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Archive for 4th WHCC

Podcast interview with Josef Woodman, author of Patients Beyond Borders

by David Williams

Medical care in the US costs a fortune. In the past few years uninsured and under-insured Americans have been venturing to places as far away as India and Singapore for surgery and other treatments. The care is often excellent, prices are low, and even surgeons are customer-service oriented. There was an excellent session on this topic at the recent World Health Care Congress in Washington, DC. I expect we’ll be hearing more about this topic.

I spoke yesterday with Josef Woodman, author of Patients Beyond Borders, Everybody’s Guide to Affordable, World-Class Medical Tourism. Listen in and hear what he has to say.

You can buy the book at Amazon and other retailers.

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Wal-Mart’s $4 generics having an impact

by David Williams

Wal-Mart’s CEO, Lee Scott closed out the recent World Health Care Congress in Washington, DC. Now Wal-Mart’s PR folks have put together a 4 minute video on their $4 generic program. It has ‘real people’ talking about how Wal-Mart has helped by making drugs more affordable for them. The video ends with a bullet point summary of the program’s impact:

  • Includes 14 of the top 20 prescribed meds
  • Available at all 3810 Wal-Mart’s
  • Saved consumers ~$290 M since it was put in place last year

If anything, Wal-Mart is being too modest about the program’s impact. I’d add the following:

  • Improves medication adherence and health status by making it affordable for patients to take their medicine as directed, rather than stretching it out
  • Saves money for consumers who don’t shop at Wal-Mart, by encouraging other retailers to reduce prices
  • Saves money for purchasers of insurance, by resetting the baseline for what generics should cost

The landscape of health IT, and interview with Lonny Reisman, ActiveHealth Management

by Emily DeVoto

I’m interested in bringing evidence into practice, and talked with people at last week’s World Health Congress about IT systems and products that provide clinical decision support. Ideally such products are also a way to evaluate clinical quality, and to monitor potential adverse drug interactions and flag them before they happen - or at least in time for intervention.

As you’ll see from other posts in this blog, getting over the barriers to implementing IT is the next big - and hopefully easy - step to improving quality, in part by allowing consumers ownership of their health data. Making such systems interoperable, within the bounds of privacy issues, will be crucial for using these data for the research we need to best evaluate and continue to improve the performance of health systems (think quality measurement, whether for public consumption or for internal quality improvement).

Industry has not waited for government and patients to get over fears of privacy to start developing electronic health records, clinical decision support systems, and the like. A number of IT vendors who’ve been developing such systems in parallel are exhibiting here at the Congress and have been happy to chat about their work, some of which has already been put to use by health systems.

ActiveHealth Management’s products analyze data somewhat downstream from a clinical encounter and send alerts, reminders, etc. to doctors and patients. It’s also integrated with a personal health record, which patients can access through a web portal. It’s also… well, there are a number of other components and products that I’ll not attempt to describe, let alone tie together. Their website is here. Here’s a podcast of an interview I did Monday with Lonny Reisman, MD, CEO of ActiveHealth Management. Not meant to be an endorsement on my part - remember there are lots of good products out there - but a chance to learn about what one such system can (and can’t) do.

icon for podpress  Emily DeVoto interviews Lonny Reisman [19:48m]: Play Now | Play in Popup | Download

Interview/Podcast with Mark Ganz, CEO Regence and Luis Machuca, CEO Kryptiq

by Matthew Holt
This is the transcript from the interview I did at WHCC last week with Mark Ganz, the CEO of Regence, the Oregon based Blues plan that operates in the Pacfic Northwest, and Luis Machuca, the CEO of Portland-based health IT messaging company Kryptiq. Machuca is innovative as both and employer and a technology guy, and Ganz is, shall we say, not your typical insurance company executive! This is crossposted over at The Health Care Blog

Matthew Holt: This is Matthew Holt with the World Healthcare Blog, reporting from the World Healthcare Congress, doing a podcast. It’s kind of funky back here because we are in this glass-enclosed blogger’s corner which they put together at the back of the exhibit hall, but they are still setting up the exhibit hall, so you can hear the vacuum cleaners in the background. But no matter, we are on with the first podcast of the day.

