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Commentology

Feb 12, 2009• 1

Jay wrote in on Dr. John Haughton's post on the health IT provisions in the latest version of the stimulus package. ("Stimulus bill offers docs big incentives for technology, but demands effective use.")

"While a move to EMR is a necessity to reduce medical costs for the
country, I don't believe that providing purely financial incentives for
individual doctors is going to bring about the desired change. So many
doctors are already operating as small business owners so going through
the selection, procurement, integration and ongoing maintenance of an
EMR system is going to be both time consuming and expensive, much more
so than the $40K in incentives.

How many doctors are going to be a position to effectively wade
through the sea of EMR systems to find one that will integrate as
painlessly as possible with their clinical activities. By my judgment,
not that many. At the same time, what happens when a particular system
fails to meet expectations or fails outright; is the doctor paying
someone to be on the phone to work through the technical issues? How
much support is the doctor going to receive as just one small user of a
product?

In my mind, a far better solution and use of the funds would be for
a centralized application commissioned by the federal government."

Stuart wrote in on the same thread, with an alternative suggestion:

Omitted in the "stimulus" bills is EHR using very secure, patient-carried EHR smart cards. They are well-proven, safe, easy to use, effective and in wide use in the EU. The French card system gets especially high marks.
But why ask our EU friends for a proven system when we can waste $20B screwing around for years with web-based systems that are so insecure that Americans will never agree to their use?

10 Simple Rules For a Non-adversarial Healthcare System

Feb 12, 2009• 5

By Peter Nesbitt

Most discussions regarding health care focus on parts that need fixing. Health care has many parts and some are broken and some aren't. But if we want to solve the problem, first we better decide on whether we have the right model. In the model that follows, we strongly emphasize building trust between participants but, as always, trust has to be verified.

Several years ago, we had the idea of building a non-adversarial managed care system for large employers and their injured workers. We named it "The Managed Care Alliance." As people familiar with workers' compensation know, it is among the most adversarial medical systems in the world. Employers and payers have little control over medical care and attendant costs. Abuse was rampant and providers, patients, and payers were pitted against each other. Many cases ended up in the courts. Our theory was that by eliminating friction, we could better ensure appropriate care for patients and significantly lower costs. Over a 10 year period during which I was involved, that is exactly what happened.

Missing in action: The National Coalition on Health Care

Feb 12, 2009• 10

By Roger Collier

Browsing through some 2007 entries in Bob Laszewski’s Healthcare Policy and Marketplace Review blog recently, I came across Bob’s rave review for a health care reform proposal from the National Coalition on Health Care.

The National Coalition, for anyone unfamiliar with the organization, is (or ought to be) a health care reform powerhouse. Members of the Coalition listed on its website include the AARP, General Electric, Duke Energy, UnitedHealth, the AFL-CIO, Michigan Blue Cross Blue Shield, the American College of Surgeons, the California Public Retirement System, the Episcopal Church, and the Salvation Army—a remarkable cross-section of business, health care, and social and community organizations.

Individual supporters listed include such BIG political names as former Presidents Jimmy Carter and George H. W. Bush and former Senate majority leaders Bob Dole, George Mitchell, and Tom Daschle, as well as health economics luminaries Henry Aaron, Stuart Altman, Arnold Relman, Donald Berwick, and Uwe Reinhardt. It’s hard to imagine a more impressive list, or one with more potential firepower in the battle for reform.

The Coalition was formed in 1990, just as reform was becoming one of the top items on the national political agenda. It was established as a non-profit, non-partisan organization, with—in the words of its early materials—“members united in the belief that America needs better, more affordable health care and that all Americans should have health insurance.”

A Business Case to Tackle Obesity

Feb 12, 2009• 18

By Sarah Arnquist

In the grocery business, volume counts. Profit margins of mere pennies comprise the bottom line, and so health care costs rising at nearly double-digit inflation rates threaten to undermine the grocer’s business model.

Hence, one of the nation’s largest supermarket chief executive officers has his sights set on reducing rates of obesity among his 200,000 employees.

