Managed Care

AHIP Pix

And speaking of payor technology vendors, last week’s AHIP conference was considerably smaller than 2007.  Our intrepid Account Executive Melissa Bruno provided a pictorial report:

Getting priorities straight - the busiest booth of the conference.
 

The second busiest booth of the conference.
 

Make sure your health plan covers Wii wrist sprains before visiting Portico’s booth.
 

This boat manufacturer was selling new technology paradigms. Fish love them.

Posted by Shawn Whalen on June 26, 2008 at 12:54 PM
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Your Premiums at Work

It seems that health plans have a little money left after paying all those healthcare costs. The trend of health plans acquiring technology vendors continues.  Care management vendor MEDecision is to be acquired by Health Care Service Corporation (HCSC), which operates Blue Cross and Blue Shield plans in Illinois, New Mexico, Oklahoma and Texas.  HCSC paid $121 million and will keep MEDecision independent.

BlueCross BlueShield of Tennessee and The Regence Group Blue are taking a minority ownership in TriZetto Group, which will be going private.  Others include UnitedHealth’s Ingenix , Aetna’s ActiveHealth Management, and Independence Blue Cross’ AllOne Health Management Solutions.

As I’ve written before, payors will be the major players in pushing technology adoption in healthcare, be it provider side with EHRs or consumer side with PHRs.

Posted by Shawn Whalen on June 23, 2008 at 8:47 AM
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Rated PG: Physician Good

CIGNA announced a national website ranking doctors and hospitals by cost and quality measures. As I’ve written before on doctor ratings, this movement is inevitable despite all the my-patients-are-sicker claims by doctors, or the efforts of various Attorney Generals.  Such watchdogs efforts are important though to see that health plans don’t skew the data for their own financial goals.

Cigna’s site names hospitals in specific regions with the lowest death and complication rates. It also offers lists of questions patients can ask their doctor about specific conditions and tools to help patients locate pharmacies with the lowest prices.

In New York, Cigna was one of many plans who pledged in writing to detail its ranking criteria. They’ve also tapped the National Committee for Quality Assurance to guide their ranking program.

Meanwhile in Massachusetts the MA Medical Society is up in arms about the state’s doc rankings. They sued the Group Insurance Commission to stop the rankings, claiming low-ranking doctors will be defamed and those patients who have to pay higher copayments based on their doctor’s ranking have been defrauded.

And last but not least, though most confusing to Joe Smith consumer, will be Consumer Reports new hospital rating service for 3,000 organizations. Their “intensity of care” index of 1 to 100 will rate how intensely a hospital treats patients, based on time spent in the hospital and number of doctor visits for nine serious conditions. This strikes me as a controversial and incomplete criteria compared to other methods.

Posted by Shawn Whalen on June 6, 2008 at 10:51 AM
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Don't Believe the Hype?

But Don’t Let That Stop You Promoting It ;)

A sobering case study for CDHP/HSAs. Financial services company T. Rowe Price adopted its consumer-driven health plan in 2004. You’d think they’d succeed, given the 5,000 financially savvy U.S. employees and a sophisticated benefits program already in place.  Enrollment in the plan hit 8 percent the first year, not bad.

Enrollment remained flat for three years, then rose in ’08 to 9 percent - too low to produce substantial savings. What could (maybe) make a difference? More incentives and tools for consumerism. A majority of consumer-driven plans today are stagnating like T. Rowe Prices. The most common plan designs don’t contain the seeds for their success.

It’s telling that when Towers Perrin wanted to quantify cost savings from CDHPs in a recent study, it found the CDHP landscape too small to do a credible survey.  PR folks at vendors or companies succeeding in CDHP’s may have a media story in that success, going against the grain of poor performance through the solutions or approach that you offer.

Posted by Shawn Whalen on May 30, 2008 at 11:12 AM
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CEOs Support Wired for Health Care Act

Today brings a guest column on healthcare quality and technology by Maria Ghazal, director of public policy with the Business Roundtable, an association of CEOs of leading U.S. companies with $4.5 trillion in annual revenues and more than 10 million employees.

Health IT Will Save Lives and Money - First We Need Policymakers to Wire Us for Health Care Quality

Imagine if every few days a passenger plane crashed while travelling across America. There would be a massive outcry over safety standards and America would want answers…the airline industry would be investigated, held accountable and would make the necessary changes to ensure air travel is as safe as possible. Shockingly, the equivalent is happening in the healthcare space and no one seems to notice. Every year as many as 98,000 people die due to preventable medical errors, the equivalent of a 747 crashing every two or three days, and yet there is no public outcry, no call for reform and no alteration to our current health care system.

This must change. I work for the Business Roundtable – an association of CEOs of leading U.S. companies such as Verizon, Aetna and General Motors – who are pushing Congress to recognize that the cost we currently pay for our outdated system, in both human lives and dollars, is unacceptable. Based on both their business experience and their insights from insuring more than 35 million Americans, Business Roundtable CEOs believe that utilizing health information technology, more commonly known as health IT, will provide better quality of care while saving money and ensuring the security of private medical information.