Today we have got some very interesting folks: Mark Ganz, who is the president and CEO of the Regence Group, which is the big Blue’s plan in Oregon and the Pacific Northwest; and Luis Machuca, whose name I just got wrong again. [laughs]

Luis Machuca: Machuca!

Matthew: Machuca! Sorry, my pronunciation is–they never taught you that about proper Spanish accent in the English school I went to. He is the CEO of Kryptiq, which is an IT messaging company. Well, I should let Luis tell you about that. Mark has already been on the podium twice today in two different areas; Luis has just been talking about an initiative that is being run for his employees with Regence. So let’s start there; Luis, give us the quick find out about what are you doing with your employees and how you work with Regence and what innovative things you are doing around employee healthcare at Kryptiq.

Luis: Hi Matthew. So, really what Kryptiq is all about is building tools that enable healthcare transformation. We’ve really, from day one, always felt that transformation starts from the inside out. So before we try to transform the world of healthcare outside, and build tools for them, we wanted to make sure that we were sensitized to the notion of delivering the very best possible healthcare in the most efficient of ways. So we’ve done many things along those lines, starting with reimbursing for email and patient portal enable clinics for employees.

More recently, and why Mark is here really, is to align with health plans who also embrace the notion of transformation and the notion of getting more decision in the hands of the employees, and more tools and information for employees to make the right decisions about their healthcare dollars.

Matthew: So what does that mean in real life? How have you structured your employee benefits so far, and what’s that actually mean? I’ll ask you, and then I’ll ask Mark the other side.

Luis: Yeah, in real life that means, number one, that we want to make sure that employees have easy, highly productive access to excellent healthcare, and thus the email and portal enabled reimbursement for clinics that do that; and two, a high, high component of a mix of an HSA combined with tools from our health plan that allows people to be guided about the decisions that they make, about the choices that they have, about things that are going to work for them, both in a preventive and also once they have some disease.

Matthew: So, are you funding the HSA from the company, or is that sort of more skin in the game from the employee.

Luis: We fund half of the HSA, so we fund half of their limit.

Matthew: Well, that’s pretty interesting. Now Mark, tell me a bit about how it works out from the insurer and the kind of work you are doing with them.

Mark Ganz: Well, one of our core beliefs as a company is that the fulcrum for full healthcare transformation is the individual customer, the consumer; and that if you look at, when they talk in healthcare about the misaligned incentives among the various players in healthcare, it’s because we are not aligned toward a single individual or person that we serve.

Our belief is that if we focus on the needs of the individual and engage that individual to move beyond the sort of state of entitlement that they are currently in, and create a more of a healthcare marketplace that is very responsive to consumers and in which a consumer is able to navigate and make choices, value-based choices, that that will begin the seeds of more fundamental change throughout the healthcare system.

Based on that belief, we’ve started a pilot within our own company with our own 6,000 or so employees, now we are closer to 7,000 employees, focusing on how do we engage them in their own use of healthcare benefits, in their own use of healthcare, so that they have a better understanding of the interconnection and interdependence, frankly, between and among themselves around their use of care and even their desire to remain healthy and not need the care in the first place.

Matthew: What does that mean in terms of - you showed in the last session some of the dashboards, and some of the tools and techniques. Could you go down to the details of what you’re using?

Mark: Sure. What we’ve done is focused around the key outcomes we want to achieve in terms of engagement of employees, and set up a series of programs designed to achieve those outcomes. We measure our ability based on those outcomes.

So, specifically, the first year we were into this, we designed health risk assessments that all of our employees filled out. Based on what we learned from that, from what employees told us they wanted to work on most, we then developed a series of wellness programs that were designed to address those very issues.

