Above the Fold

Novel Data Sources for Quality Improvement

Feb 27, 2009• 1

By JOHN HALAMKA

This Thursday I gave a presentation to the National Committee on
Vital and Health Statistics (NCVHS) about measuring quality using
“traditional” and emerging, novel sources of healthcare data.

My
definition of traditional data sources that are currently used to
measure quality includes administrative claims data aggregated from
hospital-based claims databses (for example, BIDMC has an Oracle
respository called Casemix), payer-based databases (all have a claims
warehouse to support disease management), physician organizations (Beth
Israel Deaconess Physicians Organization has worked with Heathcare Data Services to create all payer business intelligence tools ) and health data consortia (such as the Massachusetts Health Data Consortium offers de-identified aggregated claims to enable institutional comparisons)”

Commentology

Feb 27, 2009

Helen Darling of the National Business Group on Health wrote in to comment on the thread on Robert Laszewski's post on the realities behind the Obama health plan. ("For the Obama administration health care reform will require cost containment.")

We have known for many years that we have a wasteful health care system full of overuse, misuse and underuse. The system is not getting better and people are less healthy than ever. It is exciting and inspiring that we have political leaders who are willing to fight the tough and thankless battles that they will have to fight to get us on the right track as a nation. While there will be plenty of specifics to make everyone unhappy about one element or another, can't we all pull together to have a much better, more effective and affordable health care system for the good of the country?

In the thread on MEDecision CEO David St. Clair's post over the brewing battle over privacy in Washington "Consumers Need All the Facts in the Privacy Debate" Inchoate but Earnest writes:

"At present "healthcare privacy" is a wraith, a boogeyman, & like most boogeymen, it is foisted upon the innocent by people, by institutions, that would retain power over them. The unknown deserves respect, but rarely fear …"

Making Price Competition Work

Feb 27, 2009• 3

By ROGER COLLIER

Part 1 of this two-part piece asked why Adam Smith’s “invisible hand” seems to be affected by a palsy that causes health care price competition to fail, especially when employers and employees select health plans. This part focuses on a second failure of price competition: when insurers build their networks. Our hearts don’t often bleed for health insurers, but it’s possible to feel a little sympathy as they struggle to assemble networks of the most cost-effective providers.

The insurers’ first problem is the data used to pick their preferred providers. Few carriers or PPOs have the analytical capability or the data base of the Dartmouth Atlas Project; most will be drawing conclusions from their own more or less limited claims data, along with possibly anecdotal perceptions of quality.

The insurers’ second problem is the need to include in their networks “essential” providers, like prestigious or sole community hospitals, or major specialist groups. These key providers are well aware that insurers will not want to alienate employers—or have gaps in their networks—and will set their prices accordingly. In the early days of managed care, insurers drove down prices by negotiating with subsets of providers, offering higher patient volumes in exchange for lower prices. It worked, right up until the big provider push-back against managed care in the 1990’s, when hospital mergers and amalgamation of specialist practices created quasi-monopolies that insurers are now unable to circumvent.

I really don’t understand Wall Street, part 98

Feb 27, 2009• 7

By Matthew Holt

On the campaign trail Obama said that he would if elected cut the overpayments to Medicare Advantage plans by about $15bn a year. Once elected he confirmed that he would.

Stupid me thought that this would mean people on Wall Street would listen and that this freely available information would have been priced into the stocks. After all Bob Laszewski and I have been asking each other about this for quite some time!

So did I spend the last few weeks building up a big short position in the for-profit health insurers? No, this news was well known and already reflected in the stock price.

And when Obama’s budget came out today and essentially showed that it would cut Medicare payments by about the same amount he said he would (OK the cut proposed is $17.5 bn not $15bn but close enough). So did the stocks stay flat? Err… look at the chart

Healthplans

They’re all off 10% today alone, and Humana, one of the biggest Medicare players is off 20% today and 40% for the week! Were you short? Or were you too clever—just like me?

Musings on Integrating Care at the IOM

Feb 26, 2009• 5

By Matthew Holt

So I’m in
DC figuring out how the East coast medical policy elite tries to change the world. While the rest of DC is buzzing about Obama’s speech and budget, The Institute of Medicine is having a conference on Integrative Medicine. But most people think it should be called integrative health.

What is integrative health, you ask? Good question.

