by Malorye Allison
September 5, 2008 at 2:18 pm · Filed under Uncategorized, Policy Makers
It was the briefest mention possible, but at least John McCain did touch upon health care in his acceptance speech last night at the Republican National Convention.
McCain spent a bit more time bashing Obama’s approach then discussing his own: “My health care plan will make it easier for more Americans to find and keep good health care insurance. His plan will force small businesses to cut jobs, reduce wages, and force families into a government-run health care system where a bureaucrat stands between you and your doctor,” he said.
The “c” word was used liberally throughout his speech, such as when he declared that, “We need to change the way government does almost everything.”
At a glance, McCain’s health plan is indeed the more radical of the two, because he’s aiming to reform the tax code and his approach could impact the longstanding employer-based health insurance system. Currently, employers who pay for their workers’ health insurance can exclude every dollar of that from employee income and payroll taxes. This translates to a massive tax break for those workers.
MCain’s uniform tax credit system means everyone gets the same break – a $2,500 credit for individuals, and $5,000 per family.
So, the first question is, if McCain wins, can he possibly get support for this when the Democrats want something so very different? As, the ReformPlans Comparison Grid shows. the two candidates are at polar opposites on the specific steps to reform health care. Obama has shown some flexibility on how he approaches health care reform, but many of the Democratic lawmakers are still emphasizing the steady expansion of public programs. A significant number of those lawmakers would love to have a single-payer program.
Is compromise possible? Or under McCain, would we just see more of the same dreadful impasse?
Finally, neither McCain nor his rival has really explained how they are going to make health care more affordable for anyone – patients, employers, or the government.
Recently Aon Consulting Worldwide released data that health care costs will increase about 10.6 percent over the next 12 months. The good news was that this is the smallest increase in years. But the bad news is that there is rising evidence that we have squeezed most of the benefits out of all those little fixes – disease management, wellness, and generics drugs.
Meanwhile, growth in Medicaid costs is eating up state budgets.
Pretty soon, we need to address the root problems here. The U.S. health care system must be re-engineered so there is a real correlation between spending and value. Only someone brave enough to wrestle with that problem is going to have any effect.
Unfortunately, health care seems to be totally eclipsed by the economy and Iraq right now. We must hope that some of the rumblings from people like Senate Finance Committee Chairman Max Baucus and the Bipartisan Policy Center are signs of real determination to keep this issue alive.
by Lola Butcher
September 2, 2008 at 4:47 pm · Filed under Uncategorized
Dr. Paul Ginsburg, president of the Center for Studying Health System Change, underscores the difficulty of turning passive patients into savvy shoppers:
I don’t think consumers are going to be very receptive to using price information until they have more confidence in understanding the quality of different providers… Consumers can actually act perversely in the sense of not having confidence in the quality information, and equating higher price with higher quality, and thus shifting to higher priced providers, even if they actually reduce their quality of care in the process.
At the World Congress on Consumer Healthcare and Wellness in mid-September, Dr. Ginsburg will participate in a panel that addresses something everyone in health care is wondering about: Will Consumers Be Effective Catalysts to Reform the U.S. Health System?
Here’s part of our conversation:
Butcher: You just released a study that says 56 percent of American adults - that’s more than 122 million people - sought information about a personal health concern from a source other than their doctor during 2007. Does this suggest that Americans are becoming more active participants in their healthcare decision making?
Ginsburg: Oh, yes, they certainly are. American’s interest in their health has increased a great deal, say, over the past decade. We just know how much more space newspapers and television is devoting to personal healthcare issues, and of course we have a lot of development on the internet as far as sites that people can go to seek this information.
Butcher: Many health plans have developed consumer support tools - speaking of the internet - such as online information about hospital and physician quality, and calculators that help plan members estimate the cost of care. Are consumers using these tools, and if so, how are they using them?
Ginsburg: Well, I’ve spoken to the plans, and the plans are all eagerly developing these tools. So when you ask them, Are consumers using them? They don’t know.
