Savvy stuff, of course. Go read.
Above the Fold
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.
Interview with Fred Goldstein, US Preventive Medicine
Last year US Preventive Medicine (USPM) caused a little splash with some full page ads in the Wall Street Journal proclaiming itself the future of preventative care. Since then the company, which has raised a significant chunk of private capital, has been diversifying into various aspects of prevention–including what looks more like disease management.
About a year ago USPM acquired Fred Goldstein’s company Specialty Disease Management Services. And since then it’s been marketing The Prevention Plan to employers–including a recent deal with AON–and also putting out a very neat online service that was shown at Health 2.0 in October.
Prevention is getting some lofty rhetoric, including Prez2Be Obama suggesting that it’s a major key to cutting health care costs. But many people in health care think that it doesn’t have an ROI. Fred disagrees and told me why in a wide-ranging conversation about the company, the concept of prevention and whether it’s really the wave of the future. Click here to listen
Now United HealthGroup settles with investors, your Friday teaser
Can someone tell me how much money Bill McGuire has got left?
California transplant surgeon acquitted
By 
A jury acquitted a San Francisco transplant surgeon Thursday of criminal charges
related to his alleged actions during an attempted organ harvest nearly three years ago in a small town on California’s central coast.
In what’s thought to be the first case of its kind in the United States, prosecutors accused surgeon Hootan Roozrokh of ordering excessive amounts of painkillers to hasten the death of a potential organ donor.
The not-guilty verdict relieved the
transplant community, which feared the case would have chilling effects
on the public’s willingness to donate organs and surgeons’ willingness
to participate in the rarer type of donation done in this case, called
donation after cardiac death or DCD.
The Medicare Ponzi Scheme
Just today, our next President spoke out against the largest investment swindle in US history. The alleged behavior of Bernard Madoff may have cost investors up to $50 billion.
“In the last few days, the alleged scandal at Madoff Investment Securities has reminded us yet again of how badly reform is needed when it comes to the rules and regulations that govern our markets. … And if the financial crisis has taught us anything, it’s that this failure of oversight and accountability doesn’t just harm the individuals involved, it has the potential to devastate our entire economy. That’s a failure we cannot afford.” — Barack Obama Dec. 18, 2008
What did Madoff do? He lured investors with big returns, and used the “profits” as a means to encourage additional investment by investors, while luring new ones.