So we had a number of employees that smoked and wanted to quit. We engaged them in ways in which they could do this. We had a number of employees - a lot of employees - who were very overweight. In fact, I think they’d been attracted to our company because we had rich benefits and they felt they would be well cared for as employees in our company.

A lot of them were overweight, so we designed a series of financial incentives and programs that were aligned with those incentives to help people lose weight. In fact, we’ve had amazing success.

And what’s really been interesting is that once we created those programs and then helped people engage in them, what we’ve really tried to do is get employees working with each other to carry it forward. We’ve seen this amazing interplay amongst employees in terms of their desire to lose weight, to get more fit, to be more engaged in taking care of chronic diseases, that we aren’t necessarily mediating. We’ve just created the opportunity for employees to talk to one another and support one another as they try to address those issues for those own lives.

Matthew: You come here with a really crucial issue (while we’re doing this someone’s trying to break the door down), which is how do you motivate people, how do you get them to get off the dime and change behavior? And there are a couple of things going on which I think are related which were on the previous panel, with George Halvorson from Kaiser Permanente.

There’s also this move in the information therapy movement which I’m sure you guys are familiar with, talking about some of the stuff that John Wennberg just mentioned earlier about decision aids and people making the right decision about their care. In some ways, take decisions back a bit from some of the excess we’ve seen in the provider community. I don’t want to put those words in your mouth! But we are talking about how we change the behavior of individuals. Some of it’s motivated with money. Some of it’s motivated with almost a community spirit, that you were discussing.

Let’s change the focus a little bit: At the same time, some of us are saying that the move towards HSAs and individual self-directed accounts actually mitigates against that and tends to put the healthy people up against the sick people and then we have the 3% of folks who drive most of the spending as George Halvorson was mentioning, who are absolutely not so amenable that type of approach.

How do you think that this fits in to the chronic care model?

Mark: OK, a couple thoughts. First off, the healthcare system is an inefficient, opaque, paternalistic system.

Matthew: No disagreement. [laughs]

Mark: And that is true no matter whether you are suffering from chronic disease or you have a hangnail. The fact of the matter is that if we’re going to get at fundamental cultural change in the way the system functions, I believe you start with the 80% that use 20% of the care who have the ability to make choices. You can educate them about how they use healthcare and about how their decisions impact the lives of others.

And, frankly, another piece is that how their contribution to the insurance pool is actually helping others out in the community. I think they have to understand both. And it’s amazing how little we understand that in this country. We believe that somehow it’s me against the big machine when it’s time for me to use healthcare. The mindset of people is often, “How can I extract the most value out of the system?” which means “How much can I extract the most value out of the system, ” which means, “How much can I use and continue to use?” They don’t see the relationship about how, when they use care, they’re essentially taxing other people within their community for their use of care.

Trying to get at that challenge — that is one of the key challenges we face. If we are able to get the health-care system to act more efficiently when it’s dealing with 80% of the people it sees, I believe it will act more efficiently when it’s dealing with the 20% of the people it sees who use 80% of the resources. That the system will change fundamentally to become more efficient, and that maybe that 80% who are elective today might be part of that 20% five years from now.

If they change the way they view healthcare when they’re healthy, or relatively healthy, that when they do get to a certain age where chronic disease sets in, they will be more thoughtful about how they use care. So it’s a belief that you’ve got to change the fundamental economic rules of the system. I don’t believe you get there by simply focusing on changing the game for the 20% using 80% of the care. I think you have to take a broader look.

Matthew: Luis, How is that playing out with what you’ve done in your company so far? What are you seeing from your employees so far, in terms of their changing care?

Luis: I want to go back to something Mark said on his speech earlier today, when he talked about an example. He was talking about a person helping his wife go through the final stages of a cancer, and how, in summary, they were almost forced to surrender control in order to really be able to cope with the health-care system’s role or participation at those stages. What we’re trying to do, and what we are all about, is whether it’s through HSAs or some of the things that Mark talked about, that the more that the decisions become available for people to make — whether it be small decisions or big decisions — the more the dynamic will change with the providers.

