Healthcare Transparency

FUD Factors

An Envision Solutions/Kelton Research survey found that 85.6 million U.S. adults, or 38 percent of the population, have doubted the opinion of their doctors or other medical professionals when it conflicts with information found online. Forty three percent of consumers ages 18 to 34 reported they doubted their health provider's advice when it conflicted with online sources.  

Only 3 percent of Americans seeking advice about how to manage a serious medical condition would view patient developed online health information as trustworthy. I’m sure this perspective would change if a consumer was faced with a serious disease or condition, hence the popularity of sites like PatientsLikeMe.com.

Few consumers listed the government, the media or non-profits as credible healthcare information sources. The survey shows that a majority of Americans still view health providers as their most trusted source of medical information overall.

Posted by Shawn Whalen on October 3, 2008 at 11:21 AM
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PHR Thoughts

While it may take a decade for widespread adoption of PHRs, it will definitely happen. It is another medium for communicating your medical condition to a doctor, which today is done verbally. Data supplied into the PHR by health plans, or the doctors via EMR interchange, will be more accurate as patients memory – selective or otherwise – isn’t often reliable.

What will help doctors is a high degree of interoperability between the PHR and the EMR, otherwise it’s still easier to take down a patient’s information verbally. When the Certification Commission for Healthcare Information Technology (CCHIT) starts certifying PHRs this will hopefully be addressed.

Other obstacles that will be overcome with time is general technology acceptance by doctors. The old guard's resistence will be replaced by younger doctors who are more comfortable and trusting of technology. Ubiquity of PHRs via Microsoft, Google, health plans and hospitals will move PHRs from “nice to have” to “must have."

This presents PHR vendor PR folks with opportunities to highlight how their solutions are making adoption easier, helping facilitate the vision of universal PHRs.

Posted by Shawn Whalen on September 16, 2008 at 11:03 AM
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PHR Factoids

A recent Markle Foundation survey found that regardless of their interest in using an online PHR service, 79 percent or more of the public believe using an online PHR would provide benefits to individuals in managing their health. Fifty six percent cited worries about privacy and confidentiality as a reason for their reluctance.

Only 2.7 percent of adults have an electronic PHR today (representing about 6.1 million persons). Most (57.3 percent) do not keep any form of personal health records, and 40 percent keep some paper health records.

What you can do: If you're a PHR vendor PR person, utilize the survey findings to support your solution. Use the statistics in press releases or collateral to help make your case. Highlight the privacy and security safeguards that your product takes, given that privacy is a major obstacle to PHR acceptance.

Posted by Shawn Whalen on September 2, 2008 at 6:39 PM
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Cloudy Outlook for PHRs?

According to market research firm Gartner, government ITexecutives should investigate the impact of personal health records (PHRs) and health information exchange programs.

PHRs, such as Google Health, Microsoft HealthVault and ActivePHR from ActiveHealth Management, are free and controlled by the consumer and could achieve a high degree of interoperability with clinical systems operated by healthcare providers and other third parties, says Gartner. Microsoft recently announced a pilot project with Kaiser Permanente to enable data transfers between consumers' medical records and Microsoft's HealthVault online health site.

Gartner says these publicly available applications are built on important characteristics of cloud computing - they are enormously scalable resources that offer services directly to end users and to other IT products through an application program interface (API). Gartner reports they have the potential to achieve several important benefits:

Continue reading "Cloudy Outlook for PHRs?" »

Posted by Shawn Whalen on August 20, 2008 at 2:31 PM
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Dialing Health

There has been much hoopla over the new iPhone 3G.  As we all know, healthcare is one of the most popular topics among consumers, and new iPhone enables consumers to access many new healthcare applications. One of the more interesting ones is the A.D.A.M. Symptom Navigator.

The Symptom Navigator, which is free, matches medical symptoms with relevant assessments and appropriate treatments. Consumers are presented with an image of the human body and they click on the affected area of the body to receive a menu of related symptoms. After selecting a symptom, the user is walked through the possible causes, home care, when to consult your doctor, and what to expect from your doctor.

Healthcare IT PR pros with applications for the iPhone should consider promoting them to the media in trend stories on healthcare apps. When you have referenceable doctor or consumer customers for the app, consider case study pitching.

 

Posted by Shawn Whalen on July 15, 2008 at 12:59 PM
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Quit Your Whining

Kudos to the North Carolina Medical Board for wanting to post doctors' malpractice information on its Web site. And thumbs down on the state’s physician association for opposing it, claiming it could be misleading.

The Better Business Bureau has long served a role in helping consumers make decisions about what vendors they should use. The public is intelligent enough to understand the context and weight for individual plans.  Egotistical doctors don’t think so however.

