November 11th, 2009

Why not pay for what works?

Posted by Dana Blankenhorn @ 11:44 am

Categories: Drugs, Gadgets, General, Government, Home Health Care Equipment, Hospital Equipment, Insurance IT, Medical Equipment, Medical IT, Medical Office Equipment, Rehabilitation, U.S., state government

Tags: Patient, Health Care, McCaughey, Insurance, Financial Planning, Vertical Industries, Benefits, Healthcare, Business Operations, Corporate Insurance

In all the hullabaloo over health reform, Charles Silver and David Hyman write at The Health Care Blog, a key point of cost control has been lost.

Paying only for what works.

Silver and Hyman are law professors, not doctors. They point to a RAND Corp. study saying that “one-third or more of all procedures performed in the United States are of questionable benefit.” (The illustration is from the study.)

What happened to this simple idea?

The way to enforce it is through comparative effectiveness. Analyze data from millions of patients, develop best practices, and move physicians toward the most cost-effective solution.

This is what every other country does, regardless of how they pay for care. Formularies drive care, based on cost effectiveness. Anyone who wants to go outside what works had better have a good explanation. Often, going outside what works is simply forbidden, or patients are told to buy it with their own money.

Isn’t that how you set priorities? Why should governments or insurance companies act differently?

Unfortunately this was one of the first dominoes to fall in the debate. Reform opponents like Betsy McCaughey called this “getting between a patient and their doctor.”

This happened in conjunction with the debate over the Obama stimulus, and the subject was health IT. The purpose of the HITECH Act’s $19.2 billion in stimulus was to collect the data that would drive decisions on what to pay for.

McCaughey’s scare worked. Explicit promises were made not to use comparative effectiveness in any way to deny care, not to use evidence to decide what we should pay for.

The alternative to evidence is politics. Silver and Hyman note that millions of insurance dollars are spent annually on entirely non-medical treatments like Christian Science, but there’s more:

Lobbying from providers and supportive patients explains why many states already mandate coverage of elective services like in-vitro fertilization, massage therapy, and visits to athletic trainers. Concerns about the efficacy and cost-effectiveness of treatments are washed away by a stream of campaign contributions, and sad stories about patients who can only obtain the “necessary” services if the insurer will pay for them.

This is what is wrong with the present system. State regulation of insurance is based on politics, so your coverage includes any procedure that becomes politically powerful in your state. That’s why insurance costs are rising through the roof.

There is nothing wrong with paying for prayer but it’s not medicine, they write. There’s nothing wrong with in-vitro fertilization but it’s optional, not something everyone should have to cover.

Thus, by tossing away evidence as a way to rule-out certain coverages, you pay for a lot of stuff you don’t need.

Silver and Hyman wrote to argue against a politically-motivated individual mandate. Any mandate should be based on science, not politics, and by giving up on comparative effectiveness early in the process, it became impossible to set that standard, either through the federal government or through the states.

If this was Betsy McCaughey’s intent, she is fiendishly clever. Health care will remain a growth industry, because Americans will keep having to pay for stuff that doesn’t work, regardless of whether reform passes or fails.

November 5th, 2009

What the Google Privacy Dashboard can mean for health

Posted by Dana Blankenhorn @ 8:34 am

Categories: Consumer Information, General, Home Health Care, Hospital IT, Insurance IT, Internet, Medical IT, Medical Office IT, Medical Records, Wellness

Tags: Google Inc., Privacy, Dashboard, Health Care, Personal Health Record, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

If you have checked out the Google Privacy Dashboard, you may not have noticed that it covers all Google products.

This includes Google Health, the company’s Personal Health Record (PHR).

The media focus here has been on what Google knows about you, and the oh noes that Google will use that data against you.

But with the Dashboard’s access to Google Health, it occurs there might be another use for it.

What if you could find out where all your health data is? What if you could learn just which doctors, which hospitals, which insurers have what types of electronic data on you?