My sense is that this is clearly the direction long-term where plans will play an increasingly valuable role as an information intermediary. But I think we’re at the very early stages of it, and I doubt that there’s a lot of use. I doubt that consumers are depending on it.
One of the chicken-and-the-egg problems is that I don’t think consumers are going to be very receptive to using price information until they have more confidence in understanding the quality of different providers… Consumers can actually act perversely in the sense of not having confidence in the quality information, and equating higher price with higher quality, and thus shifting to higher priced providers, even if they actually reduce their quality of care in the process.
Butcher: Is America’s healthcare system organized in a way that allows consumers to be effective shoppers for healthcare services? And does the healthcare marketplace respond to consumer behavior in the same way that the retail marketplace works?
Ginsburg: No, the healthcare system is very far from accommodating consumer desires, to the degree they have them, of being effective shoppers. For most cases, medical care isn’t standardized enough that you can just call up places and, knowing what you need, find out what the price is and the indicators of quality. Because so much of health care involves diagnosis, checking into what something is going to cost (and learning about) a provider (requires the patient) to invest a lot of time and money to make that call.
If you go to the dentist, if you need an inlay put in, a dentist won’t give you that over the phone because they’re going to say it all depends on the details of your condition. So, you’re going to have to invest the time and money of visiting a dentist to get an estimate.
So, I don’t think the healthcare consumer will ever be able to be as good a shopper as in other areas.
by Lola Butcher
September 2, 2008 at 4:20 pm · Filed under Business of Health, Hospital Administration
This is the kind of remark that gets my attention:
Throughout the country, I’m seeing more and more reports where you have people checking into hospitals, into clinics, and so forth, and they are posing as the individual who owns this particular social security number and/or insurance policy, and they’re either getting medical treatments under that person’s insurance, or they’re getting pharmaceuticals, prescription drugs, under that person’s medical insurance.
That’s from Robert Siciliano, chief executive officer of IDtheftsecurity.com, who spoke to me about medical identify theft.
Mr. Siciliano will speak at the upcoming World Healthcare Innovation and Technology Congress later this year. Here’s more of our conversation….
Butcher: Information technology is in the process of transforming healthcare delivery. Patients are telling physicians about their symptoms over e-mail and checking their lab tests on line, to give just a couple of examples. What security issues should hospitals and physicians be thinking about?
Siciliano: First, it does start with your information technology administrators. They are responsible to protect you from the outside–from criminal hackers– and from the inside, if you happen to have a bad seed working within your organization. So, it all starts with the IT administrators. The physicians themselves, and the employees at all levels, need to understand what their responsibilities are regarding safety or security and privacy policies, and those policies must be enforced at all times.
Butcher: If a patient’s personal healthcare information does end up being stolen from a hospital’s computer system, what happens? What is the hospital’s liability?
Siciliano: Over the past few years, there have been some major, major breaches of personal information at the government level, corporations, associations, healthcare, insurance companies - you name it. Just about every industry has been affected by a data breach at one level or another.
And as a result of this, state to state, they have passed data breach notification laws, which require corporations–entities whose information has been compromised–to disclose that breach and to make sure that they notify those who have been affected by that breach, so that those people can then go out and take the necessary steps in getting protection, in getting some type of insurance, or credit monitoring, whatever the case may be, so that their identity is not further damaged as a result of that breach.
Unfortunately, criminal hackers have changed the motivation significantly over the past few years, and they are really targeting everyone. I mean, nobody is immune.
Butcher: It seems to me that protecting against identity theft ultimately is the individual’s responsibility. Do you see this changing in the future, and if so, how?
Siciliano: Unfortunately, it is absolutely the individual’s responsibility. While the organization may be responsible for doing their part to keep that data safe and secure, ultimately, if it is compromised, it is in the personal identifying information, including name, address, and especially social security number, that individuals are ultimately responsible for self-protection.
Responsibilities do boil down to managing your own personal information, and ultimately making sure that, even if they do get that data, that there’s not a whole lot they can do with it.
Butcher: What should health care executives know about medical identify theft?
Siciliano: First, I think it’s very important that everybody understand the extent of the problem, that the issue of medical identity theft is becoming an ever bigger problem.