The majority of the panelists are mainstream health care players like Bill Novelli (AARP), George Halvorson, (Kaiser Permanente), Ralph Snyderman, (Duke). They’re talking about integrating coordinated allopathic health care and information across an individual’s personal health plan. Snyderman, said we need to move from “find it, fix it” to a “personal health plan”. Halvorson said (surprise, surprise) that we need electronic health data on every patient, and to not just replicate the current silos of care in our new data strategy. Novelli went straight at the environmental factors—smoking, fast food et al. And to not ignore them. Mehmet Oz (he of the Oprah show) said that

Consumers Need All of the Facts in the Privacy Debate

Feb 26, 2009• 14

By David St. Clair

The economic stimulus package that President Obama has signed contains upwards of $20 billion to create electronic health records for most Americans within five years. The president has been very outspoken in his belief that EHRs are essential to health care reform and that the subsequent savings they’ll generate will help to strengthen the larger overall economy.

Whenever the subject of proliferating EHRs catches the national spotlight, you can bet that debates about privacy aren’t far behind. Indeed the privacy issue has already started to gain some traction in the media. In this video clip, CNN’s Campbell Brown and Elizabeth Cohen examine how easy it is for someone to obtain private medical information online by simply using someone’s Social Security number and date of birth.

While this assessment may be accurate, it’s a bit light on the fairness
scale. Brown and Cohen only make a very brief mention of facts like
President Obama’s plan to appoint a chief privacy officer and to
implement unprecedented privacy controls to safeguard the EHR
transformation. Instead they emphasize the more sensational angle
implying that electronic health information just isn’t safe. They also
seem to downplay the fact that a simple thing like creating a password
can protect one’s private information.

Dartmouth Atlas — cool new tool

Feb 26, 2009• 2

By Matthew Holt

The Dartmouth Atlas releases this afternoon a really cool interactive atlas showing the disparity in Medicare spending between states AND showing the relative growth rates in spending between metro areas. Fabulous graphics, fantastic research and much much more grist for the mill — why was annual average growth in Medica spending from 1992 to 2006 in Miami, FL, 5% while it was only 3% in Los Angeles, California?

And don’t forget what Einstein said about compound interest.

Flash Player Required

Why Technology is No Longer Optional in Public Health

Feb 25, 2009• 5

By ANDRE BLACKMAN

So I just got back from a very informative & interactive event
where I learned about the application of
mobile technologies in
creating social change. It’s here at this meeting of the
socially-conscious minds and the focus of impact creating technology,
that I began thinking about the real ways in which cutting edge tools
are being used in the public health world.Let’s face it, we’re living in the year 2009 and whether you are a young kid or much older,
technology has been integrated into our lives – both for work and play.
Several industries and disciplines have been traditionally linked with
technology (e.g. science, engineering) however in recent years with the
advent of the Internet and social media, fields such as PR/marketing and education have latched onto emerging technologies and have been making quite a bit of use of them – making things better.

How are they making things better you ask? Well, they are doing a couple things:

Medpedia: Who gets to say what info is reliable?

Feb 25, 2009• 4

By e-Patient Dave

Unless you’ve been offline since last week, you know that Medpedia
has gone into public
beta. I
have a concern about the reliability of
their model, based on my personal experience and the self-education
I’ve been doing for the past year. I want to lay out the concern, my
reasons, and a proposal.

It was a year ago that I first learned of the e-patient white paper, E-Patients: How They Can Help Us Heal Healthcare (available free in PDF or wiki), which lays out the foundational thinking for what we’re now calling participitory medicine. The Wikipedia definition of the term includes this:

"Participatory medicine is a phenomenon similar to citizen/network
journalism where everyone, including the professionals and their target
audiences, works in partnership to produce accurate, in-depth &
current information items. It is not about patients or amateurs vs.
professionals. Participatory medicine is, like all contemporary
knowledge-building activities, a collaborative venture. Medical
knowledge is a network."

In this context, I’ll lay out my concerns.

First, I understand the need for evidence and the desire to to filter out flaky assertions.

Health costs increase despite recession

Feb 24, 2009• 3

By Merrill Goozner

The latest one- and ten-year outlook for health care spending from
the Center for Medicare and Medicaid Services projects health care
spending growing 50 percent faster than growth in the overall economy.
By 2018, health care will account for fully one in every five dollars
of gross domestic product, according to the projection. The biggest
jump in health's share of economic activity will come in the next two
years as the sector continues to grow while the rest of the economy
shrinks.

And that's the good news.

There were several unrealistic assumptions built into the
projections. First, the CMS economists assumed Medicare's physician
payments will be cut by 20 percent at the end of next year when the
current payment fix expires. As anyone who follows that issue closely
knows, that never happens. Congress always steps in and restores the
cuts.