What we do is we understand that most providers, it’s not that they want to retain control, and it is not that they’re cynical. It’s that, in many cases, they really are unable because they don’t have access to their own data. They don’t have access to the continuity of healthcare to be able to put data, to be able to put the full picture. So they’re only giving an opinion or a prescription based on what’s in front of them.

As a technology company, what we are trying to do is put in the connectivity tools to allow those things that are in the periphery to come in and form a better picture, so people can have more informed decisions — both as providers, so people can give a menu of choices, and then also for the patients, to be able to make better choices.

The way we see that with our employees is our employees have become very discriminating about the providers that they choose, whether it be on the chronic disease pool or not. The chronic disease employees are gravitating much faster to providers who are going to help them manage a compliant state, than who are just going to be there on an episodic basis. Too early to tell in terms of what data is out, but from a behavioral and anecdotal, observational point of view, we are right on track where we want to be.

Matthew: Yeah, and actually this leads us almost to a point which is, I know, a slightly controversial point in the Northwest around managed networks and high-performing networks. [laughs] If this was TV, you could see Mark sort of cringing there.


But it’s absolutely a key issue….

Mark: It’s a hard lesson learned.

Matthew: It’s a hard lesson learned, but it’s a lesson…. In some ways, you could argue what Luis just said was that some self-selection on the consumer side is moving towards the right thing, the right network perhaps.

Mark: I think if you actually educate…. If you provide financial incentive, however that’s structured, whether it be HSA or whether it be the employer specifically putting more money in the pocket of the employee and saying, “This is your money; go spend it wisely.” However you create that incentive, and you educate them how to be good shoppers, you create more of the marketplace economic dynamic that I think will start changing the dynamic of the supplier of healthcare, i.e., the physician, the hospital and the like.

If you look in those areas of medicine that are not subject to the third-party payment mechanism, that are subject to a marketplace dynamic where the individual is spending their own money and the health-care provider is responsive to that economic relationship, what you see over time is costs are stable, and in some cases they even drop.

Let me give you an example: Lasik eye surgery versus cataract surgery. You look at Lasik over the last several years, and you see what’s happened in Lasik. Number one, quality has gotten better. Customer satisfaction has gotten better. Outcomes are better. Prices have dropped. And there are more people available to do it, because it’s a competitive marketplace.

Cataract surgery, which is subject to the third-party payment system — there’s really not much new that’s happened in cataract surgery over the last ten years. But what’s happened there? Prices have gone steadily upward, because there is not a marketplace dynamic. It’s basically “I want cataract on demand.” Physicians, who actually are much more efficient at doing the surgeries, simply do more of them and charge more for doing it. And we, as health plans, all the while are sitting back, patting ourselves on the back, saying, “Aren’t our discounts great!” When in fact, the alpha upon which our discounts are based continually goes upward.

Now, that’s an example where I think you can look at it and say, “If you give consumers the right incentives, and you educate them how to be shoppers, they’ll figure it out.” They will make good decisions and they’ll be more satisfied with the decisions they make, because they feel like they had a sense of taking charge of their own healthcare, as opposed to being run like a rat through a maze. Which is, unfortunately, I think how healthcare works.

Matthew: Let’s just raise that, though. I’m going to try and draw two things together here. The issue of Lasik versus cataracts has come up a lot, and there’s been, as you know, studies going both sides of that equation. But it’s a very definable, neat piece that you can do. Whereas we know, when we talk about chronic care, which is where most of the money is spent, it’s less definable. Part of the problem is something that Luis brought up, which is that the average physician doesn’t have enough information about the patient, the average patient, is seeing how many number of patients?

So let me ask both of you to jump in on this. How far are we along — maybe just here in Oregon and the Pacific Northwest — how far along are we in the integration of information that makes that potential easier? Then the next question is speculate, about the end state and the way that you’re going to be paying for that expensive chronic care, because of stuff that isn’t like Lasik?