Identity thieves have been working at this for as much as 20 years now, and they’ve figured out just about every single way to compromise our information, and then turn that data into cash.
by Malorye Allison
August 29, 2008 at 1:07 pm · Filed under Uncategorized, Drug Development, Health IT
As Web 2.0 tools infiltrate health care, some surprises are in store. PatientsLikeMe.com highlights one of the big ones: Here’s a site that extols the virtues of sharing your health data, warts and all so to speak, with as broad an audience as possible. The patients use aliases, but they all share detailed medical data with each other, and 10% of them open up their data to the whole world.
“We flip the whole privacy thing on its head,” Benjamin Heywood, one of the site’s founders, told me last week. The notion that people wouldn’t dare share health information was one of the early obstacles for social networking in health care. PatientsLikeMe has the most daring and ambitious model, but a flurry of other similar sites, including Trusera.com and HealthCareScoop.com have followed.
PatientsLikeMe differs from most of these in a critical way. This is not what you might expect it to be – a chummy site where you can chat with numerous fellow sufferers about what it took to get your shingles properly diagnosed and why you think Vitamin C supplements helped the most to control them.
At PatientsLikeMe, people do give each other support, but they also contribute real, measurable data, including symptoms, and effects of a range of interventions, including test scores and lab data, depending on the condition.The idea of wide-open data sharing is part of the company’s philosophy: “When patients share real-world data, collaboration on a global scale becomes possible,” it reads on the website.
That data is the kind researchers can actually use in studies. And that’s the site’s unique business model – partnering to do real research. The site is poised to offer a new way to do clinical trials and disease management.A quick tour of the site brought me face-to-face thousands of people and their data – the drugs they are taking, how their disease is progressing, and myriad other possible details, such as whether the patient said a prayer that night. Many of the patients include real photos of themselves.
Clicking through it, at first I was very surprised at how much people were willing to reveal. But I’ve heard patients gripe about the downside of privacy before. Many want more people to know about their problems. They think that’s the best way to find real solutions more quickly. The sites’ founders agree.
“The site makes it easy to aggregate patient experiences,” Heywood says. “We are explicit and transparent, and by engaging patients in data sharing, we’ve found a way to engage industry as well.”
PatientsLikeMe only has five groups running so far – ALS (amyotrophic lateral sclerosis, or Lou Gehrig’s disease), HIV, multiple sclerosis, mood disorders, and Parkinson’s disease, but they have just over 17,000 patients contributing to the site and Heywood estimates that in 3 to 4 years they will have the equivalent of “200 Framingham Heart studies” going on, involving about one million patients.
The site has several partners, including Novartis, and some intriguing findings already coming in. Recently the site was able to rapidly accelerate research into a potential therapy for ALS — a rare but lethal neurodegenerative disease. ALS was the site’s founding group: The company was formed in part to try and help one of Heywood’s brothers who was suffering from the disease.
The site already has over 2,000 ALS patients contributing data, and was in a good position last winter a when a study came out on the promising effects of using lithium, an old standby psychiatric treatment, to slow ALS. That study looked at about 40 patients who were using lithium in combination with the only other FDA-approved drug for this condition, riluzole. When the study came out, only about 25 ALS sufferers on PatientsLikeMe were taking the drug.
Within just a few months, however, that number has soared up to 250 and the site is effectively carrying out its own clinical trial.
“Now we have data on all those patients, blood levels of the drug, side effects,” Heywood says. So PatientsLikeMe and its partners will be able to take a much closer look at lithium’s effectiveness.
It’s easy to find problems with this approach, but traditional clinical research is itself fraught with many ghastly problems, including massive costs, a painfully slow trajectory, and a lot of cumbersome “privacy” issues. Meanwhile, we’re at the point where people are increasingly skeptical about what traditional research finds. Merck’s ill-fated Vioxx, for example, was the subject of countless traditional trials before it’s dangers were revealed.Another intriguing finding is that members of the site’s Mood Disorders community are finding that they are spending less time in the hospital since joining the group.