Actual malpractice payment amounts or patient names aren’t disclosed, according to the article in the Raleigh News & Observer. The Web site would note that malpractice payments don't always suggest negligence, and that some specialties draw more lawsuits.  North Carolina says that about four percent of the state’s doctors are on the malpractice list.

Doctors need to face the inevitable tide of quality and cost transparency. They are vendors like everyone else. North Carolina is the 23rd state to disclose medical practice information.

Continue reading "Quit Your Whining" »

Posted by Shawn Whalen on July 2, 2008 at 10:43 AM
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Plans and Progress

Last week at a conference I heard doc Kolodner, head of the Office of the National Coordinator for Health Information Technology (his business card is extra long), talk all about the federal government’s health IT five-year strategic plan for 2008-2012. Kolodner was refreshingly frank about the level of progress given government bureaucracies, but at the same time optimistic.

The plan lays out a road map and milestones in more than 40 areas, including interoperability, security, privacy and IT adoption.  In this last area, the government would like to see PHRs linked to EMRs by 2010.  The full strategic plan is available here.

PR pros should review the plan to see what aspects are applicable to your products and services. Then position yourself with media as helping with the government's efforts by offering solutions today to enable the healthcare future of tomorrow.  Media who write about HHS and government health IT efforts would be good to target.

For those interested in looking back over the last four years since the Office was founded, please hit the “continue to read” link below.

•    2004: Laying the Foundation
•    2005: Initial Steps and Progress
•    2006: Major Accomplishments
•    2007/8: Major Accomplishments/Next Steps

Continue reading "Plans and Progress" »

Posted by Shawn Whalen on June 11, 2008 at 3:15 PM
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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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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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Medical Record Paparazzi

Ahnald is angry and calling for tighter medical record security after his records, his wife’s and those of 32 other celebrities were breached.  The ex-Terminator told the Los Angeles Times that he’s been a victim of unauthorized snooping following heart, hip and shoulder operations.

Is that any surprise? I’m sure it happens all the time, whether it be medical, police or other public institution records. It’s politically convenient to raise the issue as part of a broader healthcare platform.

The former Conan the Barbarian said that every time he left the operating room he was told that people were going through his file. They had white coats on and snuck into the hospital, "They had nothing to do with the hospital staff at all," he told the Times.

California's health department said the agency would sanction the UCLA Medical Center after confirmation that improper hospital workers had accessed medical records of more than 60 patients.  In the past, a handful of UCLA employees were fired after an audit showed patients medical records had been violated. 

Posted by Shawn Whalen on April 11, 2008 at 1:55 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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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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Social Media - Get A Life

There has been much ado about the social media, the FaceSpaces and MyBooks and YouLifes and SecondTubes. I think it's a bunch of hype largely irrelevant to the intended HCIT vendor readership of this blog, who are selling to hospitals, medical groups and managed care organizations. All of these markets are well-known IT laggards who wouldn't know what was wrong with the first sentence of this post.

If you're selling to consumers under 30 it may be a different story. Or if you're in the insular and me-too world of high school, college or high tech. Even in those cases, it's still a lot media-driven hype. Most people are busy enough with real life and real friends.

It will take a complete generation for a majority of folks to care about or participate in social media, which by then will be very different. Very few of my peers here at Schwartz have Facebook pages (plenty of interns do, and about a quarter of the twentysomethings.) In the media, some reporters do if their beat happens to include technology and the Internet.

This perspective on social media shouldn't be confused with the Health 2.0 trend. As discussed in an earlier post, this is a new set of companies targeting consumers and as such their use of social media is expected and required. Indeed, many of these companies are social media in and of themselves. One client example is icyou.com, called the "YouTube of healthcare" by the San Francisco Chronicle.

But I'm a PR guy and the question comes up about how healthcare IT marketers can capitalize on this latest trend. So this week brings a guest blog post about Facebook by colleague Mark McClennan.

Continue reading "Social Media - Get A Life" »

Posted by Shawn Whalen on February 1, 2008 at 11:06 AM
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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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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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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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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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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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Defining Quality Healthcare

My May 1 post, "Our Hidden Health Crisis: Misdiagnosis" was well received. The healthcare quality issue continues to be confusing, as providers, payors and consumers grapple with how to judge quality.  The core of healthcare quality is correct diagnosis and treatment, period.  Here is a client guest blog post by Best Doctors' President Evan Falchuk on the subject. 

"Quality" Healthcare:  What Does it Really Mean?

By Evan Falchuk, Esq.