 

Continue reading "CEOs Support Wired for Health Care Act" »

Posted by Shawn Whalen on May 19, 2008 at 1:46 PM
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Support Your Local HCIT Events

Here in Massachusetts, the Massachusetts Technology Leadership Council’s  Healthcare/IT Summit is being held Thursday, June 5, 2008, at the Hyatt Regency in Cambridge.

Is the Consumer the next big HealthCare IT Buyer?
Opportunities & Obstacles

Thursday, June 5, 2008
8:00-11:00am Program
7:30am Registration

Register here.

According to MTLC, during the past 18 months, we've seen significant investment in patient-centric healthcare technology solutions from major IT vendors such as Microsoft (HealthVault), Google (Google Health), IBM (Center for HealthCare Management), Intel (Digital Health Group), and Apple (iPhone as healthcare platform -- Kleiner Perkins is investing $100M into companies developing new applications for the iPhone).

MTLC has convened a panel of thought leaders from the IT community to brief us on their investments and their vision for the healthcare IT market. They've also assembled a panel of healthcare CIOs and IT buyers to give their perspectives on these investments.

Participants:
- Michael Barrett, President, Critical Mass (moderator)
- Patrick Boyle, Vice President, America's Healthcare & Life Sciences, IBM
- John Halamka, CIO, Care Group/Beth Israel Deaconess Medical Center
- Paul Mattes, Managing Director, US Health & Life Sciences, Microsoft
- Dan Nigrin, CIO, Children's Hospital
- Gary Sevounts, Senior Director, Global Healthcare Solutions, Symantec
 

Posted by Shawn Whalen on May 16, 2008 at 1:19 PM
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Care Management Thoughts

At the recent World Healthcare Congress there was much talk about health plans and care management. In the increasingly competitive payor market differentiation is important, so some insurers are looking to move beyond disease management to “care management.”  This focus on member care comes with longer term cost savings that go beyond comparatively simple utilization management.

Executing this care management beyond marketing pabulum requires a combination of new technologies, particularly in the data analytics and evidence based medicine realm, as well as more aggressive communication with members via HRAs, PHRs, clinical content and more health/wellness programs.

Some health plans are doing better than others in particular slices of the care management spectrum, but few have brought it all together in an integrated fashion. While outsourcing certain simple functions such as transaction processing remains an answer for many, the wisdom from WHCC attendees favored a holistic in-house effort to achieve care management.

The risk and reward of care management resides with both insurer and provider, as the specialized networks can gain from pay-for-performance initiatives aligned with different populations.

For the healthcare marketers, consider that the care management topic will be growing in popularity in the media. As more plans and vendors discuss care management, media will seek examples of approaches, tools and end users. This could mean a PR opportunity for you.

Posted by Shawn Whalen on May 12, 2008 at 2:55 PM
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Frankenstein vs. BC CA

E-newsletter FierceHealthcare reported on Blue Cross of CA's attempt to enlist doctors to help expose patient’s healthcare discrepancies in order to cancel policies (read below). This is of course troubling, though not surprising (do health plans have ulterior motives like this in pushing PHRs?) 

Even more troubling is the existence of Dr. Frankenstein, who is head of the California Medical Association. This Dr. Richard Frankenstein was “outraged” by Blue Cross’ action.  I would be careful Blue Cross. Dr. Frankenstein doubtless has powerful progeny who you do not want to meet on a dark and stormy night, unless you have a lot of torches.

“Blue Cross of California has raised eyebrows around the state, and sparked protests from some physician groups, by sending medical groups applications filled out by beneficiaries and asking the doctors, in effect, if the patients lied about their health. With the applications, which went out to large medical groups who have capitation contracts with the health plan, Blue Cross advised doctors to narc on patients who had any conditions not listed on the applications. This is just the latest in the plan's attempts to aggressively weed out sick patients. Blue Cross has already faced the ire of regulators for issuing policies then canceling them when the patients incur big medical bills.

The Good Doctor, Before His Outrage

The letter and accompanying application "outraged" the California Medical Association, according to president Dr. Richard Frankenstein. He argues that with doctors in the role of police, patients may be afraid to share their whole medical history with doctors, putting their health at risk. The association has sent a letter to state regulators asking them to order Blue Cross to stop asking doctors for patient information. A spokesperson for the state insurance commissioner said that while their office hadn't gotten any complaints about the letter, they consider it "extremely troubling," in that it effectively places doctors in the role of underwriters.”

The Villain of our Tale

Post Script.  A few weeks later, BlueCross of California relented before the outrage of Dr. Frankenstein and his physician minions. Policy changed. Happy ending.

Posted by Shawn Whalen on April 1, 2008 at 6:06 AM
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PHR Privacy?

As summer rolls around so will the general availability of Google Health and Microsoft HealthVualt’s Personal Heath Records (PHR). These major players, plus the offerings from WebMD, Revolution Health, ActiveHealth Management and a dozen other PHR players raises the question of privacy and HIPAA.

These third-party PHR technology vendors are not covered healthcare entities according to HIPAA. Hospital and managed care associated PHRs do fall under the HIPAA privacy and security mandates.