“We think this is potentially a very effective disease management platform,” says Heywood. “Health plans have very few good options with mood disorders, if this works it’s going to be attractive.”It’s far too early to call PatientsLikeMe a real business success, but at least the site is teaching us some important lessons. Clearly, everything we thought about privacy may not be true. Maybe it’s time to rethink some of our other preconceived notions about health care as well?For more information about that lithium study, go here.
by Malorye Allison
August 29, 2008 at 12:57 pm · Filed under Uncategorized
Standing in front of more than 84,000 people at Denver’s Invesco Stadium last night, Barack Obama said a few short words about health care, and they came towards the end of his list of promises.
“Now is the time to finally keep the promise of affordable and accessible health care for every single American,” Obama told the cheering crowd. “If you have health care, my plan will lower your premiums. If you don’t, you’ll be able to get the same kind of coverage that members of Congress give themselves.”
Then, visibly moved and in a slightly angry tone, he added: “And as someone who watched my mother argue with insurance companies while she lay in bed, dying of cancer, I will make sure those companies stop discriminating against those who are sick and need care the most.”
Now the official democratic presidential candidate, Obama gave more attention to the economy, the war in Iraq, and oil prices. On that last topic, he stunned some listeners by pledging to end U.S.
dependency on Middle Eastern oil within ten years. Not surprisingly, most of his speech addressed his sources of inspiration, what’s wrong with what Bush has done or what McCain would do, and a long list of promises. But he also warned that Americans should be ready to help make all this happen.“Government cannot solve all our problems,” Obama said. “But should do that which we cannot do for ourselves.”Obama gave much more details about some aspects of his plans than others. Regarding how to pay for all these promises, he said he would “…close corporate loopholes and tax savings that don’t help
America grow.” In addition, he would “Go through the federal budget line by line eliminating programs that don’t work and making the ones we do need work better and cost less.”
See our health care plan brief for Obama here, and to see how his plan stacks up against McCain’s and the other stakeholders’ plans (such as the Federation of American Hospitals, the American Medical Association, and American’s Health Insurance Plans) see our unique Plan Comparison Grid.Listen to the whole speech, in two parts, at CNN: Part I and Part II.
by Lola Butcher
August 25, 2008 at 2:24 pm · Filed under Uncategorized
I was lucky to interview Stuart Guterman, senior program director of the Medicare’s Future program at the Commonwealth Fund. A couple of things that caught my attention:
Butcher: How should value in health care be measured, and do we need more measures or fewer?
Guterman: That’s really the crucial issue. There has been a lot of discussion about paying for outcomes, and certainly one can make a strong case that how the patients survives the health care, what the health status of the patient is in the long run is really the bottom line. But I think we are where we are on being able to pay for quality because we’ve developed a set of more reliable process measures, that is measures of how services are provided that are expected to lead to better outcomes. So we now can put together a list of things that are pretty much accepted as ways health care should be provided that will lead to better outcomes.
In terms of more measures or fewer, there are arguments for fewer measures because a long list of measures is thought to present the prospect of confusion. I think that actually if you have a longer list of measures and if you really are comprehensive in the list of measures for what you pay for, then you’re really transmitting a broader message that the objective is to improve quality and improve the value that you get for the health care dollar. I think that’s really the message that needs to be sent in value-based purchasing, not doctors should do this or doctors should do that. Doctors should really do a broad range of things that lead to better health for their patients.
Butcher: How should providers be rewarded for value?
Guterman: There are different ways to approach rewarding for value. Certainly you want to reward providers that provide the best care. There have been studies that found, however, that if you rely only those kinds of measures, then you end up basically making most of your bonus payments to providers who already are at the level that you’re looking for. If you’re really trying to improve the system, then you need to provide incentives for providers that aren’t where you’d like them to be to get where you’d like them to be.