Luis: Well I want to stay to your example, because I think that it’s a good place to frame the difference of possibilities. The popular notion is that people think that we want to know who gives the greatest chronic care. “Tell me who the good doctors are versus the bad doctors.”

I think that’s really a bad question to ask, for the following reason. You’re not going to be able to drive the healthcare system with 20% of the doctors, no matter what. The premise of my point is that the data is there to make the overwhelming majority — a very large number, 80-plus, 90% of the providers — to compliance, to manage a chronic disease in a very effective way, both a cost- and outcome-effective way, if they were connected to the data.

So what I want my health plan to tell me, in terms of their network, is not “who are the good doctors and who are the bad doctors,” but steer me to the people that know how to manage to compliance — as opposed to darkness, where I don’t know the difference. I don’t need to know, tomorrow, all of the details about a particular provider versus another one. But I would like to have some qualitative information about: What kind of tools do they have? Are they committed to a compliance management system? Are they willing to take whatever those steps are?

That, to me, is an important question that can be answered by health plans and others, in terms of the managed networks and which are the better networks.

Matthew: And where would you say we are, on a one-to-ten scale? How far down the path are we to that kind of information integration between those providers, which is seriously a lot of the problem that we’re talking about?

Luis: I would say, that’s not going to give you a numerical answer, but I’ll tell you this: the toothpaste is out of the tube. We are headed in that direction; it’s going to happen, certainly within the next five years. Any attempt to suppress it or repress it will result in market uncompetitiveness and either people losing jobs or people going out of business. But I think we’re past the point of no return on that. So I am very optimistic.

Matthew: I love your optimism At Institute for the Future, I remember we always used to say that the electronic medical record, you know, it’s a technology that is five years in the future and always will be. [laughs]

Luis: A very good example, the electronic medical record, you know, 80% of physicians today do not have an electronic medical record, but 95% of that 80% can do an electronic referral or could do an email consult or could send me my lab results electronically. And those get me to my next step in the healthcare chain much better armed and much better informed.

So the electronic medical record is an example of something that I think became a big initiative without a benefit/value proposition that was to the purchaser; unlike this idea where me as an employer, you know, I want to get guidance from my health plan as to where my employee is going to get better disease management for diabetes or hypertension.

Mark: I want to come back to culture here for a minute, because I am leading the effort in Oregon to try to create an interoperable free exchange of data amongst the healthcare providers. We are starting in the greater Portland area because that is where the greatest population center is. We created a committee, a steering committee under the auspices of the broader business community, the Oregon Business Council, which I chair, and we have at the table the CEOs of the major hospitals; and they are the key to making this work.

If they don’t play, because, I think as you know, the value proposition that hospitals have used into selling the idea of EMR to their own boards has generally been that by having EMRs within their own system, that in a sense it creates a higher set of castle walls.

Matthew: Yes, sure.

Mark: They keep patients within the system, they keep doctors referring into the hospital; it’s a way to make sure that the beds stay full.

It’s been an interesting impediment to the conversation that when you realize that when you talk about democratization of that information across hospital systems, that is very threatening to an old business proposition. It was what I referred to, I was trying to refer to, in my earlier speech about how sometimes things that have gotten us here from a profitability standpoint, we have to put at risk, we have to let go of and look for other ways to provide value. And right now the challenge for hospitals is to provide a greater degree of value to the community through the more easy flow of information.

When we did the study to determine where the economic benefit was of that project, the numbers that came back were essentially, the primary economic benefit was in reduced tests, duplicate tests. Because right now, you know, I am being treated at Legacy, I go up to OHSU, OHSU gets to run all the same tests because they can’t get the information from Legacy. If they can get it, they don’t have a reason to do those tests. And that is, I mean, I understand, I have compassion for the CEOs of the hospitals saying “Wait a minute, why is this a good thing for me?”