As most readers of this blog know, HIPAA provides strict standards that classify medical information as a privileged communication between a doctor and patient. If the medical records aren't protected by HIPAA, the information could be used for marketing purposes.

In most cases, each health profile, including medical history, prescriptions and allergies, will be password protected. Vendors will likely have their own privacy policies which could match HIPAA laws, however they are just policies and not laws. 

Smart PHR vendors will go the extra mile to assure customers that their data is private and secure. This issue should be proactively addressed by PHR vendor PR people.
 

Posted by Shawn Whalen on March 26, 2008 at 11:44 AM
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A European Perspective

Research and consulting firm Health Industry Insights (HII) released its 2008 Western European Top 10 Predictions. According to HII analysts Jan Duffy and Silvia Piai, European healthcare providers are facing an "inconvenient truth": the traditional healthcare service delivery model — based on big box hospitals set up to deal with acute episodes, doctors as the only owners of clinical information, and little attention dedicated to wellness and prevention — is no longer sustainable. New patterns of demand, resource constraints, and glitches in the quality of service have brought this model to the point of no return. Health Industry Insights foresees common patterns of transformation of both the service delivery model and information technology modernization in Western Europe.

For their predictions for 10 key changes taking place in 2008, please click the "Continue Reading" link.

Continue reading "A European Perspective" »

Posted by Shawn Whalen on March 18, 2008 at 9:05 AM
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EMR Blues

I thought it progressive of Blue Cross Blue Shield of Massachusetts to give out $50 million in grants a few years ago to medical practices to adopt EMRs. So it was interesting to see BCBSMA suggest that the financial ROI wasn’t worth the cost to doctors in medical practices.

Citing studies including an AMA report saying docs get only 11 cents of every dollar saved through the use of an EMR, BCBSMA decided not to require physicians to install an EMR to participate in its bonus program. They still however offer financial incentives to medical groups to adopt EMRs.

BCBSMA’s own cost-benefit analysis showed that CPOE made financial sense in the hospital setting. So they will require health systems to install CPOE by 2012 to participate in the bonus program.

The BCBSMA news came after a local study by the New England Healthcare Institute. It found that that CPOEs could help prevent 55,000 medication errors in MA and provide an annual cost savings of $170 million, or $2.7 million per hospital.  No surprise there, given medication errors are one of the more easily addressed problems with IT.

BCBSMA estimates it would take five to six years for an EMR to recoup its cost in an office-based practice. AMA policy supports EMRs but does not support requiring physicians to purchase them.

While I think the financial ROI aspect of EMRs is important, especially if you’re the doc paying for the system, there are other quality, safety and pay-for-performance benefits that should be considered. Understandably however, the small and medium sized medical practice has a tough time swallowing the cost of the typical EMR.

Industry is responding with cheaper, simpler, hosted solutions. Insurers continue to support and provide financial assistance.  Changes in the Stark Law are allowing hospitals to provide free or discounted systems to their network practices. And perhaps government will start providing tax incentives.

Massachusetts may pass legislation that would provide $175 million in grants to physicians to adopt EMRs.  This may change MA insurers perspective on EMRs and bonuses.

Posted by Shawn Whalen on March 10, 2008 at 10:17 AM
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Transparent Motives

Payers and Healthcare Transparency

In a survey of U.S. payer organizations, research firm Health Industry Insights found that more than half of respondents plan to make significant investments in transparency initiatives in 2008. According to Health Industry Insights, key payor initiatives include investments in creating electronic access to information; improving data and information processes; consolidating duplicative, redundant, or disconnected data sets to produce accurate, reliable data sources; adopting standards; and moving toward common formats.

For key survey findings on online claim payment and adjudication, cost and quality information and payor investment trends in 2008, please click on the "Continue Reading" link below.
 

Continue reading "Transparent Motives" »

Posted by Shawn Whalen on March 3, 2008 at 12:16 PM
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Report from HIMSS

Another year, another HIMSS.  Florida was a nice break from the cold of Massachusetts. We had about 10 clients at the show, fielding a combined 100 media interviews.  Plenty of others whose job it is to analyze have covered the show, such as Healthcare IT News.  So I’ll just share some photos.
 

Sniffing out prospects. Attendance seemed lighter than last year, though HIMSS claims otherwise.
 

Klaatu barada nikto. The aliens have landed, and they come bearing interoperability.
 

This doc looks smart enough to buy an EMR.
 

Hyland not only had the most popular booth - a sports pub serving beer - but also a novel marketing idea using baseball cards.
 

Vroom, vroom. Driver decision support and PHR come standard.
 

The GE Kingdom. Will they follow Cerner and not return next year?
 

These sleek filing cabinets hold up to 200 patient records per drawer ;)
 

Organic, green, enviro-styling booth, though I can’t recall what they do.
 

R2-D2-EMR. Good for carting around rebel IT secret plans.
 

The wheeling and dealing home base.

