The Health Care Blog – Page 920 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

A Research Agenda for Participatory Medicine and the Connected Medical Home

Mar 25, 2009• 15

By DAVID C. KIBBE AND JOSEPH KVEDAR

  Recently, in a blog post published December 22, 2008 in The Health Care Blog entitled "The Connected Medical Home,” we described the synergy between the efforts of proponents of Participatory Medicine and the Medical Home. Our main purpose was to suggest that both providers and patients are longing for a synthesis that takes the best features of Health 2.0 as consumer-generated health care, and combines these with a primary care medical home model offering personal relationships with health professionals who understand the power of the Web and are willing to use the Internet to improve patient care.   

Since our earlier writing, which received mostly positive commentary, a new President has been elected and Washington is on fire with talk of health reform and economic stimulus. Health IT and the medical home are primed to take center stage in the evolution of health reform, most observers would agree. However, there are still many details to be worked out. It is not entirely clear what constitutes the best uses of health IT inside the medical home model, nor how to hold these uses accountable for improved care and lower cost of care, let alone how to connect these with consumer-based technologies and bring both to market at a reasonable price, certainly a prime consideration during a recession and if we expect efficient widespread use.   

Karen Ignagni lie of the day, part 68

Mar 25, 2009• 49

By Matthew Holt

The big insurers now seem to be doing anything they can to prevent a Medicare-equivalent public plan
being launched to beat them up. Yes AHIP has apparently decided to throw the schlockmeisters off the boat, and more or less agree to end medical underwriting.

Those of you who listened to my interview with Tom Epstein of California Blue Shield will recall the cognitive dissonance he was suffering when he had to defend Blue Shield and other insurers’ behavior in the individual insurance market (hey, it’s the man’s job), while at the same time calling for policies that would essentially end the individual market and create a near-universal purchasing pool. By definition, that would require some level of uniformity of benefits and some risk-adjustment mechanism, and consequently it would put several currently profitable lines of insurers business out of business—yes I am talking about Tonik and Mega Life & Health among others. In general this might be a good trade for the bigger plans as they’d add a bunch more younger healthier lives at a higher price point (although what Wellpoint’s actuaries and accountants really think about it is yet to be determined—note their opposition to the similar ArnieCare legislation).

PharmaSURVEYOR

Mar 25, 2009

PharmaSURVEYOR is The Most Advanced Drug Safety Utility for consumers
and professionals alike. PharmaSURVEYOR offers a personalized drug assessment tool designed to
show users not only drug-drug interactions but the much more common and
often dangerous adverse drug side effects making it a valuable tool for Medication
Therapy Management and Medication Reconcilliation. By partnering with
other healthcare sites and services such as Electronic Health Records
(EHRs) and Personal Health Records (PHRs), it can automatically
bring in a patient's medication list from a partner, run a Drug Safety
Survey on their drugs, and show them the combined risks as well as
interactions from their drug regimen. PharmaSURVEYOR then provides a
"what if" capability to "try" substitute drugs and help find those
which will reduce the adverse drug effects of greatest concern to a
patient.

To learn more about PharmaSURVEYOR go to www.pharmasurveyor.com

Two Birds With One Stone: Covering the Uninsured by Fixing Medicare

Mar 25, 2009• 31

By Victor M. Sandler, MD

As a nation, we are in a heap of trouble. Our medical system is a
disaster—overly expensive and ineffective. On average, we spend two to
three times more per capita on health care than other developed
countries. Yet on measures of quality, we rank 22nd out of 23 among
those same countries, according to the World Health Organization. Not
only that, Medicare, our national insurer for the elderly and disabled,
is facing more than $30 trillion in unfunded liabilities over the next
40 years. We have 50 million people who are uninsured in this country
and millions more who are underinsured because employers have shifted a
larger percentage of premium costs to them and increased deductibles
and coinsurance payments, causing some to forgo medical treatment
because of the expense.

The bad news is that we are on a path that is much too costly and
clearly not sustainable. The good news is we can get off that path by
cutting medical costs dramatically without negatively affecting
quality. The way to start is by acknowledging the fact that we don’t
have the best health care in the world, as former President George W.
Bush and others have touted.

What we have is the most health care in the world.

The Causes of Medical Waste
The factors that feed our obese medical system are manifold. But three
are especially troublesome. First, there is an unfortunate ethos within
American medicine and society at large called “heroic positivism.”¹
Essentially, it is the idea that the more we do to and for our
patients, the more they gain.

A Healthcare IT Primer

Mar 24, 2009• 15

By JOHN HALAMKA

Now that Healthcare IT is part of the stimulus and newsworthy, I
receive many questions from reporters
about the fundamentals of healthcare IT. Here's a primer with the Top 10 questions and answers:

1. Can you define EHR, EMR, PHR and PM in simple terms?

Electronic Medical Record – An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by
authorized clinicians and staff within one health care organization.

Electronic
Health Record – An electronic record of health-related information on
an individual that conforms to nationally recognized interoperability
standards and that can be created, managed, and consulted by authorized
clinicians and staff, across more than one health care organization.

Personal
Health Record – An electronic record of health-related information on
an individual that conforms to nationally recognized interoperability
standards and that can be drawn from multiple sources while being
managed, shared, and controlled by the individual.