But I’ve been very impressed with the vision of folks so far, to stay with this and believe that this is the right thing for the community as a whole. And that’s what gives me hope in believing. I’d say, you know, you asked me how far along we are, I’d say we are still, we haven’t reached that tipping point. I’d say, I agree with Luis that the toothpaste is out of the tube. That is going there, but we haven’t quite got to that place where we have everybody fully admitting or fully embracing the notion that the new world around healthcare data interchange is better than the old world of “keep the castle keep strong, build the castle walls higher.”

Matthew: Right, and the last sort of question on this concerns the “Wall Street Journal” article about Virginia Mason a couple of months back, which I’m sure you saw–Starbucks was their driving employer–and went to them saying “could we reduce tests?”. VM was having trouble getting all the health plans to actually reward them in a way that was conducive to that. What do you think? I presume you are still largely a fee-for-service based payer, as it were, what’s your likely evolution in reimbursement?

Mark: We are putting a great deal of focus–it’s one of our key initiatives right now–in fundamental reimbursement–basically, out-of-the-box thinking about how we reimburse. I am convinced that much of the brokenness of the system is a direct outcome of the way we reimburse.

And when George talked today about how fragmented the system is, how it doesn’t respond to diabetics and the like, I think we have to turn around and point the finger at ourselves and say that how we reimburse medicine creates that fragmented approach. Do you think for a minute that if a diabetic who had complete, you know, had the financial resources and that the system was completely accountable to him, do you think for a minute we would continue with this fragmented system? Diabetics, as consumers, would never allow it; and the system would respond to provide more of a holistic, comprehensive way to treat their illness.

I think that we, as health plans, have to change the way, we have to be willing to move away from the discounted, secret, negotiated rates that we have, that in a sense, I think, provide very little value in reality. I mean, is it really a benefit to consumers to have a 20% or a 25% discount off an alpha that is going up at twice inflation every year? I don’t think that we are really delivering enough value there. So we better think about a different way of reimbursing, and then use that opportunity, by the way we reimburse, to change the way that physicians practice.

So for example, if we were to pay on a regular basis for email visits, would we change the efficiency and the outcomes of people’s experience of healthcare? I think we might. On the other hand, it’s very scary to the actuaries and underwriters in our company who say, “Well, if we start paying for that, who is to say that doctors aren’t just going to start billing us crazily for email visits as well as all the other things they bill us for as an alternative too?”

So we’ve put together an interdisciplinary team of healthcare economists, informatics, actuaries, and, well I would just say, creative thinkers; to start working in an R&D kind of context, trying things, seeing if they work and looking at them in the lab, if you will, to say “Could these things work, and would they drive a different outcome? Would they increase people’s experience of healthcare and tend to lower the usage of healthcare?” And if it does, if we can accomplish those things as well as increase satisfaction through that, both of the physician as well as the consumer, I think we are on the right track, and then we can try it as a pilot, and then if it works in the pilot we can take it out broadly.

Luis: Matthew, there is a very good technology example illustration of what Mark just said. The enormity, perhaps all of the software investment that has gone into tools for health plans to date, has been in the claims. How do we pay claims efficiently? And that really gets to the point of Mark, that that happens very late in the process, really at the end of the process, and doesn’t take into account any real intelligence, any real purposefulness as to what are the behaviors that we want to incentivize.

The premise of Kryptiq’s Courier line, for example, is really to go upstream and help a health plan, from a software point of view, connect all those dots that he just went through, so that it can be purposeful and intentional about the decisions they make upstream, and then the claims payment payroll takes care of itself.

So we are seeing that shift as well, not just in the strategy piece, but also in the software investment. So the software investment is also moving upstream as well.

Mark: Yeah, and actually the primary reason that we bought that product from Kryptiq and are working together is because it starts with having a common vision. And that’s what’s made it exciting in terms of working with Kryptiq, is we sort of are coming at this issue, this broad issue, from two different angles, but there are many points where we meet; whether it’s us engaging with them around what they want to accomplish in terms of employee engagement, or they engaging with us in terms of helping us with that upstream process.