Posted by Shawn Whalen on February 27, 2008 at 3:15 PM
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2008 Trends to Watch

Industry analyst firm Health Industry Insights released their 2008 healthcare IT predictions. Business intelligence tops the list.  Their announcement discusses how data integration and interoperability will continue to drive major shifts in IT spending. These initiatives will be sharpened by an industry focus on cost containment, process improvements, and improved patient outcomes. Listed below are key highlights from their provider and payer top ten trends.

U.S. Provider 2008 Top 10 Predictions identifies major trends that will impact the provider IT landscape in 2008. The industry is approaching a critical turning point whereby delivery models and applications are increasingly accessible and easier to use providing much needed data exchange and interoperability. Providers need to examine opportunities to expand EMR investments as this is becoming a key requirement in the inpatient and ambulatory care setting. Health Industry Insights also predicts that providers should keep an eye on Health 2.0 as it is changing the way consumers interact with healthcare information.

U.S. Payer 2008 Top 10 Predictions reflect a volatile and changing business and technology environment, with investment planned in multiple traditional areas and new initiatives, rather than the more single-themed focus of some previous years (e.g., HIPAA, consumerism, the collaborative business model). Business intelligence, prioritized investment on consumer information management and transaction tools, as well as "extra-enterprise" technology investment emerge as overarching themes and areas of the greatest investment in the next 12-18 months. Fragmentation and high technology costs will continue as the U.S. healthcare payer market technology investment encompasses over 50% of the total worldwide healthcare payer IT spend.

Health Industry Insights’ Top 10 predictions across the industry sectors include:

- Business intelligence and related information management are leading categories of technology spending increases in 2008 across all segments
- Outsourcing seen as instrumental as the focus on cost reduction continues to increase
- Drug safety will remain front and center as a primary concern in 2008
- SaaS (software as a service) will spur adoption of EMR's for small providers
- Healthcare/financial services interface and competition will heat up in 2008 as healthcare payers shift costs and payment responsibilities to consumers
- "Extra-enterprise" investments become mainstream as over 40% of healthcare payers report technology investments for use by consumers and providers
- Retail clinics and their technology will proliferate, increasingly disrupting healthcare delivery

"We predict there will be accelerated investment in 2008 in the Business Intelligence segment with spending growing more than 13% over the next 12-18 months," said Scott Lundstrom, vice president of Research, Health Industry Insights. "In addition, the healthcare industry should anticipate more innovative use of Web 2.0 technologies in healthcare by mainstream technology vendors and niche companies over the next 12-24 months."

Posted by Shawn Whalen on January 14, 2008 at 10:32 AM
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Health 2.0 - The Next Big Hype

Health 2.0, likes its older cousin Web 2.0 and uncle Web 3.0, is getting more and more attention. My colleague Bonnie Andersen pointed out the December 11 Modern Healthcare article, in which the magazine describes the three most important principles of what a Health 2.0 company or application is. 
 
The first principle is the software of a Web 2.0 company has to be  Web-based, has to provide a service and that service has to be structured  so that the more people use it, the better it becomes. An example is eBay;  as more and more buyers and sellers participate, the broader the eBay  market becomes, which creates more value to the customer. 
 
The second key principle is "harnessing collective intelligence," which  also is referred to by others as "the wisdom of crowds." To avail  themselves of this wisdom, Web 2.0 developers must create applications that  are dynamic, with user participation designed into the systems, so that  participation itself becomes an integral part of making the underlying  database more valuable. 
 
The third principle, "Data is the next 'Intel inside,'  notes that  specialized data, enhanced through analysis performed by the service  provider as well as by the contributions of service users, becomes the core  asset of a Web 2.0 company. Amazon wish lists, for example, are aggregated  by Amazon and used as buyer's guides.
 
Matthew Holt of the Healthcare Blog and co-founder of the Health 2.0 conference is looser in his definition, placing the qualifying emphasis on whether the service or application promotes the healthcare experience as an "ongoing process" rather than a "series of episodic events.

Another view expressed is that Health 2.0 is centrally concerned with improved outcomes and, in the spirit of consumer-driven care, giving doctors and patients the tools they need to better achieve them.

Whatever the definition, if there is money to be made I'm sure more companies will be making a land grab in the Health 2.0 landscape.  There is still a much hype on the topic. As usual the payors and employer groups will be the driving force. Much of what's bandied about around Health 2.0 is being done by larger players already.

Posted by Shawn Whalen on December 19, 2007 at 4:44 PM
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Paranoia Andy Grove Would Be Proud Of

I was reading about progressive wellness programs last week, and yesterday watching Moore's Sicko again. A thought occurred to me. Personal health coaching as part of wellness programs is in vogue right now. Are health plans tracking compliance to such programs, for the purpose of later denying associated condition claims on the basis that the individual's noncompliance contributed to a pre-existing condition?  I wouldn't put it past them. What do you think?

Posted by Shawn Whalen on November 23, 2007 at 6:06 AM
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A Joking Matter

A few have said my last several posts are getting to be too cynical. How could I ever be that ;) To lighten the mood, perhaps I should offer a monthly doctor joke?

Three Doctors in Heaven

Three doctors are waiting in line to get into the pearly gates.

St. Peter walks out and asks the first one, "What have you done to enter Heaven?"