Knowing what’s out there, and knowing the rules for releasing that data, you can have full control of your privacy as we move from paper records to electronic records.

Given the trend within health IT toward more open standards, and more standards generally, it should not be too hard to provide support for this capability within, say, the NHIN-Connect system, which the Administration now calls the Health Internet.

There are lots of ways for this to go down, but the most efficient might be for the Health Internet to support a spidering technology that lets service providers offer a full health dashboard to consumers. Where within the NHIN system are what types of data on you. Not the specific data, but who has stuff, which is information we should all be entitled to.

I’ll bet that would be an incredibly valuable service, because it’s something we don’t have right now. The availability of such a service might even drive consumer acceptance of the Health Internet itself.

Take my case, for instance. In addition to my regular doctor, I have an eye doctor, I’ve seen an orthopedist, I have an insurance company, and a guy who did my colonoscopy. I also have a pharmacist. All that data, in time, is supposed to feed my Personal Health Record, along with data I might create, like my workout data.

Knowing who has what puts me in charge. Computers can tell me that. This encourages me to embrace computers, and powers the movement toward PHRs.

Did I mention Google Health is a PHR?

November 2nd, 2009

Obamicans rebranding NHIN-Connect as the Health Internet

Posted by Dana Blankenhorn @ 7:45 am

Categories: Curioisities, General, Government, Hospital IT, Insurance IT, Internet, Medical IT, Medical Office IT, Medical Records, Open Source, U.S.

Tags: Health Care, Obama Administration, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

The Obama Administration has a new brand for the NHIN-CONNECT service that debuted earlier this year.

The Health Internet.

(The button to the right is currently on the CONNECT home page.)

CONNECT is a set of open standards and protocols, originally developed under contract by Harris Corp., primarily using technology from Sun Microsystems (soon to be part of Oracle).

Among the open source tools in NHIN-CONNECT are the GlassFish application platform, the Java Composite Application Platform Suite (CAPS) SOA Platform, and the Sun Java Identity Management suite.

Since its April launch the Department of Health and Human Services has been hosting a series of “code-a-thons” where programmers can dissect and improve the software. About 100 participated in the first such event in August.

The frame of a health Internet is drawing effusive praise from Robert Kolodner, who was the last National Coordinator for Health IT under the Bush Administration, and who recently went to Open Health Tools.

All this is part of an important policy turn by the Obama Administration which, as Kolodner’s support for it indicates, really has nothing to do with politics.

Under the Bush Administration, policy favored contractors, who kept their work proprietary. The hope was that privatizing development would save government money in the long run. The Veterans Administration even lost control of its own lab software, after decades seeking to develop it internally under its VistA system.

Now the VA’s CIO thinks VistA is the bees knees, and the open source movement has even invaded the Defense Department, which appears to welcome its new penguin overlords.

Having health records moved nationwide under a set of open, accessible standards is also great news for Personal Health Record (PHR) systems like Microsoft HealthVault and Google Health, which may soon have a single set of open standards every proprietary system is writing to.

The pitch that NHIN-CONNECT is a “health Internet” reflects all these changes. Ordinary citizens won’t access the system, but they will be able to gain its byproducts, including PHRs delivered through tech companies, insurers or hospitals.

It’s real health reform, and it cost nothing that wasn’t already being spent under the previous Administration.

October 28th, 2009

The fight for medical cost transparency is coming online

Posted by Dana Blankenhorn @ 9:11 am

Categories: Consumer Information, Finance, General, Government, Insurance IT, Internet, state government

Tags: Ingenix Inc., Health Care, Vertical Industries, Benefits, Healthcare, Insurance, Human Resources, Business Operations, Corporate Insurance, Dana Blankenhorn

When conservatives criticize health reform one of the first things they suggest might work is greater transparency in health care costs.

Sites like Healthcarebluebook.com and Changehealthcare.com have been trying to offer this service for some time.

