Wednesday, November 25, 2009

Personal Care as Health Care Reform

As Micah shared in a previous post, we went to the World Health Innovations and Technology Congress (WHIT5.0) in Washington, D.C. last week.  It was an awesome experience, and Micah gave a great overview of the conference.

I walked away with several clear impressions:  one of them is that before we can make significant progress on health care reform, we need to engage patients (notice I'm talking about health care reform, not reform of the ridiculous financial system that surrounds it).  In fact, both Bill Clinton and Newt Gingrich agreed on this point, and you can't get much farther apart than that on the political spectrum.  Many other speakers and panelists at the conference said the same thing.

Why patient engagement?  Because patient engagement in their own care will encourage lifestyle changes -- changes like losing weight, stopping smoking, exercising, managing diabetes more carefully.  And these changes would result in big reductions in major illnesses:  type II diabetes, stroke, heart conditions, and many cancers.  In turn, besides increasing quality of life for millions of Americans, billions could be saved on treatment of these diseases -- diseases which are extremely high cost in both length and type of care.

Billions of dollars saved, which can be used to pay for health care for the un- and under-insured; to finance rural clinics; to reduce insurance premiums; to improve care of non-lifestyle-related illness.  Okay, this is a little pie-in-the-sky, because some of that money will end up in the pockets of insurance companies; but the possibilities of freeing up that kind of money are pretty exciting.

What's next?  Well, lots of companies are working on various platforms that will allow patients to be involved in their care.  They range from Web applications that integrate directly with the patient's EHR (like Palo Alto Medical Foundation's PAMFOnline built on Epic's foundation) to Keas' care plans and self-monitoring tools to Google Health's online records.  All show promise in different ways, but my bet is on provider or payor driven (or funded) systems, because they have the most to gain by using these systems.  Vendors like Keas will be successful only if they can pull in corporate users and figure out a way to be transparent to physicians.  But there are definitely some changes going on in this space, and they bode well for health care reform and financing.

Saturday, November 21, 2009

Guest Blog: WHIT 5.0

Written by my good friend (and boss), Micah Dylan:

Members of the VelocIT executive team participated in the World Healthcare IT Congress in Alexandria, VA this month. Bruce Fielding and Micah Dylan attended, and we sponsored Dave Burrill, from Wisdom Legacy, and Joyce Hunter, an executive consultant from Washington, DC, as co-attendees.
A few highlights from the show:
  • Bill Clinton spoke on the need to increase healthcare capacity in developing countries, but in the US we have to focus on removing rigidity from our healthcare system. It has become ossified due to a lack of standards that have locked easy flexibility and capability away from patients.
  • Newt Gingrich spoke about the problem of personal accountability and the type of programs and incentives that address individual, cultural, and organizational issues before financial ones. His new foundation, the Center for Health Transformation, is focused on these issues.
  • Dr. Donald Simborg from Health Level Seven (HL7) became our new hero when he said that "it's more important to agree on a standard than to find the perfect standard. The most value comes from simply having a standard and moving on. The Internet developed because we had TCP/IP, not because that was the best networking standard you could possibly have."
  • The 'last mile' problem from a local Health Information Exchange (HIE) to providers is probably the biggest technical hurdle. That encompasses standards, implementations, and adoption issues which may be insurmountable.
  • The move to a National HIE (NHIE) is extremely far off and 'unlikely in our lifetimes' according to some. The last mile problem looks more like the last light year.
  • Others are focused on orthogonal problems, such as leveraging the skills of healthcare experts to provide personalized healthare to the many rather than the few. One good example is, by a former Google VP.
  • Within existing systems, value needs to be increased by focusing on usability and better return on value to payers and providers through automation and business process improvements.
  • There has to be a focus on involving patients in their own care.  Several speakers noted that the largest savings in health care costs will stem from preventing conditions like diabetes, heart disease, and life-style related cancers.
-- Micah Dylan

Monday, October 12, 2009

High Touch Medicine: Touching the Pocketbook

If you haven't already, you're going to start hearing more and more about high touch medicine.  High touch (as opposed to or in addition to high tech) focuses less on using technology and more on things like spending time with patients, physician listening skills, and on greater pro-activity in treating chronic patient conditions.