"I am a pediatrician and have brought thousands of the Lord's babies into the world."

"Good enough to enter the gates," replied St. Peter and in he goes. The same question is asked of the second doctor.

"I am a general practitioner and go to Third World countries three times a year to cure the poor." St. Peter is impressed and allows him through the gates.

The third doctor steps up in line and knowing the question, blurts out, "I am a director of a HMO."

St. Peter meditates on this for a while and then says, "Fine, you can enter Heaven... but only for 2 days."

Okay, nevermind the monthly jokes ;)

Posted by Shawn Whalen on November 5, 2007 at 1:29 PM
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A Joking Matter

A few have said my last several posts are getting to be too cynical. How could I ever be that ;) To lighten the mood, perhaps I should offer a monthly doctor joke?

Three Doctors in Heaven

Three doctors are waiting in line to get into the pearly gates.

St. Peter walks out and asks the first one, "What have you done to enter Heaven?"

"I am a pediatrician and have brought thousands of the Lord's babies into the world."

"Good enough to enter the gates," replied St. Peter and in he goes. The same question is asked of the second doctor.

"I am a general practitioner and go to Third World countries three times a year to cure the poor." St. Peter is impressed and allows him through the gates.

The third doctor steps up in line and knowing the question, blurts out, "I am a director of a HMO."

St. Peter meditates on this for a while and then says, "Fine, you can enter Heaven... but only for 2 days."

Okay, nevermind the monthly jokes ;)

Posted by Shawn Whalen on at 1:29 PM
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Rank Profits?

From PRing doctor-ranking companies Subimo, Best Doctors and HealthShare Technology, I figured it was only a matter of time before MCOs would use transparency altruism to mask ulterior profit motives.  NY Attorney General Andrew Cuomo seems to think so, calling last week on NY health plans to halt doctor ranking programs. He also directed Empire BBCBS to disclose their criteria in doctor rankings.

Information from the press release: In an expanding industry-wide investigation, New York Attorney General Andrew M. Cuomo today issued letters to Empire Blue Cross Blue Shield, Preferred Care, and HIP Health Plan of New York/GHI requesting information on the insurers' doctor ranking programs. The Attorney General also alerted New Yorkers about potentially deceptive programs driven by financial motives and not consumers' best interests.

"Consumers need to be aware that doctor ranking programs as currently designed may steer patients to the cheapest, but not necessarily the best doctors, letting profits trump quality," said Attorney General Andrew Cuomo. "Transparency and accurate information are critical when making health care decisions and should not be clouded by conflicts of interest."

To read on, hit the "Continue Reading" link... In the three separate letters sent today, Attorney General Cuomo said:

Continue reading "Rank Profits?" »

Posted by Shawn Whalen on October 26, 2007 at 4:29 PM
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Outsourcing - What's the Big Deal?

Today's New York Times article on outsourcing by the State Department should be no surprise. Outsourcing, business process outsourcing, smart sourcing - whatever you want to call it, contracting out services is a business mainstay and fundamental. 

Healthcare is no different, though of course few people like to talk about. Privacy concerns abound. The reality is there's not much privacy to begin with and outsourcing will continue to grow.

In healthcare, offshore outsourcing is commonly used for claims processing, customer service, medical transcription and billing services. However, as certain clinical areas experience talent shortages amidst rising demand, healthcare providers are looking for more outsourcing solutions.

According to research firm IDC, nearly $322 million was spent on offshore healthcare services in 2005. They project a 79% increase to $575 million in 2008.

According to public data, among those managed care organizations that do offshore outsourcing are Aetna, BCBS Michigan, BC of N. PA, Cigna, Coventry, Horizon BCBS, Humana, Kaiser Permanente, Regence Group, United Health, WellCare, Wellpoint/Anthem and others.

According to U.S. Government Accountability Office (GAO) reports, 19 percent of Medicare Advantage contractors do offshore data transfers as part of outsourcing. Four percent of Medicare FFS contractors do so, and 2 percent of state Medicaid agency contractor vendors do so.

Posted by Shawn Whalen on October 24, 2007 at 12:01 PM
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Outsourcing - What's the Big Deal?

Today's New York Times article on outsourcing by the State Department should be no surprise. Outsourcing, business process outsourcing, smart sourcing - whatever you want to call it, contracting out services is a business mainstay and fundamental. 

Healthcare is no different, though of course few people like to talk about. Privacy concerns abound. The reality is there's not much privacy to begin with and outsourcing will continue to grow.

In healthcare, offshore outsourcing is commonly used for claims processing, customer service, medical transcription and billing services. However, as certain clinical areas experience talent shortages amidst rising demand, healthcare providers are looking for more outsourcing solutions.

According to research firm IDC, nearly $322 million was spent on offshore healthcare services in 2005. They project a 79% increase to $575 million in 2008.

According to public data, among those managed care organizations that do offshore outsourcing are Aetna, BCBS Michigan, BC of N. PA, Cigna, Coventry, Horizon BCBS, Humana, Kaiser Permanente, Regence Group, United Health, WellCare, Wellpoint/Anthem and others.