Procedures like MRIs, CT scans, colonoscopies, minor orthopedic surgeries and mammograms can all be shopped with these resources. You can also compare drug prices and learn what to do if a medical claim is denied.

Increased deductibles are giving more families a reason to consult these resources. But they are only a partial answer. Insurers control most costs through their repayment schedules.

This is where government action has proven necessary. But not national government action.

After Ingenix, a unit of UnitedHealthCare, was caught manipulating its repayment rates, New York Attorney General Andrew Cuomo won a settlement that includes a third-party estimate of what insurers should be paying.

That national database, to be called FAIR Health, will debut in about a year under a contract signed recently with Syracuse University and other state universities. The database will calculate “reasonable and customary” charges, based on location, eventually replacing Ingenix.

While Ingenix was used only within the industry, FAIR Health will be available to the public, so you can compare your own doctor’s charges to the market.

Reform and cost controls are a big problem with a lot of moving parts. Most experts agree broadly on what needs to be done. Comparative effectiveness is one tool. Price transparency is another. These are moving ahead regardless of what happens in Washington.

October 28th, 2009

Insurer research arm pushes comparative effectiveness

Posted by Dana Blankenhorn @ 6:03 am

Categories: Finance, General, Government, Insurance IT, Research, U.S.

Tags: Health Care, Lewin Group, Vertical Industries, Benefits, Healthcare, Insurance, Human Resources, Business Operations, Corporate Insurance, Dana Blankenhorn

The Lewin Group, the research arm of UnitedHealthcare, is pushing for greater use of comparative effectiveness in personalized healthcare,  programs tied to patients’ genetic makeup.

Attacking comparative effectiveness as “getting between you and your doctor” was a big feature of the political attack on health care reform this spring and summer, where it was called “rationing.”

But this was never the view of the insurance industry, which will control the health care market in the absence of regulation. Lewin maintains its own site on comparative effectiveness research, and delivered its latest report at a conference hosted by the drug industry.

In an online summit on comparative effectiveness hosted by The National Journal last spring, Lewin Group actuary John Sheils noted that guidelines produced by the research are adhered to barely half the time, suggesting that they be enforced with higher patient co-pays or government refusal to pay for care outside the guidelines.

These are precisely the actions anti-reform activists focused on in their attack on reform.

It’s certainly not necessary for people on the same side of the issue to have different views. But the views that will control in this case are those of The Lewin Group. Failure to pass health reform will have no impact on the move toward rationing care based on guidelines or using your genetic code to decide what is to be done with you.

If you want to fight that, take your tea party to UnitedHealth Group. Need someone to draw you a map?

October 26th, 2009

Cantor Insurance expands benefits counseling with Wellnet unit

Posted by Dana Blankenhorn @ 8:49 am

Categories: Finance, General, Insurance IT, Medical IT

Tags: Health Care, Insurance, Cantor Insurance, Wellnet, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

Cantor Insurance Group, a unit of Cantor Fitzgerald, has signed a deal with the creators of Wellnet’s Point2Point service to develop a buying tool for corporate health insurance.

Cantor (no relation to Republican Congressman Eric Cantor) signed the deal with HealthCare Interactive,  a Maryland software developer, which promises a HIPAA-compliant platform like the one it delivered WellNet, a fast-growing Maryland-based benefits company which supports employers controlling employee health care data.

WellNet owns a majority of HCI.

Cantor Insurance, founded in 2005, says it “operates a number of companies that broker insurance products, trade and service life settlements, and advise clients on insurance-related financial products” but has no page of its own on the Cantor.com Web site.

HealthCare Interactive claims its application can save companies 15% on their health care costs using “predictive modeling, information sharing, and intelligent Web services.” Among its services is DestinationRX, a drug costs comparison site it licensed in 2008.

The idea may be that Cantor will use the HCI system as a sales and modeling tool for its services, finding customers that WellNet can’t find on its own.