So I think at some point you need to be able to reward improvement over time, and I think you also, when we have more information and we’re able to be more confident about setting levels of acceptable care, that we might want to pay on that as well. I think a good pay for performance system will basically incorporate measures of all three types of good performance so that we can have rewards for the folks who do it right, incentives for the folks who aren’t quite there yet but are improving, and then some more explicit recognition of the fact that you really need to be at a certain level in order to be considered a top-notch provider.
by jsidorov
August 22, 2008 at 8:11 am · Filed under Uncategorized
The World Health Care Blog welcomes Jaan Sidorov as a regular contributor. Dr. Sidorov writes the Disease Management Care Blog, where this piece 1st appeared.
I recently had an interesting lunch conversation with the Chief Medical Officer (CMO) of a regional health plan. After investing more than a million dollars in per year in ‘pay for performance’ (P4P) over the last few years, progress has stalled. As a result, the focus in this organization has shifted from P4P to the Patient Centered Medical Home (PCMH). This health insurer, like many others, is planning to invest in a PCMH project in the coming months. The CMO I spoke with cited two reasons why the PCMH was in many respects displacing P4P: a) the emerging realization doctors ‘can’t do quality alone’ under 1st generation P4P only — even if considerable economic incentives are available — and b) the PCMH promises a reduction in claims expense for persons with chronic illness within 1-2 years.
One would think that P4P would have led to local investments in practice redesign required to achieve the outcomes (performance) necessary to achieve the added revenue (pay). In this CMO’s experience, that simply didn’t happen. Apparently, the physicians’ pay wasn’t used to buy EHRs, hire additional care managers, or invest in decision support. Instead, the docs simply ‘added’ quality activities whenever they could in the course of business as usual. Perhaps the added revenue was used to offset the declining primary care payments we’ve been reading about. Another interpretation is they kept the P4P money and ran.
Has P4P’s less-than-perfect track record added to the growing luster of the PCMH? While any association between P4P’s disappointment and PCMH’s acclaim may be spurious, I wonder if there is more to it. In fact, I’m struck by an underlying similarity between P4P and PCMH. Much like P4P, PCMH involves additional ‘pay,’ but the performance measures have changed from process and outcome measures to ’systemness’ measures: for example, it’s not LDLs but referrals, not A1cs, but registries, not medication management but self management and it’s not cancer screening but clinic teaming. For the average CMO, those underlying similarities and available money make the transition from P4P to PCMH intellectually and operationally easier.
There are some interesting messages here:
1) while advocates of PCMH may suggest that managed care organizations should consider redirecting resources away from disease management to the PCMH, one has to wonder if the monies being used are being redirected from P4P and,
2) once again, much of the hope for PCMH is riding on its ability to reduce health care costs. If PCMH is going to survive in this CMO’s health insurance plan, it better deliver and quickly.
by David Harlow
August 21, 2008 at 5:30 pm · Filed under Hospital and Health System CIOs, Consumer Engagement, Health IT, Business of Health, Electronic Medical Records
A week or so ago, I read a disturbing article in the NY Times about Dan Kaminsky’s talk at the Black Hat conference: he’s been beating the drum for a while now, warning of what sounds like a serious security hole in Domain Name Server software offering an open door to hackers of websites containing confidential information and into email (which could allow phishing for usernames and passwords for otherwise protected sites). The technorati seem to agree that he’s identified a serious problem, and it seems that not all affected parts of the internet infrastructure have applied patches or upgraded their software.
Yet another reason to be wary of assurances that if the internet is safe for banking then it’s safe for health care information. Even the latest compact on privacy doesn’t count for much in the face of a technical issue of this magnitude.
Providers that have not adopted EHR systems to date could use this sort of news as an additional excuse to try to delay the inevitable. A study published in the NEJM a couple of months ago found that the reason most often given for lack of EHR in a practice is cost. (One commentator takes issue with that conclusion. I’ve also posted in the past about issues other than cost that stand in the way of EHR adoption.)
On the PHR front, this sort of news could scare off many people from uploading their health data into Google Health or Microsoft’s HealthVault.
