretty worrying!

Incidentally for a TV novice, I could barely hear the conversation, and couldn’t see anything, which meant that I never knew when I was on camera or not—so hopefully they don’t catch me picking my nose or something on screen! Here’s the “debate” and here’s part 2.

Beware the Bursting of the Health Care Bubble

May 12, 2009• 45

By GEORGE LUNDBERG

The good news is that if and when the American healthcare bubble bursts, some value will remain. The bad news is that the annual appropriate value could actually be only about 60% of the current expenditure.

The turn of the 21st Century has been marked by the creation, expansion, and im/explosion of at least 3 significant economic “bubbles”: the huge company Enron, plus the fields of dotcom and real estate/finance. A “bubble” comes to pass when a commodity of great promise and wide applicability entices many to participate and grows at a pace that reflects hope, excitement, sometimes greed, but does not have sufficient underlying substance to support its continuing growth.

The demise of the fraudulently inflated Enron forecast much of this decade’s financial collapse. A once successful oil and gas distribution company, Enron enjoyed accelerated growth in an essential field. But it came acropper by fakery, derivatives, and manipulation, out of synch with sound principles for sustaining value. When the trickery was exposed, little remained . Enron had become a “bubble” company with a top stock price of $90 in 2000 that shrunk to pennies. This emperor had no clothes. It was a house built of Texas sand.

Humor: Voluntary Cost Control? Never Mind!

May 12, 2009• 3

By MICHAEL MILLENSON

Health Care Stocks Hurt as “Promise” Spooks InvestorsNEW YORK – Major health care stocks plunged today as investors worried that a series of voluntary actions the industry pledged in order to control costs represented a serious threat to profits.“Leaders of drug, device and health insurance companies gave their solemn word to the president of the United States that they will cut costs,” said Pinocchio Paparazzi, an analyst with Bear, Bulle and Morbull. “Simple math says if you trim two trillion dollars from spending, that’s two trillion dollars lower revenue. That reality should be reflected in stock prices.”Merck and Edwards Lifesciences, two companies whose CEOs personally attended a White House briefing announcing the coalition’s goals, led the decline with double-digit drops. Health insurance giants Wellpoint and UnitedHealth Group also slumped, as did the for-profit hospital sector, as investors decided that making the health care system “more affordable and effective for patients and purchasers” might be good politics but was bad for the bottom line.