The Congressional Budget Office (CBO) has released two comprehensive papers detailing the policy and
financial options for health care reform: Key Issues in Analyzing Major Health Insurance Proposals and Budget Options, Volume I: Health Care.I can’t overestimate the importance of these documents to health care reform. I recently did a post as sort of an open letter to the CBO: To the Congressional Budget Office: Please Keep Playing it Straight!After reading these two reports, totaling more than 400 pages of some of the most valuable health policy analysis I have ever seen, I now know that I had no reason to worry that the CBO would just tell the politicians what they wanted to hear.Any Congressional health care reform proposal will need to be “scored” by the CBO and, by preempting the coming proposals with this report, the career CBO health care experts
have now made it very clear they will not be an easy touch. Reformers
are going to have to play the game on the up and up—show real savings
or find the money elsewhere. CBO Director and incoming Obama Budget Director, Peter Orszag, also deserves a lot of credit for supporting his staff and issuing this report.It is also clear that, whoever the Congressional Democratic leadership appoints to succeed Orszag, a marker is down. The CBO is
on the record about what the likely reform options will cost before
anyone had a chance to bring political pressure to bear. And, that just
might have been intentional.The work contains an inventory of about all of the health care reform options being discussed complete with a thorough cost/benefit analysis detailing their impact on federal
spending. There would certainly be impact on private spending from many
of these options but this at least gives us a relative cost index to
compare the many health care reform ideas. This is also a financial report and did not attempt to measure quality improvements.
Above the Fold
AARP, online trends health IT and fixing US Healthcare
By Val Jones MD
I had the chance to speak with John Rother, Executive Vice President of Policy and Strategy for the AARP
about the intersection of online health, information technology (IT),
and the baby boomer generation. Find out what America’s most powerful
boomer organization thinks about the future of healthcare in this
country. > Listen to the podcast
Dr. Val: Recent studies suggest that Americans age 50 and
older are more Internet savvy than ever before. How are AARP members
using the Internet to manage their health?
Rother: People over the age of 50 are the
fastest growing set of online users, and healthcare is the major reason
why they’re going online. They’re looking for health related news, help
with diagnosis, and finding appropriate healthcare providers.
Dr. Val: What role can online community play in encouraging
people to engage in healthy lifestyles that may prevent chronic
disease?
Rother: Our experience is that online
communities can be extremely helpful in several ways. First, it
provides emotional support for people who have a shared experience,
whether it’s as a caregiver, or being recently diagnosed with a disease
or condition. Second, people seem to feel more comfortable asking
questions of others with their condition than they do their own
physicians. And third, online communities can reinforce needed behavior
change. Whether it’s weight loss, exercise, or quitting smoking –
online communities can be just as effective in encouraging behavior
change as a face-to-face community.
Dr. Val: Tell me a little bit about the communities on the AARP website.
Rother: Currently our communities are organized
around medical topics, but in the future I think the communities will
become more geographical. An online community designed to serve the
needs of people in a given location can facilitate information sharing
about how to navigate a particular hospital system, for example,
instead of just general information about coping with a disease or
condition.
Next Steps for Interoperability
There are some folks in Washington who have made statements that we
should delay investments in EHRs because current vendor products lack
the functionality needed to support a coordinated healthcare system.
Others have said that we lack the standards or security framework to
implement interoperability. Here are my thoughts.
Take a look at
the successes in Massachusetts and New York with commercial EHR
products. We’ve implemented eClinicalWorks, which includes decision
support, e-prescribing, administrative transactions with payers,
clinical summary sharing across the community, and quality measurement
(all the National Quality Forum high priority measures). It’s
web-based, using a service oriented architecture in a cloud computing
environment. By implementing this product at BIDMC, we’re meeting all
the payer guidelines for delivering appropriate, coordinated, high
value care. Vendor products from Epic, Allscripts, NextGen, GE,
Meditech, eMDs, MedSphere, and other CCHIT certified vendors have
similar features.
Should we wait for something better that has more interoperability?
Do
you drive a car? Why? It pollutes, costs a lot, and generally is not
very efficient in traffic. You’d be much better off asking Scotty to
beam you up via the transporter. Should we eliminate all cars, planes
and trains until the transporter is invented? The same can be said of
EHRs and health information exchange.
An EHR We Can All Agree On
This is a modified post from one I wrote in Nov of 2007. I report this as a part owner of a small business whose costs are increasing every year while revenues are decreasing.
Therefore, I present to you all the new, improved EHR: Effective Hourly Rate.
With the absurdity of bailouts and the apparent transition from a constitutional republic to an elected monarchy, let’s see if the powers that be require us to ‘move from a 20th century economy to a 21st century economy’— by making the change from the worthless concept of ‘wages and tips’ on the W-2 to the concept of ‘total compensation’.
Should I suspect that both parties will be unable, and unwilling, to make such a tiny change in reporting that would benefit the people of the United States with real, you know, information.
The EHR should be given to all employees of all companies. What it will consist of is simple: all of the total compensation divided into what that rate would be on an hourly basis.
Let’s give an example:
JSK on Health IT in 2009
Savvy stuff, of course. Go read.