However, the bottom line is that there is clinical value to using electronic health records and personal health records, and to the extent that providers and patients see that value, the benefit can be weighed against the cost of a potential security breach. The cost-benefit analysis will vary from person to person, depending on a variety of factors ranging from EHR considerations like the short-term effect of EHR adoption on productivity vs. the clinical benefits that can accrue to patients, to PHR considerations like tolerance for junk mail, a snowbird’s desire to keep doctors in two locations up to speed on conditions and treatments, and concerns about being denied employment due to a genetic predisposition to an occupational disease. (I know that’s supposed to be illegal, but, gee, do you think that might happen sometimes anyway?)
Would I prefer to stand firm and insist on perfect online privacy protections for financial and health care information? Of course! Is that practical? Of course not!
A few years back, my credit card information was inappropriately released by a vendor that apologized semi-profusely and paid for a year’s worth of fraud monitoring and reporting. Have I stopped using credit cards? No. The cost would be too great. Am I concerned that my physician’s EHR system could be hacked into? Well, my thinking on that is that hackers with limited resources probably want to go after something with greater interest, or at least greater value in the marketplace (e.g., Britney Spears’ medical records) so I am willing to continue to be part of the online system.
I am resigned to living with some of the burdens of modernity. Having completed my own cost-benefit analysis, I am not willing to live “off the grid.” Some of you out there may be willing to do so — you’ll maintain your privacy, but you won’t be able to read HealthBlawg any more.
– David Harlow
by JMoore
August 20, 2008 at 4:27 pm · Filed under Uncategorized
August 18, 2008
Adam Bosworth made quite a name for himself in the healthcare space while he was leader of the Google Health initiative. All got quite strange, however, when while on vacation late last summer, Bosworth decided not to return to Google Health. And while Bosworth went into stealth mode to develop Keas, Google chose not to replace him (a mistake) and Google Health fell under the tutelage of Marissa Mayer.
Bosworth has kept a very low profile since leaving Google, but Matthew Holt was able to get an interview with him, which Matt posted today. Roughly 35 minutes long, it is a good interview to listen to if you have the time. If not, here are my take-aways, with some commentary in italics:
Despite Holt’s prodding, Bosworth gives tells little of what happened at Google that led to such a sudden departure. Bosworth claims that he decided he wanted to work in a small, entrepreneurial environment that was nimble without a lot of “processes”. This rings hollow as he worked at Microsoft and BEA prior to Google, both very big companies. I’m not sure what happened at Google, and not sure anyone will ever know the full story, but clearly, more happened than Bosworth is ready to divulge.
His new company, Keas, has 15 employees, is about 6 months old and is looking to provide consumers with the personalized information they need to better manage their health. Boy does that ever sound familiar and I could probably rattle off about 15 Health 2.0 type companies claiming to do the same thing. Bosworth will be at the upcoming Health 2.0 conference so maybe he’ll divulge more there. Right now, all I see (should I say heard) in this interview is a company with another me to product. Barriers to entry for such products are quite low, but risks are high. Just look at the Health 2.0 poster child Xoova, which appears to have gone up in flames. This whole Health 2.0 stampede takes me back to the glory dot com days when everyone was talking about how all procurement was going to move on-line and multipleon-line markets were created for various industres. There was a land-rush and the spectacular bust. We may be seeing the beginnings of something similar occurring now in the Health 2.0 market.
Bosworth sees a clear need for better consumer tools to manage their health, tools that leverage Personal Health Information (PHI). Surprisingly, he thinks there is enough digital data today (labs, medications & images) to provide significant value if it is leverage correctly. He praised the efforts of Google and Microsoft, particularly Microsoft, (hmm, that’s odd) for their efforts to collect this type of data into a consumer-controlled data repository. He also sees biometrics playing an increasing role as well. I believe this is where Keas will focus its attention - creating a solution that leverages PHI for structured search and presenting actionable information for the consumer to take preventative actions.
He sees the big adoption hurdle as not being the consumer, but the physician. Bosworth believes that a compelling motive for physician adoption and use of HIT has not been presented. Bosworth and I both agree that eVisits may be the silver bullet. Concurring with my recommendation to Sec. Leavitt in July, Bosworth stated that CMS can take a leadership role here by aggressively supporting eVisits, which may kick-start physician adoption. Gets back to the old, ‘Show me the money!”