According to U.S. Government Accountability Office (GAO) reports, 19 percent of Medicare Advantage contractors do offshore data transfers as part of outsourcing. Four percent of Medicare FFS contractors do so, and 2 percent of state Medicaid agency contractor vendors do so.

Posted by Shawn Whalen on at 12:01 PM
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Newt on Hilary

Speaking of politicians, Newt Gingrich has been making some noise again. I thought his David Merritt-ghosted Oct. 15 National Review Online article (link) on Hilary Clinton healthcare proposals somewhat interesting. The disgraced former Speaker for the House, the only Speaker to ever be fined for ethical misconduct, runs the for-profit pseudo-think tank Center for Health Transformation. I'm not going to rehash the many criticisms media such as the Associated Press and blogs have heaped on his corporate sponsor pay-for-play issue support scheme.

Posted by Shawn Whalen on October 21, 2007 at 10:52 AM
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Newt on Hilary

Speaking of politicians, Newt Gingrich has been making some noise again. I thought his David Merritt-ghosted Oct. 15 National Review Online article (link) on Hilary Clinton healthcare proposals somewhat interesting. The disgraced former Speaker for the House, the only Speaker to ever be fined for ethical misconduct, runs the for-profit pseudo-think tank Center for Health Transformation. I'm not going to rehash the many criticisms media such as the Associated Press and blogs have heaped on his corporate sponsor pay-for-play issue support scheme.

Posted by Shawn Whalen on at 10:52 AM
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A Smart PHR Vision

Continuing the discussion of PHRs started on Aug. 28, this week brings a guest blog post from Dr. Lonny Reisman, CEO of client ActiveHealth Management. Dr. Reisman explores what to look for in a PHR solution.

Fulfilling the PHR Vision: Analytical Interactivity Empowering the Consumer

In today's fragmented healthcare system, patient data is scattered among physicians, hospitals, lab companies and pharmacies. This can lead to medical errors, adverse patient outcomes, costly hospitalizations and disabilities. Efforts are now underway by leading health plans and employers to aggregate patient information into personal health records (PHRs). This aggregation of data into a patient-centered and patient-controlled record can empower consumers of healthcare and enhance care optimization among physicians, other caregivers and patients.

PHRs can help enable the consumer-driven health movement, and support President Bush's federal priority to provide Americans with electronic health records by 2014. They are a centerpiece for public and private sector initiatives for healthcare IT connectivity to improve care, reduce medical errors and lower costs. PHRs also offer an opportunity to tailor information to the unique needs of the individual and support patients as they play an increasing role in managing their health.

The Model for an Ideal PHR: Analytical Interactivity is the Key

Continue reading "A Smart PHR Vision" »

Posted by Shawn Whalen on September 17, 2007 at 10:27 AM
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UnitedHealth Settles - The .005% Fine

UnitedHealth Group, the company doctors love to hate, rolled over in the lawsuit brought by 36 states for the insurer's claims processing practices, or lack thereof.

In the settlement, UnitedHealth will be pay $20 million to the 36 states. They will also start a three-year "process improvement" plan of quarterly reports and annual benchmarks to cut down on claims-payment errors, help speed payments and better field complaints. If the process improvement plan requirements aren't met, the managed care giant could pay up to $20 million more in fines.

In 2006, UnitedHealth made $4 billion in profit. I'm sure they'll feel the pain of that $20 million.

Continue reading "UnitedHealth Settles - The .005% Fine" »

Posted by Shawn Whalen on September 10, 2007 at 12:55 PM
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R U PHRed?

Magazines are spilling much ink over Personal Health Records (PHRs), the latest piece of IT that will fix healthcare. I asked my small-practice doctor a few weeks ago what he would do if a patient presented him with a PHR.  Not much, he answered (first I had to explain what it is.)  No insurer would pay him to populate the data and it isn't integrated with his (limited) PPM system.  The patient would be welcome to a copy of his medical records (for an exorbitant "handling & copying" fee) to populate the PHR himself, but good luck making out the doctors handwriting, medical abbreviations and terminology. If one had seen specialists, those seperate records would need to be secured and entered as well.

The PHR hype is in full swing, and it will likely take a decade minimum for a majority of patients to have PHRs.  I doubt most people will even look at their PHR even if they have one, but that's besides the point.  Progressive insurers like Aetna offer members a pre-populated PHR based on claims data.  In the long term, this will help Aetna improve care, reduce errors and lower costs. Follow the money and one will see the adoption path PHRs follow.

As with all technologies, the question of standards is arising with PHRs. AHIP has taken a good first step in creating a standard that is expected to be ready by December of '08. The standard includes data set and portability requirements to take into consideration a person's change in employers and health plans.

Some payors like Medical Mutual of Ohio and  Anthem BCBS have PHRs that align with the AHIP standard. Time will tell how PHRs are accepted by consumers, but for now it's a great story angle for healthcare PR pitching.

Posted by Shawn Whalen on August 28, 2007 at 2:20 PM
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Pay Cuts in Never Never Land

In corporate America, when people make mistakes they or their company pay for it. In the world of healthcare, doctors get paid for their mistakes. Thankfully some of that will be ending, as the Bush Administration is stopping Medicare compensation to hospitals for "reasonably preventable" and "never events."