Practice
Management – An application used to manage the physician business
operations including scheduling, registration, and billing …

Health Care Reform: Ideology, Self-Interest and Rhetoric

Mar 24, 2009• 55

By Humphrey Taylor and Ian Morrison

Thirty years ago, one of us asked the retiring CEO of one of the largest drug companies what was the worst mistake he had made as CEO. Without hesitating he said, “Opposing Medicare. We were so ideologically hostile to a big new government program that we lost sight of our own self-interest. All the major drug companies except Syntex opposed it. Luckily we lost. We have made billions of dollars because of Medicare.”

The White House “summit” on health care reform was a nice start but as the as the reform debate unfolds, public and congressional opinion and the positions of the powerful interests involved – pharmaceuticals, insurers, device manufacturers, physicians, large and small employers, and technology companies – will be swayed by their ideology, perceptions of self-interest and the rhetoric used in the debate.

At one level, there is a broad consensus in America that we need to reform healthcare to expand coverage, improve quality, and make healthcare affordable. Public opinion polls show broad agreement and large majorities in favor of fundamental change. Even among specific stakeholder groups, from employers to hospitals and doctors, there seems to be widespread agreement that healthcare needs to change. But, the combination of a deep ideological divide, self-interests that are mutually exclusive, and rhetoric that is capable of turning public opinion against change may end up creating an environment of inaction.

Drug war lunacy–Connecting the Dots

Mar 24, 2009• 9

By Matthew Holt

Next month the Supreme Court will be given the chance to redress one minor the lunacy of the last thirty years of the so-called “war on drugs”. It will get to decide whether in the name of "zero tolerance" a thirteen year old girl can be strip searched in the quest to find some OTC ibuprofen. Oh, and she was an honor student falsely accused by a former "friend". Given the current make-up of the Supreme Court—yes Clarence Thomas still gets a vote—we can probably expect nothing sensible.

On the other hand nothing sensible, and much worse, is going on south of the border. My former colleague Paul Saffo points out that Mexico is on the verge of collapse. He notes a major signal—the cops are wearing masks while a major drug dealer stands proud.

Narrow Networks – Part II

Mar 24, 2009• 8

By CHARLIE BAKER

For the past six years, Harvard Pilgrim has offered a limited
network product to our New Hampshire members called “New Hampshire
NetOption.” Simply put, all New Hampshire providers are Tier One
providers – lowest co-pays – and so are all Massachusetts community
hospitals. Tier Two providers are MA-based teaching hospitals (members
have a higher co-pay for services there). That’s it. Two tiers – one
for NH hospitals and MA community hospitals, and a different one for
MA-based teaching hospitals.

There is, however, one catch. All NH hospitals and their physicians
and all MA hospitals and their physicians are “in network” for this
product – except Partners. When we set the product up, Partners chose
not to participate because the plan design treated teaching hospitals
differently than it treated community hospitals. That’s their call.
NBD, as my kids would say.

The Public Program Impasse: A Proposal

Mar 23, 2009• 14

By ROGER COLLIER

Health care reform proponents could find encouragement in recent Obama administration comments on the issue of taxing health care benefits. The President, having adamantly rejected the concept during last year’s campaign (thereby violating a cardinal rule of politics: “never say anything you can’t later on claim was misinterpreted by your enemies”) indicated through White House budget director Peter Orzsag that he considered the issue very much on the table.

Since passage of health care reform is likely to require almost unanimous support by the fifty-eight Senate Dems—or maybe fifty-nine, depending on the eventual emergence of a winner from the long Minnesota winter—the President’s willingness to back down is a positive step (although sophisticated financial thinkers will note that shuffling funding sources will do nothing to reduce total costs).

What the administration’s openness to compromise also does, however, is move the spotlight onto another issue with the potential of sinking health care reform: the inclusion or otherwise of a public program option in a reform structure.

Commentology

Mar 22, 2009• 3

JR wrote to us with an interesting question:

“Given the attempt to recover bonus payments to AIG, can you envision a scenarios where CMS attempts to recover payments from physicians that they retroactively deem too high? What if a new national standards board establishes a rate for hip replacements that is lower than what it is today? Similar situation? Not at all? I’d like to see a discussion on this.”

CCHIT President Mark Leavitt likes the Obama administration’s pick for National Health IT Czar. He left this comment on Matthew’s post on the selection.

I had the opportunity to work with David Blumenthal recently when I served on an expert panel for the health IT adoption studies. He has a deep understanding of applied health IT and, even more important, how clinicians interact with these systems in the real world. This is great news for everyone interested in advancing the use of health IT to improve quality, safety, and cost efficiency.

Commentology regular Christopher George thinks the courts missed the underlying point in both of the cases that Tobias Gilk discusses. “Pharma vs. Devices – FDA, Supreme Court and Liability Whiplash“

“In both of these [instances] the product was mis-administered. The
Medronic balloon was inflated above the pressure for which it was
rated; the drug was mis-administered by the nurse. In both cases, the fault lay with the doctor or nurse using the
product, not the product. There is no “failure to warn” here. The
balloon was over inflated. Every balloon, when overinflated enough will
burst. The injection was made into an artery.”