Matthew: Fantastic. So the World Healthcare Blog was started because the World Healthcare Congress was interested in looking at more innovation, and there we have a bunch of innovation! Luis, Mark, thank you very much indeed.

Luis: Thank you.

Mark: Thank you.

The Wyden Plan

by Merrill Goozner

Ron Wyden (D-OR) knows health care, knows health insurance, and knows the history of health care reform. He also knows politics. So the carefully considered calculations he put into his universal health insurance bill (S. 334, the Healthy Americans Act) are worth reviewing.

First, he believes the time is right to end the employer based system. He rejects the poll-driven concept that this would scare the bejeezus out of most Americans. His bill would tell employers to end their plans, give their employees a dollar-for-dollar increase in wages with the money (this makes the cost still tax deductible to employers, but taxable to employees), and have those workers go out in a revamped insurance marketplace to buy individual or family plans. Oh, and for individuals and families, buying insurance would be mandatory – like getting a driver’s license.

Consumers will like it, he claimed in the second-to-last session of the conference this afternoon, because “if they can buy insurance for less than what the employers give them, they keep the money.” Employers will like it because they are freed from all future health care cost increases.

Wyden said insurance executives have told him that they can “thrive and prosper” in this revolutionized environment. That’s interesting because his plan calls for throwing a national regulatory blanket over the entire field, something that has never been tried. When it comes to all forms of insurance, regulation remains a state-by-state affair.

He would have the federal government outlaw companies’ ability to discriminate against people in poor health or choose to insure only younger, healthier people (the adverse selection problem). He would impose a community rating system and create a minimum set of services that must be provided by every plan. “The days of cherry picking are over,” he said. “You don’t get to just choose healthy people and send the sickest people over to public programs.”

He also challenged the conventional wisdom that health insurance reform must await the next president. He believes it’s possible to get some traction this year. He has ten senators – Republicans and Democrats – signed onto his bill and he expects something similar to be introduced in the House.

Is this politically feasible? He mentioned in passing that there would be no new taxes and no new health care expenditures under his bill. The Lewin group has projected it would save $1.45 trillion over the first ten years, money that could be redirected to covering those who get either inadequate benefits or no benefits at all now. Turning the benefit into wages will also generate new taxes for the federal government to channel into subsidizing those who can’t afford to buy insurance in the private marketplace.

Sounds pretty good, but let’s get hypothetical. How will this affect the solidly middle-class voter who currently has one of those eroding employer plans? They’ll get more money in their paycheck, but probably about the same or less than what it will cost them to buy comparable insurance in the private marketplace. So there’s no benefit there.

However, they’ll also face a higher tax bill because they fell above the line getting subsidy. So for many middle class voters, this will look, smell and feel like a tax increase because it will be one. Given all the corporate executives lining up behind the Wyden plan, the chance that liberals or economic populists will point out that his plan relieves employers of their burdens while taxing the “hard-working middle class” has to be rated a better than 50-50 possibility.

And will insurance companies really line up for national regulation of their industry? Perhaps. Why not test that proposition? The current individual insurance market, which will become central under this plan, is usually described as dysfunctional. As an earlier speaker said, “If you’re in the small group or individual market in this country, you’re toast.”

Instead of testing his bill’s overall strengths in this Congressional session, Wyden should introduce as separate legislation the part of the Healthy Americans Act that would impose community rating and forbid cherry-picking on health insurance carriers selling individual and small-group plans.

The President’s signature on that legislation would be convincing evidence that the insurance industry is ready for reform.

What we’re about to hear

by David Williams

Wal-Mart CEO Lee Scott will deliver the closing address in a few minutes. If you can’t wait to hear what he’ll have to say, you can check out today’s press release or read the whole speech here.