The former includes patient falls, pressure ulcers, UTIs, catheter infections and other conditions. The latter, or "never events," are for objects left in the body during surgery, blood incompatibility, air embolisms and other believe-or-not medical stupidities.  Score one for pay-for-performance.

Posted by Shawn Whalen on August 24, 2007 at 1:26 PM
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A Tip for HCIT Marketers

Part 11 in a Continuing Series on PR Strategy and Tactics

Forrester Research is offering a free trial membership on their Web site (http://web2.forrester.com/forr/reg/loginreg.jsp ).  The service offers access to free research alerts and other valuable nuggets that can help in marketing and PR campaigns.  Analyst Liz Boehm writes in a "First Look Alert" about healthcare consumerism, to see hit the "Continue Reading" link...

Continue reading "A Tip for HCIT Marketers" »

Posted by Shawn Whalen on August 10, 2007 at 12:08 PM
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Too Little Too Late?

A Commonwealth Fund report says that congressional proposals to boost health information technology do not go far enough to make appreciable difference in American health care. The proposals in question include those that died last year as well as the upcoming Wired for Health Care Quality Act of 2007.

The report says none of the health IT bills "would commit the funds and central leadership required to realize the potential benefits of a health information system."  The solution, says the Commonwealth Fund, is more funding that is in line with the country's $3 trillion spend on healthcare.

Posted by Shawn Whalen on July 30, 2007 at 2:01 PM
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Aspiring PR

Decision support vendor Asparity made a smart PR move last month in issuing a survey and reporting the findings that employees who used decision support during the 2007 enrollment season made different -- and more cost-effective -- health care choices that better met their needs than employees who did not use decision support. While there is a certain amount of obvious "duh" factor in this, the breakdown of findings is nonetheless interesting:

Continue reading "Aspiring PR" »

Posted by Shawn Whalen on June 26, 2007 at 11:00 AM
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Where Quality is Nice, But Profit a Must

"It's a healthcare company with car issues," proclaimed TIME Magazine last month in a story about Chrysler. It's no secret that among the top factors hurting the Big Three automakers (and many of the Fortune 1000) is healthcare costs. Its crippling effect has contributed to foreign leadership in many sectors of U.S. commerce. It has also led to many corporate initiatives such as the Leapfrog Group to address the issue.

Healthcare quality and cost concerns are the hot button issues for consumers, business and politicos.  But it's the cost issue that clearly is the problem and motivation.  If we're lucky, better quality will be byproduct of cost savings.

The successful healthcare IT vendors make sure their provider and payor prospects understand how their solutions reduce costs. Sure the press release headlines are about quality - who doesn't want to make patients healthier?

But in the sales environment it's all about cost reduction. Hospitals get systems to increase efficiency and revenue. Medical groups to reduce the number of FTEs and the DAR with payors. The health plans want claims systems to keep as much reimbursement from docs as possible. Companies want employees paying more premium and getting well quickly to reduce absenteeism (read costs).

Is CDH an answer? The consumer directed healthcare panacea shifts risk, responsibility and costs onto consumers who may or may not come out ahead (or healthier, for that matter.)  It is simply too soon to see categorical results on the CDH experiment; some surveys look gloomy (see my previous post on the Towers Perrin survey.)  Tools to educate consumers are few but are increasing. Hospitals and doctors need a sea-change in their perspective on revealing costs. Anemic HSA adoption will grow slowly over the decade. 

But more than any of this in making CDH work is consumers caring enough to begin with. They won't until forced to pay a larger portion of their medical and drug bills.

I certainly don't have the answers, but it seems that unfortunately government will have to step in and run a variation on national healthcare.  Sure, the doubters' lobbyists are legion. They cite pure cost as an excuse - if the issue is important enough to the right people, it can be paid for (like Iraq.)  If skeptics claim such a program can't be logistically run, look at other huge programs such as social security. My uncle gets his social security check like clockwork every month.

Posted by Shawn Whalen on June 19, 2007 at 2:59 PM
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CDHP Self Sabotage?

Like other past experiments in the world of managed care, the much-hyped consumer directed health plan (CDHP) and it many flavors could very well flame out due to lack of interest.  So says Towers Perrin in a recent survey.
 
Not surprisingly, the survey found that employees' views of CDHPs reflect how well their employers explain the plans, rather than the plans' specific features. In 2007, about 25 percent to 30 percent of companies offered employees a CDHP option; 2008 will see half of them offer a CDHP option.

Only 50 percent of those in CDHPs were satisfied with their coverage against the risk of major healthcare costs, versus 65 percent of those in traditional plans. Forty-four percent of those in CDHPs were satisfied that they had access to affordable healthcare, versus 63 percent in traditional plans. Forty-four percent of those in CDHPs felt they could find quality doctors and hospitals, versus 63 percent in traditional health plans.