Three years ago, the Rand Corporation's The First National Report Card on Quality of Health Care in America reported that patients in the United States have a 50% chance of getting the right care.  The media jumped on the story, calling it "coin-toss medicine," and it helped spark a national quality improvement movement.    

Quality continues to be a hot buzzword in healthcare. But, until recently, the industry has not looked at the issue of getting the right diagnosis and treatment as the fundamental quality metric. A recent report by the consulting firm Hewitt (The Road Ahead: Emerging Health Trends 2007) shows that this may soon change.  Employers are beginning to target the root of the issue and are looking for solutions that influence the interactions between providers and their patients.

This focus on quality at the point of care is long overdue. Patients and their physicians need solutions that help them work together to get the right diagnosis and treatment.

The "Fog of Care"

It is a story familiar to anyone who has been or knows someone who has been seriously ill.  The patient has doubts about her diagnosis and treatment, but finds it hard to get good answers.  She never feels she has enough time with her doctors.  And when she goes on-line to fill in the gaps, she finds as many new questions as she does answers.  What may be surprising is that doctors report the same frustrations and uncertainties.  It's really what could be called the "fog of care," and its representative of a healthcare system that doesn't work.

Continue reading "Defining Quality Healthcare" »

Posted by Shawn Whalen on July 11, 2007 at 3:26 PM
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I Love You, I Hate You

Showing some fancy footwork in the political dance, Secretary of Health and Human Services Michael Leavitt praises and warns Senator Edward Kennedy about his pending health IT legislation in a long five page letter on June 26.   It captures in fascinatingly boring detail the bureaucratic challenges facing health IT adoption.  The full repartee can be read here.

Posted by Shawn Whalen on July 6, 2007 at 10:56 AM
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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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Live From HIMSS!

One of a Kind: Forget the dozen+ clients we had exhibiting ;)  Here’s a HIMSS first, a healthcare PR agency taking space.

I Want My GWN-TV:  One of the more interesting technologies was from GetWellNetwork, an interactive patient care solution putting education and entertainment resources at the patient bedside.

FierceParty:  One of the many parties was healthcare e-zine FierceHealthcareIT’s party at Utopia on Bourbon Street.

Mr. Roboto:  Yours truly with a cousin of Robbie, visiting from the future. It says in 2099 EMR adoption is 40%. See, we will make progress! 

Posted by on March 1, 2007 at 1:51 PM
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Lies, Damned Lies, and Statistics

Though Twain had his doubts, marketers love statistics. So to help out healthcare IT marketers here are some stats from the Census Bureau, CMS and analysts.

The U.S. spent $2 trillion on healthcare, or $6,697 a person, in 2005.

Healthcare costs account for one-sixth of the economy, compared with one-tenth in the early 1980s.

In 2006, 61% of businesses offered health benefits to at least some employees, down from 69% in 2000.

Young adults are the most likely to be uninsured. Those between the ages of 18 and 34 account for 25% of the population, but 41% of those without insurance. Texas has the largest percentage of uninsured citizens (24.6%), followed by New Mexico and Florida. Can you say que?

According to Forrester Research, CDH enrollment will reach 12 million, or seven percent of the commercially insured market, in 2007.

Up to 98,000 Americans die each year from preventable medical mistakes they experience during hospitalization, according to the Institute of Medicine.                                                                          

Mistakes in healthcare are costly.  A wound infection costs $21,000 on average. A post-operative infection costs more than $25,000 and re-opening a surgical site will cost more than $36,000.  The Juran Institute and Midwest Business Group recently quantified the direct costs of health benefits for poor-quality care over $1,300 per employee per year with indirect costs of lost productivity from poor care at another $500 per employee per year. 

Posted by Shawn Whalen on January 12, 2007 at 5:39 PM
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Crystal Ball

Analyst firm Health Industry Insights/IDC is holding its "Top Ten Predictions for the Health Industry in 2007"  Webinar on January 10, 2007, 12:00-1:00 pm EST. Here is the link to register:

http://www.idc.com/getdoc.jsp?containerId=IDC_P14515

Posted by Shawn Whalen on January 4, 2007 at 2:58 PM
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2007 Healthcare Predictions

It's the time of year when consultants and industry analysts make their 2007 predictions on healthcare.

PricewaterhouseCoopers releases their own, calling 2007 a watershed for the health industries as health savings accounts reach a tipping point, states act where the federal government hasn't and pressure on pricing amid demand for transparency forces pharmaceutical companies, hospitals and health plans to rethink their strategies.

