The Health Care Blog – Page 961 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The inconvenient truth

Oct 29, 2008• 12

By Sarah Arnquist

The Los Angeles Times ran a great series last week called "Shedding Risk" in which it detailed through compelling human stories the erosion of the health insurance market. It’s definitely worth finding the time to read.

Matthew has talked about this eroding model for a while, including in a speech about three inconvenient truths that he gave to health plan executives in March.

Here are four key paragraphs from the first article in The Times‘ series to give you a sense of the articles:

At the heart of the problem is the clash between the cost of medical care and insurers’ need to turn a profit.Today, four publicly traded corporations — WellPoint Inc., UnitedHealth Group, Aetna Inc. and Cigna Corp. — dominate the market, covering more than 85 million people, or almost half of all Americans with private insurance.On Wall Street, they showcase their efforts to hold down expenses and maximize shareholder returns by excluding customers likely to need expensive care, including those with chronic diseases such as asthma and diabetes. The companies lobby governments to take over responsibility for their sickest customers so they can reserve the healthiest (and most profitable) for themselves.Meanwhile, insurance premiums are becoming a heavier burden on employers, many of which say that rising healthcare costs cut into their ability to compete and, in some cases, to survive.

Here are Matthew’s three inconvenient truths to the insurance execs:

e-Patient Dave tells his story

Oct 28, 2008• 7

By Matthew Holt

In the Connected Health conference at Partners I sat in on a great session in which e-Patient Dave (Dave deBronkart) and his physician, Danny Sands described his use of listservs, the Internet, email and BIMDC’s PatientSite and other tools in his (successful!) battle with renal cancer—after being told median survival was 24 weeks. I won’t tell the whole story as they’re trying to get it published in an authoritative journal—so that physicians will pay attention and promote this use of technology by patients.

Danny Sands says most patients with his condition feel incredibly alone. but "Dave told me he didn’t think he was isolated. He felt
connected.”

Dave said, “Reading and connecting online makes me a better patient. But it doesn’t make me an oncologist.” But doing all these things via ACOR and the use of CaringBridge and PatientSite did, he believe, increase his hope & outlook, and helped make his treatment successful.

A remarkable story and one that we’ll tell more about later.

(Note: I made a minor edit as my original note got garbled between my ears and my fingers!)

The latest on technology-enabled DM

Oct 28, 2008

By Matthew Holt

I sat in on another session at Connected Health about A Progress Report on Medicare’s CMHCB (Care Management for High Cost Beneficiaries) Pilot. This is the medical group alternative to Medicare Health Support operated via providers not health plans. Some quick notes…

Suneel Rataan from Health Hero: We know that we can make DM work using the Health Buddy and supporting nurses in the VA. But could they make it work in a community setting under Medicare Fee for Service. We know how badly Medicare Health Support has gone, what about this one (CMHCB)? “We can’t talk about the results but our program has not been terminated!” (Actually they have applied for an extension & expansion of the project).

Couple of others, one from Montefiore in the Bronx another from Partners—the Partners one has a variety of practices and the problem is that they need to have the consistent program across those.

Be careful what you wish for

Oct 28, 2008• 16

By Charlie Baker

Charlie Baker is the president and CEO of Harvard Pilgrim Health
Care. This post first appeared on his blog, Lets Talk Health Care.

The show is
pretty much the same – every time. Public sector entity gets in budget
trouble, cuts have to be made, and providers who do business with the
public sector get hammered – hard. It’s happened with Medicare at
the federal level for years, and it happens with Medicaid at the state
level with some frequency as well.

Well, the show is back in town, as state governments face declining
revenues. In Massachusetts, the state is not only cutting Medicaid
payments prospectively – it’s cutting Medicaid payments for some
providers retrospectively – simply choosing not to make payments to
them they had planned on and expected.

I must say, each time this happens, I can’t help but wonder if the
hospital operators and physician leaders who think a single-payer like
Medicare For All is a good idea ever stop to think about how these
agencies deal with their financial problems. When they have a problem,
they unilaterally whack their provider community hard – in ways private
sector payers would never consider.

And then those same providers who think Medicare For All is a great
idea turn to the private health plans they do business with and say,
“Hey – you need to help solve my Medicare/Medicaid deficit – which just
got worse.”

Sheesh. All I can say is, “be careful what you wish for.”

Entering the era of participatory medicine

Oct 28, 2008• 2

By Jane Sarasohn-Kahn

I’ve returned from a week of Health 2.0 immersion on the west coast. The top-line finding: we’ve entered the period we can call Participatory Medicine. For some, like the pioneering Gilles Friedman of ACOR, this is nothing new. Other people have never heard of it. It’s global. It’s local. It’s a movement and a verb, as I pointed out thirteen months ago following the inaugural Health 2.0 conference. H20logo_2

Here are some reflections…

On Tuesday, I appeared on a panel on Health 2.0 at the Commonwealth Club in San Francisco for KQED public radio, sponsored by the California HealthCare Foundation. The Club’s motto by founder Edward Adams is, "We only propose to find truth and turn it loose in the world." My fellow panelists resemble that remark! They were the inspiring Amy Tenderich, founder and blogger of Diabetes Mine; and the ebullient, motivating and insightful Dr. Ted Eytan, now with Kaiser Permanente. We riffed on the roots of H2.0, the risks and benefits of people sharing health information and opinions online, and prospects for the future. Amy and Ted were stellar and shared their special perspectives as patient and doctor, respectively. When the podcast online is available, I will point you to it.