How should you as a healthcare IT marketer respond?  I would highlight the benefits of your technology to enabling effective and intelligent use of CDHP. Play off the findings, illustrate how you address the perceived weaknesses of CDH. For example, if you are a decision support vendor, can you help educate consumers to the best choice of doctor, hospital or drug?  It will be a team effort on the part of payors, employers, providers and patients to truly make CDH a mainstream reality.

Posted by Shawn Whalen on June 12, 2007 at 11:34 AM
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Our Hidden Health Crisis: Misdiagnosis

Jerome Groopman's widely reviewed book "How Doctors Think" highlights the problem of misdiagnosis in America's healthcare system. Misdiagnosis and incorrect treatment are critical to quality healthcare but are often overlooked, despite misdiagnoses happening almost 20 percent of the time and wrong treatment plans 60 percent.

Is the current emphasis on EMR, transparency, health plan and cost efficiencies to improve quality misplaced? No, but to think these are the big answers to achieving quality misses the point. Healthcare is the right diagnosis, the correct treatment, a condition/illness healed the first time. Consumers want healthcare delivered correctly the first time, not having the system experiment on them.

Quality improvement impacts not just consumers, but also employer group and health plans costs. Three to five percent of cases represent 30-50 percent of healthcare premium costs and increases. Focusing on this critical segment of the medical population can improve healthcare quality while lowering costs for employers and health plans.

Companies like Best Doctors, Isabel Healthcare, ParadigmHealth, Health Dialog, ActiveHealth Management and Quantum Healthcare are addressing the problem from different angles.  Isabel Healthcare offers a diagnosis reminder system for hospitals. In the employer and payor world, Best Doctors' medical intervention service brings medical expertise to bear on individual complex cases. ActiveHealth's automated, evidence-based Care Considerations alert patients and their doctors about medical issues and treatments.

More attention should be put on the issue of misdiagnosis, which is far and away a problem whose solution impacts quality and cost more than any health IT issue.

Posted by Shawn Whalen on May 1, 2007 at 4:24 PM
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One in Three

Administration associated with health care claims and billing accounts for nearly one out of every three dollars that patients spend on health care, according to a PNC Financial Services Group survey of executives from hospitals and insurance companies.

According to their press release, more than three-quarters (76 percent) of the U.S. consumers surveyed said they think that health care administration should account for just 10 percent or less of total health care costs, with a large majority indicating they would be "highly upset" if those administrative costs were as high as 30 percent.

Additional survey results include:

- Hospital executives reported that one in five claims submitted, on average, is delayed or denied and 96 percent of all claims must be submitted more than once.
- Hospitals that do not use electronic billing or claims submission processes reported, on average, resubmitting a claim 11 times or more, or nearly four times more than those hospitals using electronic processes.
- Insurance executives surveyed said they go back to hospitals two times, on average, to get all the information needed to pay a claim.
-  Nearly a quarter of consumers reported having had a legitimate claim denied by their health plan; one in five ultimately paid the claim out of their own pocket.
- When asked how much could be saved annually if they had a more efficient claims, billing and payment process, one-third of hospital and health plan executives both said their organizations could save at least $1 million a year.
- The benefit of automated processes most often cited by insurance executives was that claims processing time significantly reduced, and 63 percent said that customer satisfaction had improved.
- When asked where the cost savings would be applied, the area most often cited by hospital executives was "reinvested in improving patient care."

Posted by Shawn Whalen on March 26, 2007 at 3:39 PM
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EMR Grumbles

I heard some interesting grumbles at HIMSS from doctors about the evolving pressures of EMR adoption. Acute care vendors see small medical group practices as a major market opportunity. Spurred on by Stark law reform, the vendor big boys are forcing acute care systems onto small practices. They are tapping their hospital CIOs to distribute their EMR solutions to the associated medical practices. Docs often have to choose to adopt hospital-recommended systems or deploy and pay more for their own. If they go with the hospital choice, their data may be owned or co-opted by hospital.

Some docs feel their EMR choices are being narrowed by third parties, be they payors, RHIOs, CCHIT or hospitals each of whom have their own preferences. Certain states are funding initiatives to deploy EMRs to small practices, using a self selected list tied to CCHITT. All these pressures and continued market consolidation may put the more economic or specialty EMR developers out of business.  Then again, new services like the free Google EMR and V.A.'s Vista will continue to make the EMR market interesting to watch.

Posted by Shawn Whalen on March 19, 2007 at 2:58 PM
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Follow the Money

Managed care and big business continue to step up to the plate in driving IT adoption to improve healthcare quality and lower costs.   This is natural since doctors certainly can't be relied upon to do, and payors and employers feel the economic pinch most.  Payors are granting technology to providers to improve revenue management. Pay-for-performance will force adoption by doctors interested in avoiding salary cuts. 

Examples: Aetna is making PHRs powered by ActiveHealth Management available to their 15 million members (Dr. Mike Magee writes on the benefits and risk of this in his Health Politics blog.)  Locally here in Massachusetts, the Blue Cross Blue Shield Foundation awarded $50 million to almost 100 small and medium sized medical practices for EMRs. Stark Law reform will help accelerate these efforts.

Business interests continue to come together to encourage reform. This month tw