Bosworth also commented on the privacy concerns surrounding a Google Health or Microsoft HealthVault. Some consumers will be comfortable with these offerings, others less so. He foresees more such platform plays entering the market to serve other segments of the market that do not want their PHI in a Google or Microsoft type entity, e.g., a non-profit. He also stated that for Google and Microsoft, a breach in privacy would be a disaster, thus they take extraordinary measures to insure that PHI is secure within their repositories. As I’ve stated before, I am in total agreement with his perspective on privacy as it pertains to Google and Microsoft. Do disagree on his belief that there will be a proliferation of platform plays. Simply makes no economic sense as these are expensive to build and pull a critical mass of data into, let alone establishing the multitude of partnerships to create a viable and vibrant ecosytem of Personal Health Applications (PHAs) layered on top of the platform. There will ultimately be 3, at most 4 platform plays, and that is being generous.
by jsidorov
August 13, 2008 at 9:38 pm · Filed under Chronic Care, Health IT, Disease Management, Electronic Medical Records
The World Health Care Blog welcomes Jaan Sidorov as a regular contributor. Dr. Sidorov writes the Disease Management Care Blog, where this piece 1st appeared.
Goodness gracious. If you think you have a good idea when it comes to solving the twin dilemmas of cost and a quality for chronic conditions, ‘tis the political season. While the Disease Management Care Blog thinks the short term prognosis for meaningful health care reform is poor, that doesn’t mean it’s not smart to get your proposal out there and on the table before November 4. Just in case.
As a public service, the DMCB would like to offer these two Rules for Promoting Your Good Chronic Condition Care Idea:
1. Cast It As A Leading Domestic Policy ‘Silver Bullet.’ Yes, we know chronic illness care is an impossibly obscure tangle of insatiable demand, State and federal regulations, complex actuarial principles, relentless demographics, burgeoning technology and county-by-country variation. That complexity combined with an impatient hunger for reform is the perfect setting for the simplistic Good Idea that offers to cut through the clutter. For examples outside the health policy sphere, think ‘school vouchers,’ ‘flat tax’ or being willing to ‘take a paternity test.’
Examples of Chronic Care Silver Bullets: The electronic medical/health/personal record, pay for performance, single payer system, disease management, health savings accounts, patient centered medical home and an individual insurance market.
2. Do Not Mention Shortcomings (other than cost): Not only will you tarnish the Good Idea and diminish its chance of adoption, we all have a limited attention span that is simply unable to tolerate it. It is OK, however, to mention the cost of [insert a number from 1-100 here] [insert prefix of bil, tril or gazil here] lion dollars because we’ve become used to similar-sounding amounts being spent on Iraq, mortgage lenders and botox.
Examples of shortcoming to not mention: that electronic records can introduce new types of errors, P4P can incent processes not outcomes, single payer systems are notoriously difficult to modify, disease management may not work for all populations, ‘cost sharing’ may really mean ‘cost transfer,’ patient centered medical homes are being piloted (research), not adopted (covered by insurers), many persons with chronic illness are uninsurable and that cost effectiveness studies rely on unfamiliar concepts like QALYs. Mention these and your Silver Bullet will be tarnished.
Examples of excellent SBNS (Silver Bullet, No Shortcomings) rhetoric:
From the McCain campaign:
‘By emphasizing…..the use of information technology, we can reduce health care costs.’
‘Those obtaining innovative insurance that costs less than the credit can deposit the remainder in expanded Health Savings Accounts’
‘Families should be able to purchase health insurance nationwide, across state lines.’
And in the cost is no object category:
‘…establish a nonprofit corporation that would contract with insurers to cover patients who have been denied insurance and could join with other state plans to enlarge pools and lower overhead costs.’
And from the Obama campaign:
‘Support disease management programs. Seventy five percent of total health care dollars are spent on patients with one or more chronic conditions, such as diabetes, heart disease and high blood pressure.’
‘Providers….will be rewarded for achieving performance thresholds on outcome measures.’
‘…establish an independent institute to guide reviews and research on comparative effectiveness.’
And in the insert number, insert prefix category:
invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records
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