Whether a health reform passes the private insurance market is not disappearing, so business services like this will remain important for companies seeking to limit their costs.

October 22nd, 2009

Corporate health reform comes to our house

Posted by Dana Blankenhorn @ 6:11 am

Categories: Finance, General, Insurance IT, Wellness

Tags: Health Savings Account, Health Care, Checkups, Benefits, Healthcare, Vertical Industries, Human Resources, Dana Blankenhorn

While most attention remains focused on Washington and the health reform debate, it’s also the season where corporations sign their workers to next year’s health plans.

This is where the real reform is happening. (The blog Bombing Science found this on a wall in Toronto. We’ll discuss its importance.)

My wife’s employer has offered us insurance for many years now, but she pushed this year’s brochure on me last night because, instead of offering the usual option of a PPO (Preferred Provider Organization) or HMO (Health Maintenance Organization), it’s now focused on three different choices:

1. A plan offering low deductibles.
2. A plan offering low premiums.
3. A Health Savings Account (HSA).

Having read a lot of brochures in the past, it seems clear that my wife’s employer wants me to take Option Three.

Health Savings Accounts have been around for years, mainly as part of a high deductible plan. This year our employer, in conjunction with its insurer, is pushing it as something else. Health reform.

Under the plan preventive care is covered 100%. No deductibles, no copays, nothing. Checkups are free, get yours today. Care outside the provider’s network only gets 60% coverage, but inside the network it’s the same 80% as always.

These lower rates on out-of-network care are drawing serious political heat. The HSA is a bridge between this reality and a new set of market incentives.

The idea is here is a pile of money for health care. It’s yours to spend. Use it, but if you don’t then you don’t lose it. It rolls over. It lets people save for things like cosmetic procedures. It creates an incentive for them to shop and get the best deal on costs covered by the HSA.

This will be great for people who don’t get terribly sick. For those who do, just stay in-network and you get the same deal you got before.

But giving employees free preventive care and an incentive to restrict their other use of the resource is the heart of the plan. It’s not just what Republicans have been calling for. It’s what corporate and insurance reformers have been looking toward, a way to turn consumer choice into a weapon against costs.

When people talk about having 80% agreement on what needs to be done to control health care costs, this is the kind of thing they’re talking about.

I don’t know if it will work. I don’t even know whether we’ll sign up for it. But it is a reform, in that it’s a completely different plan than anything our family has been offered before. It’s market-driven, but it also meets the Administration’s goals of having people covered at work.

Change has come.

October 1st, 2009

Health IT prevents heart attacks?

Posted by Dana Blankenhorn @ 2:00 pm

Categories: Curioisities, Drugs, General, Home Health Care, Insurance IT, Research, Wellness

Tags: Health Care, Attack, Health IT, Heart Attack, Healthcare, E-health, Vertical Industries, Benefits, Human Resources, Dana Blankenhorn

Kaiser Permanente is pushing a study in today’s American Journal of Managed Care as proof that health IT saves lives.

It proves to me my pill regimen may be keeping me alive.

In the study 68,560 people with diabetes or heart disease were given a combination of generic statins and hypertension drugs, resulting in 1,271 fewer heart attacks and strokes.

But what’s the health IT angle?

• KP HealthConnect, the insurer’s Electronic Health Record system, was used to identify the patients at risk.
• The findings validate a computer-created model predicting that the bundled drugs would cut heart attack and stroke in the target population by 71%.
• Kaiser researchers conducted the study.

The medical case for statins and hypertensives seems more compelling. Some 23 million Americans have diabetes, and heart attack is the chief cause of death in this country. The study shows that a generic drug therapy can cut the costs of those conditions dramatically.

But, more than EHRs, the study also seems to show that getting your blood pressure and your sugar checked, then doing something simple to control both, actually keeps you alive.

My own condition was found in 2000 with a manual blood pressure meter and a simple blood test.

Get yourself checked today.