PricewaterhouseCoopers' top seven trends:

1. States Take the Initiative:  In the presence of federal gridlock, states are taking the lead on divisive issues such as stem cell research, health insurance coverage for the uninsured and oversight of advertising and promotion by pharmaceutical companies.  Responding to local social and fiscal concerns, states are developing innovative insurance programs, forming public-private partnerships to spur innovation and passing legislation to drive greater accountability and transparency from hospitals, physicians and pharmaceutical manufacturers.  According to PwC, such state-led initiatives will likely expand in 2007, but the risk is a patchwork quilt of local programs and regulations.

2. Transparency Could be Revealing:   The demand for transparency around pricing, quality measures, safety standards and community benefit is being driven by and is supportive of consumer-directed healthcare and pay-for-performance.  In 2007, the health industries will focus on becoming more transparent, but government, insurers and employers need to educate consumers about the availability and use of such information.  Providers will need to dedicate more resources to reporting, a strategic issue that can no longer be delegated down in the organization.

For the other five predictions follow the link...

Continue reading "2007 Healthcare Predictions" »

Posted by Shawn Whalen on November 30, 2006 at 5:34 PM
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PHR Event

In December a panel of local experts will discuss personal health records at an event held by the Massachusetts Technology Leadership Council. More information and a registration link follows.

Friday, December 15, 2006
7:30 am registration; 8:00 am panel; 10:00 am networking
UK Trade & Investment, One Memorial Drive, Cambridge, MA
The Personal Health Record (PHR) is central to consumer centric healthcare. The promise that PHRs offer is to provide the information patients need to understand their health history and clinicians need to make effective treatment recommendations while fostering informed conversations between patients and clinicians. The opportunity is so compelling that we are seeing an explosion of PHRs becoming available to health consumers, whether they are from health content providers like webMD, PHR providers like ActiveHealth Management, providers or payors such as Aetna. The reality is that since health information comes from all of these sources including patients, their providers, and payers, the development of effective PHRs will require close collaboration between health content, technology and health care delivery professionals.

A panel of experts will look at how PHRs can enable a user-friendly experience in healthcare. Also they will explore the technology and infrastructure needed to capture accurate information, integrate it with medical records, and/or claims data, and make it easy to access and use. Join us as we explore issues that arise regarding how the data sources can be integrated (potentially through Regional Health Information Organizations - RHIOs), who controls the information in the PHR and how it all will be secured.

Featuring:

• Dr. Jeremy Nobel, MD, Harvard School of Public Health,
• Stanley Chin, Director, Practice Development, Altarum Institute,
• Dr. David Cochran, MD, Senior VP of Strategic Development at Harvard Pilgrim Health Care,
• Rose Higgins, President, iMetrikus, Inc.,
• Delia Vetter, Director of Benefits, EMC Corporation,
• Dr. Jon Wald, MD, Corporate Manager, Partners

Register Now:
http://function.masstlc.org/programs_new/event_single.cfm?eventid=744

Posted by Shawn Whalen on November 12, 2006 at 3:06 PM
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Oh You Mean That Interoperability

For all the hoopla electronic health record system certification via CCHIT (Certification Commission for Healthcare IT) received, it was surprising to hear Health and Human Services (HHS) head and CCHIT Chair Mark Leavitt describe the interoperability criteria as weak. Apparently the only 2006 interoperability requirement necessary is the ability to electronically receive laboratory test results.

That makes one wonder how poor the grades of the 17 vendors who flunked the recent round of tests were.  CCHIT withheld those names (to protect the innocence of their customers?)

In 2007, the requirement will expand to electronic prescription transmission. Eventually CCHIT will move vendors up to a more comprehensive interoperability requirement.

For a list of the latest 11 vendors to pass CCHIT, read it here:

Continue reading "Oh You Mean That Interoperability" »

Posted by Shawn Whalen on November 8, 2006 at 2:01 PM
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Profitceuticals

While public and private interest groups wring their hands about the ever-increasing cost of drugs, one drug list publisher quietly wields monumental impact on pricing.  First DataBank, a unit of Hearst Corp., publishes a benchmark list of pharmaceutical prices that health plans and state Medicaid programs use as a guide.

As reported in the Wall Street Journal on Oct. 6, First DataBank reached a legal settlement in a case of price gouging. Implicated was McKesson, who is the only company that First DataBank "surveys" to arrive at price averages. As a result of the settlement, prices on many of the most common drugs will be lowered.

This is an egregious example of unmonitored pricing, one which when addressed does more to help alleviate pricing than all the excuses of pharma executives.

Posted by Shawn Whalen on October 8, 2006 at 4:34 PM
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Bridging CDH Islands

This week I wanted to share an interesting column on consumer directed healthcare. Benefitfocus CEO Shawn Jenkins wrote in Health-IT World an insightful piece on overcoming the data challenges to make CDH a reality.