As reported in Healthcare Finance News , Ezekiel Emanuel, M.D. recently outlined a high touch approach to medicine which he claimed may be the foundation for fixing health care in the U.S.  According to Dr. Emanuel (brother of the White House Chief of Staff Rahm Emanuel), bundling reimbursement to physicians based on ailments rather than paying for individual services could significantly reduce costs and improve care.

Basically, doctors would be paid a set amount for a patient conditions, allowing them to spend more time with each patient and focus more on preventative services and care.  Since physicians would not have to worry about how many patients they see in a day, they could proactively follow-up with patients, monitoring high-risk conditions, like diabetes, hypertension, heart conditions, obesity, etc.

Why is this a great idea?

Well, patients will love it.  Their physicians will have time to sit and listen to them, and really plan how to address their health issues.  Patients won't have to remind their doctors why they've come in,  because doctors will have time to adequately and correctly chart. 

Doctors will love this because their income will no longer be based on volume.  They won't have to average a patient every 12 to 15 minutes (or more) in order to make payroll.  And they will be able to sit down and actually do real treatment planning.

Everybody will love it -- for the first few months.  Because that's how long it will take for payors (insurance companies, health plans, and the big IPAs -- yes, they really have become payors) to begin to ratchet down the payments based on... well, on something, or anything:  evidence that shows hypertension in middle-aged males should be resolved in less time; studies that show that many  chronic pain patients don't get better, and therefore magically require less care.  The list will go on and on.  And reimbursements will go down and down.

Bottom line:  until there is some sort of insurance reform, either on the part of the insurers themselves or by the government, the profit motive at the insurer level will always put a crimp in any other reform plans.  There are ways the insurers could self-reform -- we'll talk about that another time.

One more thing:  does any of this sound like a re-worked capitation system?

Monday, September 14, 2009

What "robust options" really need to be in the health care plan

With Senator Max Baucus ready to release the health care package tomorrow, we will finally get to see what the "gang of six" have been able to compromise on. My guess is that, no matter who is happy or unhappy with the package, the bill will not bring true reform. Here's why.

Both the Dems and the GOP are focusing on outcomes in terms of ideology -- okay, maybe that's a bit of an overstatement, but how many times have you heard a progressive saying that there "MUST be a robust public option"? Or a conservative telling us that real reform will only come if true competition is insured. These are ideological outcomes, not solutions to problems. Ideology may be a way of getting to a solution, but rarely so in the hands of politicians.

So, in the interest of pointing out the real solutions we need, here is my list of "robust options" that need to be in the health care reform package:
  1. A guarantee that no one can be turned down for insurance coverage for a pre-existing condition or a lapse in coverage.
  2. A guarantee that a policy cannot be canceled just because you get sick -- no matter how sick you might be.
  3. A clear path to providing some sort of affordable coverage for the millions of Americans who currently cannot reasonably afford health care (you shouldn't have to choose between groceries and medical insurance).
  4. A clear path to reduce infant mortality in the US (we rank pretty low compared to other Western nations). You can make an argument that illegal aliens spike this number, but lots of other Western nations have poor and illegal populations, and they keep this number down; we should too.
  5. A clear plan for breaking up monopolies in insurance coverage. In lots of areas of the country, "choice' is between several plans from the same one or two companies, with little or no opportunity to find anything better. Whether we do this via a robust public option or increased competition, I don't much care -- as long as it gets done.
This is the short list... I could go on, but at a minimum this is what I want to see. Anything less will not address the health insurance crisis or the health care crisis that we face. Bandage or reconstructive surgery -- now is the time to choose.