Will a $5,000-tax credit be the silver bullet to solve health care?

Oct 28, 2008• 9

By Shuka Kalantari John_mccain

If Senator John McCain becomes U.S. president he plans to give each American family $5,000 to pay for health insurance premium costs in the individual market. Individuals would get $2,500 for the same use.

How does McCain propose to pay for this? In part, by revoking the tax deductibility of workers’ health benefits and by making cuts to Medicare and Medicaid. Even with these provisions, however, The Tax Policy Center estimates McCain’s plan will run an estimated $1.3 trillion short in funding over the next ten years.

In McCain’s “Health Care Action” television ad, he says, “The problem with health care in America is not the quality of health care, it’s the availability and the affordability. And that has to do with the dramatic increase in the cost of health care.”

Make your voice heard!

Oct 28, 2008• 3

For the next week, you have a unique opportunity to make your voice heard on health information privacy issues, their impact on the Health 2.0 movement, and how best to build public trust in these technologies.

The National Academy of Public Administration (with funding from the Office of Management & Budget) is hosting a unique "national dialogue" on the intersection of health IT and privacy, which will take place on the Web beginning yesterday, October 27, and lasting through November 3.

They are seeking to gather feedback from the public on the important privacy issues that confront all of us as we promote the movement to e-health. A report will be generated based on the responses, so it is important that a broad range of stakeholders participate. Go to www.thenationaldialogue.org to find out more and to log on!

Hat tip to: The Health 2.0 social network

Some more reflections on Health 2.0

Oct 27, 2008• 7

By Matthew Holt H20logo

It’s late at night and I’m red-eye-ing it to Boston to the Partners Center for Connected Health Symposium. Just like at Health 2.0 last week there’s going to be about 1,000 people there. And while originally the session I’m leading on Social Networks was going to be about it for Health 2.0, the agenda has morphed quite a bit and several of the people and players who were on at Health 2.0 are also going to be in Boston. (Although my understanding is that the polite Harvard guys won’t torture them into demoing the way we make them do it!)

That tells you a couple of things. First, smart people think alike. While Connected Health started out as being mainly about remote monitoring and its place in disease management, the core group of consumer-facing tools that make up an increasing share of Health 2.0 are entering into the DM and Connected Health realm. Second, the semi-automated DM systems that are primarily call-center driven are suffering some more realistic expectations compared to the famous $34bn plus forecast from Forrester a while back. And that of course is highly highly related to the perceived failure of Medicare Health Support.

All of this leads to the underlying tension that Health 2.0 puts squarely on the table. Is the future of health care going to be led by self-organizing groups of patients and their representatives, or will it be dominated by technologically-extended versions of the major health care organizations who are now responsible for care delivery?

My suspicion is that the answer is both.

Firefighters attack McCain’s health plan

Oct 27, 2008• 6

By Shuka Kalantari

The International Association of Firefighters (IAFF) recently launched a campaign in support of Senator Obama for president — and an attack on Senator McCain’s health care plan.

The commercial features four firefighters. "Our job is to risk our lives to protect you, and your loved ones. We’re proud of that," one of the firefighters say. "Like you, we need our health care for our families," adds another firefighter.

The IAFF, based in Washington D.C., is a labor union representing approximately 292,000 full-time firefighters and paramedics in the United States and Canada. The commercial will air on local cable networks in New Hampshire, parts of North Carolina, Orlando, St. Louis, parts of Ohio and parts of Virginia.

A Fantasy Brought to You by the New York Times: Medicine Without Risk

Oct 27, 2008• 10

By MAGGIE MAHAR

Sometimes I agree with New York Times’ editorials. Sometimes I don’t. But I rarely learn much from them. To my mind, the problem with the form is that it encourages opining without evidence. So, I admit, I rarely turn to the editorials.

But Buckeye Surgeon pricked my curiosity by referring to a recent New York Times editorial as a “masterpiece of naiveté and contempt.”

Such strong language suggested that the editorial might be entertaining. Thus, I went back and read what turned out to be a piece congratulating Medicare for having decided it “will no longer pay hospitals for the added cost of treating patients who acquire any of 10 ‘reasonably preventable’ conditions while hospitalized. Those include incompatible blood transfusions, severe bedsores, injuries from falls, poor blood sugar control, and infections after certain surgeries.”

This is what I mean about editorials: typically they are monologues that cry out for a good copy editor who asks sensible, logical questions. The first query that springs to mind is this: exactly what does “preventable” mean? How is a “fall” preventable?Continue reading…