Integration: The Key to Bridging CDH Islands
By Shawn Jenkins

Consumerism is the biggest trend in healthcare in 30 years, as the combined forces of federal and state government, the private sector, and consumer advocacy groups call for greater healthcare transparency and cost control. CDH [spell out – does it stand for consumer-directed health?] plans offer patients more flexibility in selecting doctors; large networks; and financial control over their healthcare. For employers, CDH plans reduce premium rates and annual cost increases but are complex to design and administer.

But what will it take to make CDH a reality?

Consider this vision of an integrated CDH portal: An expectant mother, uncertain and nervous of her many health options, uses a CDH portal to obtain the best information to make choices. An integrated portal should show which insurance plan is best for her family's care, the best local labor and delivery hospitals, compare nearby pediatricians, and offer immediate advice on financial planning and spending. Her employer, health plan, and doctor communicate electronically, thereby improving care while reducing costs.

Continue reading "Bridging CDH Islands" »

Posted by Shawn Whalen on October 5, 2006 at 2:53 PM
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An Unsustainable Path

While Senate Finance Committee testimony usually isn't the most riveting reading, Dr. John C. Goodman's warnings about heatlhcare spending, health savings accounts (HSAs) and consumer directed healthcare (CDH) were interesting.

Testimony before the Senate Finance Committee; Subcommittee on Health Care

Dr. John C. Goodman, president of the National Center for Policy Analysis 

September 26, 2006  

An Unsustainable Path

Government at all levels in the United States currently spends about 7.2 percent of gross domestic product (GDP) on health care, mainly on Medicare and Medicaid.  Yet Christian Hagist and Laurence J. Kotlikoff have shown that if benefits expand at the rate of the past 30 years and if the population ages the way demographers predict, government health care spending will equal one-third of national income by mid-century, when today's college students reach the retirement age.[1]  If that is not immediately alarming, note that one-third of GDP is about equal to all government spending for all purposes today.  If private spending on health care keeps up with public spending, the nation will devote about two-thirds of national income to health care by mid-century - an amount roughly equal to the total consumption of all goods and services today. 

So in the public sphere, health care is on a course to crowd out every other government program - from education and roads and bridges to Social Security and national defense.  And for the economy as a whole, health care is on a course to crowd out every other form of consumption, including food, clothing, housing, etc. 

Clearly we are on an impossible path.  And the longer we stay on it, the more painful it will be to get off of it.  Yet it is impossible to get off of it unless someone is forced to choose between health care and other uses of money.  The question is:  who will that someone be? 

Continue reading "An Unsustainable Path" »

Posted by Shawn Whalen on September 26, 2006 at 5:37 PM
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Doctor, Doctor Give Me Some News

VHA’s Dr. Robert Kolodner, developer of the VA’s EMR system, has been tapped to replace Dr. David Brailer to head the Office of the National Coordinator for Health IT (ONCHIT).  Brailer resigned in April. Kolodner will likely last through the change in Presidential administration. 

Kolodner brings considerable healthcare IT experience to the post given his role in developing the VA’s Decentralized Hospital Computer Program, which preceded the EMR system which is technically the nation’s largest integrated health system (though many EMR vendors call it antiquated at this point.)

Said Health and Human Services Secretary Mike Leavitt in  statement: ““Kolodner joins us at a time when we are making steady progress in advancing the president’s health IT initiative, and his experience in patient care, health IT, and government will be invaluable to those efforts.”

I think it’s about time a replacement was found for Brailer, even if “interim” (technically Kolodner is on loan from the VA).  It shouldn’t be too surprising though, given the position has been one of big hat, no cattle since Bush’s paltry funding of the office. Perhaps the new administration will bolster the priority in ‘08, but likely not. The private sector will continue to inch along in the various RHIO experiments and eventually form an NHIN, but I think it will be a decade past Bush’s desired date.

For Dr. Kolodner’s full bio, follow the link.

Continue reading "Doctor, Doctor Give Me Some News" »

Posted by Shawn Whalen on September 21, 2006 at 8:00 AM
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Connecting Communities

Though surveys sponsored by IT vendors are sometimes suspect in the media’s eyes, a McKesson-sponsored Harris Interactive poll made an interesting point in hospitals being a driver of EMR adoption among medical practices.  In a survey of primary care physicians and specialists, more than seven in 10 respondents who plan to implement EHRs said they would be receptive to working with a local hospital to leverage its IT infrastructure and buying power. Given hospitals have been investing more and longer in technology, local physicians in medical groups would take advantage of such resources for connections among providers, insurers and patients.