September 25th, 2009

Intuit service shows how little patients count

Posted by Dana Blankenhorn @ 5:45 am

Categories: Finance, General, Insurance IT, Medical IT, Medical Office IT, Payment Processing

Tags: Intuit Inc., Patient, Benefits, Human Resources, Dana Blankenhorn

Regular readers may remember a piece I did in August on bill payment processing. I noted the hassles of tiny bills, and noted they cost more to process than pay.

Intuit says it has an answer, called Quicken Health Bill Pay. It is an answer. For doctors.

Intuit has integrated with major insurance billing systems so it can present patients with online invoices that are paid online. This has enormous benefits. For doctors. They can learn quickly when insurance has finished its work and balances are due. Patients are notified of this via e-mail, so doctors get their money faster.

A subhead on the press release reads “Taking the Pain out of Paying and Receiving Medical Bills.” And I find myself quoting a Saturday Night Live skit. Really. Really?

Because I don’t see it. How is it to my advantage, as the person paying the bill, that the doctor gets their money faster? What’s the big whoop-de-doo about my using your online interface when my bank already has one?

There are, in fact, two audiences for this offering. But Intuit offers real benefits to only one.

It’s as though they don’t know there is competition in the patient end, or don’t think patients expect a little something for giving someone else a benefit.

Which means that if my doctor signs up for this service, I’m going to ignore it. I’m going to wait until the bill comes to me, on paper, and I’m going to wait until it’s due to pay it. Maybe I’ll use a credit card for that next $3.47 payment.

Because unless someone is going to give me a benefit, a real benefit, I see no reason to make their life easier and mine less-so.

Really.

September 21st, 2009

How health reform and health IT reform are linked

Posted by Dana Blankenhorn @ 6:26 am

Categories: Curioisities, Finance, Government, Hospital IT, IT Management, Insurance IT, Medical IT, Medical Office IT, Open Source, U.S.

Tags: Information Technology, Republican, Health Care, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

According to the 2009 Employer Health Benefits Survey of the Kaiser Family Foundation, health care in America now costs $13,375 per family.

Kaiser came up with this number through a complex survey which it placed online.

The figure was up 5% in a year where inflation was actually negative and wages rose just 3%.

Liberal columnist Ezra Klein writes that most people who have insurance don’t know this because employers are carrying 73% of the costs. All of the average raise over the last 30 years has been swallowed by health care price increases.

One conservative argument that might drive change is the concept of actually making people pay that money out of their own pocket. The plan of John McCain from last year, offering a $5,000 per family tax credit and telling people they must all buy care in the market, was about as popular as puppy pot roast.

Liberals don’t say this, but the best way to break the logjam over health care might be to pass a Republican plan that forced people to confront the real costs of their care, then offer a public plan as an alternative.

Unfortunately that is not the way the system works. A Republican plan would pass only with a Republican Congress and Republican President. We had that for six years, and nothing happened. Maybe they know something about the reaction to their reform in action?

So what we’re left with is a Democratic Congress and Democratic President offering tweaks to “bend the cost curve” (the same comparative effectiveness research being used now by insurance companies) but without the support to impose competition in the form of  a public plan.

It’s a bit like the situation facing health IT, as described in a column by two Johns Hopkins cardiologists.

The simple solution, they write, would be to get everyone behind an open source solution, like the VA’s VistA program.

For a fraction of the $19.2 billion in the HITECH stimulus, VistA could be turned into a crackerjack Electronic Health Record (EHR) solution, and even deployed. The stimulus could even cover hardware costs.

But that is not going to happen. Instead the money will go into creating standards vendors may or may not meet, and subsidizing the purchase of gear that may or may not meet the standards.

In this way health IT and health reform are closely linked. Money is wasted supporting a market whose main function is to waste money, and the political will to cut through that does not exist because opponents of efficiency call it “socialism.”

At the present rate of inflation, by the way, health care will cost over $30,000 per year, per family, by the end of the next decade. So how long do you want the political dance to continue?