The Connected Medical Home: Health 2.0 Says “Hello” to the Medical Home Model
The concept of participatory medicine is taking hold, fueled, at least in part, by what we see as two complementary forces, these being the patient-centered medical home (PCMH) and Health 2.0. Health 2.0 is very much a grass roots phenomenon, dominated by a small but significant group of patients who are testing the hypothesis that the wisdom of the crowd can rival the wisdom of physicians. The PCMH is a concept, not new, but gaining tremendous traction in the provider sector now as a best-try effort by some providers to be truly patient centric in their approach. The two should be complementary and mutually self-supporting. One might even suggest their respective champions should be collaborating right now, when the scent of health reform is in the air in our nation’s capital. But they are not. Lets examine why and explore ways in which to create a natural bridge between these two concepts and their champions.
The medical home concept was first introduced by the American Academy of Pediatrics in the 1960s. But several factors are now converging to update this original concept for today’s health care environment. The growth in chronic illness, the emergence of new reimbursement models designed to improve quality and control costs (e.g. pay for performance), and the greater availability of monitoring and messaging technologies have providers, payers and patients taking a fresh look. This is a good thing, in that it is an effort by organized medicine and large corporations to get into the reform conversation.
But the aspects of the medical home that are getting the most airtime are largely focused on rounding out office staff, adding new roles that take work away from the physician so that the physician can tend to more patients, and taking a population view of the patient panel. This vision is idyllic, but several challenges suggest that as conceived it will be tough to get it out of the womb.
Prop 8 still reverberates, and bigotry is still with us
There’s a pretense from the anti (whoops!) pro-Prop 8 diehards that somehow this is not about them hating gay people. Rick Warren says that, as did Mike Huckerbee said when he ended his (clearly losing) conversation with John Stewart on The Daily Show. Frankly I’d be happier if they just came out and admitted it.
In a portrayal of one of the most unpleasant sounding families I’ve heard about in some time, the LA Times has a couple of juicy quotes. And the unpleasant family and their equally unpleasant pastors essentially come out and say it.
The Bible is very, very clear . . . that that kind of perversion will not get people into heaven," Abel said. "They’re fallen people, broken people, hurting people."
SNIP
Brooklyn and her family believe that gay activists have unfairly painted Proposition 8 supporters as "hate-mongers and bigots."
Hmm…who’s painting who?
But I’m always amazed that while caring so much about what happens in the afterlife, the fundamentalists among us are so determined to ruin other people’s lives in this space-time continuum.
CODA: The ridiculousness of the “resting on what the Bible says” position is of course best revealed in this classic, which ended up being used in a memorable scene in The West Wing.
Weighing in on the New FDA Commissioner
Patient
advocacy groups, most of them drug industry-funded, have asked
President-elect Barack Obama to appoint a Food and Drug Administration
commissioner who won’t cave in to pressure from lawmakers or the news
media, according to the Wall Street Journal.
It is news to me that the news media has much say about decisions at
FDA. There are reporters who highlight problems, especially safety
problems, in the nation’s food and drug supply. And there are reporters
who highlight every study suggesting the next miracle cure is just
around the corner. Large news organizations like the New York Times
have both. For every Gardiner Harris, there is a Gina Kolata. The news
media are megaphones. They are not, to use someone else’s phrase, the
decider.
Vioxx and Avandia didn’t come to light because of the press or angry
legislators on Capitol Hill. What consumers and patients, legislators
and the press learned about the lethal side effects of those drugs was
due to diligent researchers like Steve Nissen and Eric Topol and
courageous whistleblowers inside the FDA like David Graham. Ditto for
most of the other safety scandals that have plagued the agency in this
decade.
That said, patient advocates who are worried that the agency under a
more safety-conscious commissioner will somehow abandon the search for
faster cures should know that their views are well represented inside
the transition team. Josh Sharfstein, the Baltimore health
commissioner, formerly on Rep. Henry Waxman’s staff, who took up cause
of making pediatric cold medicines safer, may be leading the effort.
But his co-conveners include Greg Simon, who heads a group called . . .
da da . . . Faster Cures (not industry-funded, according to Simon). The
other team leader is attorney Alta Charo from the University of
Wisconsin, whose expertise is primarily in bioethics, not drug safety.
Cool Technology of the Week
In my experience, social networking applications gain marketshare by being first to innovate and then spreading virally.
I
was an early adopter of Facebook but delayed joining Twitter, a
microblog that enables me to post instant blog entries via SMS from my
Blackberry.
Over the past 60 days, I have seen an incredible
rise in Twitter use among my colleagues and have now joined the ranks
of folks who "Tweet" their blogs. You’ll find me at http://twitter.com/jhalamka
Here’s what I do to use Twitter :
Conservatives Need to be Part of Health Care Reform
Stuart Butler, Vice President of Domestic Policy at the conservative Heritage Foundation has an op-ed in Thursday’s Washington Times, “Four Steps Can Heal Health Care.”He makes some very valuable points and proposes four steps toward reforming the health care system most people—liberals and conservatives —could agree on:
- Making sure every working family has access to an affordable private health plan
that could include state-based default plans with agreed upon minimum
benefits and premiums subsidized through reinsurance pools that spread
any adverse risk over the broad private market. - Encouraging insurance exchanges not unlike those envisioned by Democrats but at the state level where Stuart sees these exchanges avoiding “endless Congressional micromanagement.”
- Reforming the existing federal tax preferences for health insurance by capping the value of these tax breaks as a means to encourage more efficient plans and raise revenue to help pay for premium subsidies
- Redesigning the Medicaid and SCHIP programs
by giving states the ability to streamline these programs and free-up
funds to expand the help the low-income people get for health
insurance—including vouchers to purchase private coverage.