The survey showed that three-quarters of the nation's physicians plan to adopt EHRs for their practices, with 91% planning to do so within three years. Eighty percent of respondents ranked "coordination of care across care settings" as the No. 1 benefit of an EHR, while 52% indicated that the system will save their practice money in the long run.

According to McKesson, the EHR survey was conducted in June, 2006. The goal was to explore physician attitudes toward working with local hospitals to deploy EHRs in support of a goal set by President Bush for the majority of Americans to have EHRs by 2014. The findings in the survey coincide with ongoing efforts to convert the nation's paper health records into digital format as a way to improve patient safety and curb skyrocketing healthcare costs.

The government recently took two major steps to accelerate EHR adoption. First, the Certification Commission for Healthcare Information Technology (CCHIT) established an industry-wide benchmark for EHR-certified products. Second, final regulations issued last month by the Department of Health and Human Services for e-prescribing and EHRs set the stage for greater collaboration between hospitals and physicians by allowing for the donation of e-prescribing and EHR technology.

Posted by Shawn Whalen on September 19, 2006 at 10:22 AM
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Docs Like Bush

As reported in AISHealth.com, Aug. 24, continuing his support for the adoption of nationwide health IT, President Bush on Aug. 22 signed an executive order requiring federal agencies that administer or sponsor health programs to adopt and use interoperable health IT standards and quality-improvement measures.

The order states, "As each agency implements, acquires, or upgrades health information technology [HIT] systems used for the direct exchange of health information between agencies and with non-federal entities, it shall utilize, where available, [HIT] systems and products that meet recognized interoperability standards."

According to the order, which becomes effective next Jan. 1, HHS, the Department of Defense, the Department of Veterans Affairs and the Office of Personnel Management, which oversees the Federal Employees Health Benefits Program all must comply with the order. In a conference call Aug. 22 with health care industry executives, HHS Sec. Mike Leavitt said organizations that contract with those federal agencies — such as private health plans that participate in Medicare — would also be required to adopt the same standards outlined in the order.

In response to Bush's executive order, e-Health Initiative CEO Janet Marchibroda said, "The ongoing support and keen insight demonstrated by President Bush...on the issues at the intersection of health care quality and information technology are critical to move forward and to make both better patient care and interoperability a reality."  

"These orders won't have much effect at all," Stephen Davidson, professor of health care management and management policy at Boston University's School of Management, told Information Week. According to the magazine, Davidson said, "The missing link is that not many doctors have systems that talk to each other....and even if the software works in the way it's supposed to work, the benefits of those systems go to the payers and the patients."

Posted by Shawn Whalen on August 26, 2006 at 1:31 PM
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Executive Order Up

Healthcare IT vendors should be aware of a President Bush executive order on healthcare IT. It presents media possibilities for comment. On August 22, 2006, President Bush signed an executive order that requires the Department of Health & Human Services (HHS), the Department of Defense, the Department of Veterans Affairs and the Office of Personnel Management to collect more information about the quality and cost of healthcare they provide and share that data with each other and with beneficiaries.

The order directs the agencies to work with the private sector and other government agencies to develop and enact programs to measure quality of care. The agencies would also work to identify practices that promote high-quality care. The information will enable consumers to make informed choices among doctors and hospitals, and it will help support doctors and hospitals in their efforts to improve care and lower its costs.

The order also calls for the agencies to use interoperable electronic health records “where available,” and requires the agencies to compile information on the prices they pay for common services available to their members. Agencies must have the new programs in operation by January 1, 2007.

The President said he hopes the Federal action will be followed by similar commitments in the private sector, and in the state and local government. The U.S. House of Representatives also recently passed a measure (HR 4157 “The Health IT Promotion Act of 2006”) that serves to remove legal barriers to the provision of IT technology to physician.

Posted by Shawn Whalen on August 22, 2006 at 4:39 PM
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Lunch and Learn

Support your local healthcare IT events:

Sponsor: Mass Technology Leadership Council
Event Title: Healthcare IT Lunch & Learn with Health Industry Insights
Date/Time: Friday, Sept. 8, 12:00 pm
Location: BlueCross BlueShield of Massachusetts, Landmark Ctr., 401 Park Dr., Boston
Registration is required, contact me via Comment to this blog post

Event Details: The Mass Technology Leadership Council presents an executive Lunch & Learn with Health Industry Insights Vice President Scott Lundstrom. Lundstrom will explore the latest trends in healthcare IT adoption, providing insightful market data, research highlights, success stories and actionable analysis. As public and private sectors move the healthcare industry toward wide-spread IT adoption, both providers and payers are improving not only quality of care but also their bottom line. Data mining, integration and evidence-based medicine are driving personalized care management, pay-for-performance and healthcare transparency. Join us for this executive briefing 'Lunch and Learn' session.

