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A Business Case to Tackle Obesity

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.

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Beyond disgusting

Picture 11If 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

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

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.

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A Shout-out to our sponsors

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!

Matthew HoltApparently 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!

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Locating the “Medical Home”

There’s no doubt that people — especially those with (multiple)
chronic conditions — need a more holistic model for managing their
health needs than what our delivery system currently offers. The PCMH
model is intriguing, but I have worried that many examples of PCMH
deployment thus far have been centered around the physician’s office
(and, to some extent, the physician’s needs).

In contrast, most patients with health problems are living 24/7 with
whatever is affecting their quality of life, and not much of it is
spent in the doctor’s office. Think about it: There are 8,760 hours in
a year, and how many of them are spent in a health care facility?
Unless someone has multiple hospitalizations in a given year, the
answer is probably far less than 1 percent.

I’ve been fascinated for a long time now by the potential of Ix and
Health 2.0 strategies to deliver to us more robust models of truly
patient-centered medical homes than we have seen in most of the
country. Thankfully, other (smarter) people have also been thinking
about this and were able to join us to present in a recent webinar.

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Commentology

Former Medscape and Journal of the American Medical Association Editor Dr. George Lundberg had this response to Dr. John Haughton's opinion piece on government Health IT spending. ("Stimulus Bill Offers Docs Big Incentives but Demands Effective Use.")

"There are many reasons why physicians in general (excluding
pathologists, radiologists, intensivists, anesthesiologists,large
multi-specialty groups) have not yet embraced healthcare information
technology. I refer interested readers to for Blake Lesselroth's unique take
on the barriers to full clinician adoption of HIT
and how to overcome
some of them.

 Dr. Robert Rowley's post  on his company's advertising based  electronic medical record system ("Freenomics and Healthcare IT') prompted this response from Scott Shreeve MD

I was an early critic of Practice Fusion when I first heard of their business model. However, I have come around for many of the reasons that Dr. Rowley and Dr. Kibbe mention. In fact, I would suspect that I am the only commenter on this section that has actually used the software in to take care of patients (Crossover Health personal health advisory service).  Getting a tool (an EMR) into the hands of providers (much better than paper) who can use it to improve patient care is a good thing. The fact that the tool comes with some branded messaging is tolerated because the price (free) and the ease of use is so compelling (installed in minutes).

In terms of software, I have found the features/functionality of the software to be sufficient for now, the look and feel to adequate, and the rate of ongoing development to be intriguing (several key updates over last several months). There are definitely some holes that need to be plugged, some functionality that needs to be added, but overall I find it from an EMR perspective to be "good enough".

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Certification versus Meaningful Use

Halamka

Recently, clinicians have asked me “why should I implement my organization’s preferred EHR when I’ve found a less expensive vendor that promises meaningful use?”

This illustrates a basic misunderstanding of the difference between Certification and Meaningful Use.

The certification process will be codified in a December 2009 Notice of Proposed Rulekmaking (NPRM) and will define the process for certifying electronic health records including modular and open source approaches. (The Standards for data exchange will be codified in a December 2009 Interim Final Rule and become law immediately.) We know that ONC will specify certification criteria and that NIST will oversee certification conformance testing which will be performed by multiple organizations. However, we will not have the final certification criteria or the defined process until Spring after a period of comment on the NPRM.Continue reading…

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