Safeway CEO Steve Burd looked at the numbers and concluded obesity is the root of a majority of his company’s health care costs. The way he sees it, chronic conditions, such as heart disease, diabetes and cancer, are his primary cost drivers. Obesity is behind them all.

Relying on his steadfast belief in the efficiency of markets, Burd led his self-insured company in 2005 to create a health plan that puts healthy behavior incentives squarely in front of his employees.

In the three years since, Safeway’s health costs increased only a half a percentage point, Burd told an audience of hundreds of health services and policy researchers last week in Washington D.C. In that time, most businesses have experienced about 16 percent increases in family premiums.

Beyond disgusting

Feb 12, 2009• 10

By Matthew Holt

If I worked on the editorial board of a “news” organization that was owned by a lunatic from South Korea
who is a convicted criminal whose cult has been justifiably accused of kidnapping beating, and enslaving its followers I would be very, very, very careful before I started comparing the people who support an improved national health care IT infrastructure to Hitler and suggesting that they advocate mass slaughter of sick people.

But then I don’t work for the Washington Times. But even a written comparison isn’t enough.

They actually put a picture of Adolf Hitler next to their “editorial”.

Hat tip to Neil Versel and others who are as disgusted as I am

Check Out The TED Talks

Feb 11, 2009

By Brian Klepper

The uber-fabulous (and expensive) TED conference – 4 days, $6,000 and sold out a year in advance – a collection of some of the world's most thoughtful, innovative and high achieving individuals, has just finished, and many of the talks are free to watch. They cover a breathtaking array of topics.

Take 20 minutes each morning and get your mind into gear with one if these. I just watched Bill Gates' excellent presentation about the issues associated with tackling malaria and with creating great teachers.

A Shared Roadmap and Vision for Health IT

Feb 11, 2009• 9

By John Halamka, Mark Leavitt & John
Tooker

Today’s economic crisis has highlighted our need for breakthrough improvements in the quality, safety and efficiency of health care. The nation’s business competitiveness is threatened by growing health care costs, while at the same time our citizens risk losing access to care because of unemployment and the decreasing affordability of coverage. Meanwhile, the quality variations and safety shortfalls in our care system have been well documented.

Health IT is not a panacea for all of these challenges, but it is a critical first step toward addressing many of them. Before we can restructure payment systems to reward quality, we need reliable, near real time data on outcomes. Before we can reward teamwork and collaboration that re-integrates care, we need applications that let clinicians communicate patient information instantly and securely. And in order to reverse the growing burden of chronic diseases, we need online connections that engage individuals in their care and motivate them to make healthier lifestyle choices.

A Shout-out to our sponsors

Feb 11, 2009

THCB would not exist without the support of our generous sponsors. So we’d like to give a shout to our friends at Connextions Health. Connextions Health provides people and technology-driven business process solutions for health care insurers seeking to build or strengthen their consumer direct capabilities; helping plans to attract, acquire & retain individual and small group members. Visit Connextions Health. to learn more. Thanks guys!!! Interested in reaching a national monthly audience of 75,000 healthcare-obsessed readers? Drop us a ****@***************og.com“>line. We’ll get back to you with rates and options.

Someone sit Michael Cannon down before telling him this!

Feb 11, 2009• 4

By Matthew Holt

Apparently there some kind of experimental clinical innovation going on in the UK. If this isn’t a typo from
the Torygraph, how is the mental model of the free-marketeers going to survive? I suspect that Gratzer, Giuliani, Kling & the rest had better join Michael in taking a seat. Yup, communism can mean innovation, (after all who won World War II)?

Meanwhile there is a little more news on the topic of Cato (Michael’s employer). First, they created some economic stimulus of their own Monday, with a one page ad in the WSJ opposing the economic stimulus package.

But they haven’t been listening to Robert Reich and the others suggesting that we get money into the hands of the poor to create more immediate economic impact, or at least they weren’t paying attention when they gave their cash to Rupert Murdoch. Perhaps they should have put it in Street Sheet instead!

I’m the Man of the Month, really!

Feb 11, 2009• 1

By Matthew Holt

OK, perhaps not the only man of the month in the whole world, but Missy Krasner from Google Health, who is also a founder of the relatively new Disruptive Women in Health Care blog interviewed little ol’ me.