Posted by Shawn Whalen on August 17, 2006 at 1:21 PM
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P4P MD

Here in Massachusetts, Blue Cross Blue Shield of Massachusetts continues its progressive stance on healthcare with new pay-for-performance (P4P) incentives. This comes not long after its $50 million technology grant for small practices to adopt EMRs (see my April 25 post, "The Wal-Mart of EMR.")

BCBSMA is spending $189 million on performance incentives this year. Though controversial and disliked by many doctors, pay-for-performance is gaining national traction. The long standard automatic payment to doctors for care is being shifted to a portion of payment contingent on quality, in the belief that it will make healthcare more cost effective. Premiums have been rising in double digits this decade.

In P4P, health insurers grade doctors and give bonuses on factors such as the number of patients who receive cholesterol testing, regular pap smears and mammograms, etc. About 13 percent of BCBSMA payments to primary-care doctors will be incentives, about $10,000 per doctor, up three percent from 2005.

In critiquing P4P, doctors frequently complain about having sicker patients or dispute third party standards. Often
doctors will boost their business volume to raise income to offset potential incentive hits. I wonder if increasing the number of patients lessens their individual time and overall care quality?

Another wrinkle: Data amassed and crunched by IT systems runs most P4P analysis. While large hospitals have IT systems with more comprehensive data, a majority of care is delivered by small and medium sized practices who lack such IT. In their case, BCBSMA uses billing data which many in the industry say lacks the necessary detail. And this may be simplistic, but if doctors get stiffed because a patient's health doesn't improve, will they start rejecting chronically ill patients?

Payors are certainly aware of these issues and are slowly working out the wrinkles. As a business practice, P4P is putting capitalist pressure on a bloated system to bring to bear quality and cost improvements, which I think is a good thing.

Posted by Shawn Whalen on July 19, 2006 at 1:31 PM
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A Penny for Your Health?

As we celebrate National Health IT Week this week it's interesting to put the United States healthcare IT consumption into a global perspective. As reported in AISHealth.com, the May/June issue of Health Affairs states that U.S. government is spending just a few cents on the dollar on healthcare IT when compared with other industrialized nations. America is about a dozen years behind most other industrialized nations in healthcare IT adoption. Citing a lack of studies that prove a correlation between cost reduction and HIT adoption, the study points out that simply because the U.S. trails in HIT spending, one can't conclude there is a direct relationship between its relative performance and its spending on care. Congress authorized $125 million for fiscal 2006 and $155 million for fiscal 2007 for healthcare IT. A RAND study puts the amount at $156 billion over a five-year period.

Posted by Shawn Whalen on June 5, 2006 at 2:50 PM
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Support Your Local HCIT Events

A quick plug for the Massachusetts Technology Leadership Council's Healthcare IT Program. This group brings together local HCIT end users, vendors, thought leaders and interested parties to discuss important issues. The next event, open to the public, is Wednesday, May 17, 7:30am-12:30, at Sun Micro Systems in Burlington, on healthcare technology and robotics. Panelists include executives from Harvard Pilgrim, Boston's Children Hospital, Sun, CIMIT, Foley Hoag and Benemax. Register here.

Posted by Shawn Whalen on May 8, 2006 at 4:04 PM
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Healthcare IT Industry Analyst Webinar

IDC's Health Industry Insights is offering a complimentary Webinar on Thursday, May 4, 2006, 12:00-1:00 EST. Click this to register.

Analysts Lynne Dunbrack and Marc Holland will discuss U.S. consumer attitudes toward Electronic Health Records (EHRs), Electronic Medical Records (EMRs) and the privacy of health information. Topics that will be discussed:

- Consumer awareness of the Federal initiative to make EHRs available to all citizens by 2014;
- Consumer thoughts regarding the value of EMR systems used by primary care physicians, specialists, emergency rooms and hospitals;
- Consumer willingness (or lack thereof) to share their personal health information;
- Implications for regional health information organization (RHIO) stakeholders formulating privacy policies;
- Current and expected future use by consumers of personal health records(PHRs) and related market opportunity for vendors.

Posted by Shawn Whalen on May 2, 2006 at 1:30 PM
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Windows Open; Brailer Exits; A Stark Reality

The company everyone loves to hate announced its panacea for the managed care industry. Microsoft unveiled it's Knowledge Driven Health Plans at the recent World Health Congress. The solution set, usually customized for managed care via partners, is comprised of the .NET framework, BizTalk Server, Windows Servers and Communications, SQL Server and of course MS Office.

Scuttlebutt among the cynical at the conference was that Microsoft was following its usual strategy of setting forth a borrowed vision, solution set, partner list and demonstration of momentum that makes its "leadership" position only natural. This is news to the payor IT leaders who own the market -- Amisys Synertech, EDS, DST Health, Perot Systems and TriZetto Group -- none of whom appeared in Microsoft's partnership press release.

But you can't argue with success, and no one has been more successful in technology than Microsoft. Their formal entry into the managed care market comes as Federal healthcare IT czar Dr. David Brailer resigns. Microsoft will help bring further attention and technology to help connect islands of information in healthcare. This is one of Brailer's chief concerns in his resignation speech, as reported in eWeek.

"Everybody's connected but nobody is sharing," says Brailer. "That's the natural consequence without federal intervention." Brailer's other big worry: Smaller healthcare providers will be left behind (see my Plight of the Small Doc post).

Those worries aside, Microsoft, other vendors and hospitals are still wondering about the Stark and anti-kickback legislation that has hindered health IT adoption. These laws prevent hospitals and vendors from donating technology or services to doctors. Congress proposed some exceptions, but the issue remains. Time will tell if Brailer's replacement has the cure.

Posted by Shawn Whalen on May 1, 2006 at 1:00 PM
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The Price is Right. Not .

On April 3 the Wall Street Journal profiled Alan Hubbard, President Bush's point person on healthcare and a leading proponent of healthcare transparency. The debate about price data continues and so does hospital opposition. A cogent nail on the head of the issue in Matthew Holt's blog:

... Painful though it may be for the right-wing free-market crowd to hear this but no patient actually has the hospital "price" that is on the chargemaster paid for their care. Either the hospital is paid a discounted rate organized by the patient's insurer (e.g. the DRG case-rate Medicare pays), or the uninsured pay some fraction that they can--which is the subject of a contentious but separate debate. The relevant number for Hubbard and the consumer payment crowd is, what does the consumer actually pay out-of-pocket for hospital care? And the answer is, even with a high deductible plan, if they go near a hospital they pay pretty much their max out-of-pocket, and then not too much beyond that. And so the hospital's pricing schema is irrelevant to them. Which is why hospitals don't care about what their consumer pricing is and why they find it impossible to explain it.

Posted by Shawn Whalen on April 13, 2006 at 10:31 AM
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Blue Book for Healthcare? Read Carefully.

President Bush recently announced that Medicare medical procedure costs will be made public to consumers. Health plans like Aetna are posting hospital charges, and services like Subimo and WebMD are offering cost and quality data.

An article recently in the Washington Post reports on HealthGrades effort to become the Kelley "Blue Book" of healthcare by selling cost data. This is laudable and inevitable as consumer directed healthcare gains steam. Consumers with Health Savings Accounts paying more out-of-pocket expenses will welcome such data. But scratch the surface and this data can be tricky if not deceptive.

Average costs can be deceptive and exclude quality issues. Consumers should be weary of misleading cost averages - cost ranges are more informative. HealthGrades' topics are procedures only and exclude office visits, tests and drugs. Beyond this, the cost doesn't define exactly what is included. Geographic regions, an important factor considering cost trends across the country, are limited. Consumers are wise to ask their health plans about quality indicators and consult additional quality sources.

Medicine is complex, health plans and doctors calculate rates differently, and quality definitions vary. Buying healthcare is nothing like buying a car, and quality can't be graded on a star basis like movie reviews. Only if accurate pricing is coupled with quality reports on doctors and hospitals can consumers make knowledgeable decisions. Otherwise consumers and their wallets will be in for a rude awakening.

Posted by Shawn Whalen on April 7, 2006 at 3:49 PM
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Consumer Health Data Online: Error, Page Cannot Be Found

As RHIOs form and an eventual national health information network is reached, healthcare data will come to live on the Internet. This is ultimately a good thing and necessary to improve care and help reign in costs long term. But according to a recent study by Health Industry Insights, it will take some convincing of consumers.

The survey of 802 insured patients found that one third of respondents were uncomfortable sharing their health information with doctors if it was going to be made accessible on the Internet. Half wanted to control access to Internet-accessible information. Fifteen percent didn't trust their health plans to protect the data.

Not surprisingly, 72% value the confidentiality of their medical information as much as their financial information. Do these 72% think that their financial information isn't residing in private and public Web sites? Like anything else, time and sustained education of consumers will ease their reluctance.

Posted by Shawn Whalen on April 3, 2006 at 9:25 PM
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