Scott will announce a major expansion of Wal-Mart’s in-store health clinics program. Over the next two to three years, Wal-Mart intends to open 400 more in-store health clinics. Scott will also announce that Wal-Mart customers have saved $290 million thanks to Wal-Mart’s $4 generic prescription drug plan. Nearly 30% of those prescriptions were filled without insurance.

As I’ve written on the Health business blog, I’m hopeful that Wal-Mart can save the US health care system by making it unnecessary to have health insurance for routine expenses. I’m looking forward to the speech.

The text is attached.

Medical tourism–the Singaporean story

by Matthew Holt

The WHCC is truly a global conference. The small city-nation of Singapore is looking for more patients. Why? The reason may surprise you, but it’s not just about making money. I spoke with Jason Yap, Director of Healthcare Services at the Singapore Tourism Board.

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Mr. Google comes to Washington

by David Williams

Google’s Adam Bosworth told the standing room crowd that came to have breakfast with him this morning that since he was in DC it was appropriate to “talk about rights,”rather than products. He enumerated a variety of rights (he also used the word “powers”) consumers should have:

  • Power to discover –from whom and where to get help
  • Power to own one’s own data — with complete control of how it is used. This he characterized as an “inalienable right”
  • The right to choice:
    • of provider
    • of insurer
    • of treatment –in partnership with physicians. If the physician sees their patient as a “partner” rather than a “puppet” it makes all the difference in the world in how the patient is treated
  • The power of privacy –meaning the consumer can decide what to disclose to whom, and whether to withhold information without having a large red X for “meds not disclosed” appear on their chart

If consumers had all these rights, they would engage in the power of action to make better choices, though Bosworth freely offered that he doesn’t have the magic bullet.

Bosworth made a couple of other interesting assertions:

  • That the technical challenges involved in getting data into consumers hands are not hard to overcome
  • That once consumers understand what’s really going on they’ll rebel against being exposed throughout their lives to the threat of bankruptcy from medical expenses and will put the burden back on the government or others

I asked Bosworth whether he felt consumers had a role in determining their diagnosis –in partnership with their physicians– as well as their treatment. His answer: “sort of.” He doesn’t want to see patients play at being doctors but he recognizes that physicians exhibit diagnosis bias and that consumers want a “breadthwise search” to see a long list of things they may or may not have so they can rule out the scary ones.

Those looking for details of the forthcoming Google Health offering were probably disappointed but not surprised that Adam didn’t reveal much. But here’s what I picked up in trying to read between the lines:

  • Google wants to include in their PHR transaction data between physicians and health plans, physicians and PBMs, labs and physicians and so on. They are not planning to rely on feeds from physician EHRs to do this –Bosworth made a point of pegging EHR adoption outside the hospital at <10% though I think he’s understating the truth– but to try to plug directly into the payment streams
  • Google is trying to lay the groundwork to have HIPAA overturned, and short of that would like to educate providers and patients about how to get at their information even within the constraints of current laws. They’d like to see consumers have the ability to review and challenge their records as is the case with credit bureau information
  • In keeping with the Google philosophy, Google Health is likely to be a “simple, sloppy solution”

And a final tip for those wanting to work with Google: he seems to like medical experts who’ve written books

Neil Versel interviews Bill Bria

by Hylton Jolliffe

Head over to Neil Versel’s blog for a podcast interview he conducted with Dr. Bill Bria, chief medical information officer of Shriners Hospitals for Children and president of the Association of Medical Directors of Information Systems. Among the topics discussed, says Neil:  the increasing importance of CMIOs as hospitals align their IT strategies with overall institutional goals, including quality improvement, and the similar growth of AMDIS.

Day Two of the 4th Annual World Health Care Congress

by Hylton Jolliffe

Another busy day at the conference, as you’ll see in our expanding photo gallery, as well as here on the blog. Among the posts from Monday:

Michel Porter talk and reactor panel

The full video for Michel Porter’s remarks, as well as those of Ronald Williams of Aetna and George Halvorson of Kaiser Permanente, is now online. (Please be patient on the loading of the video - it’s a large file.)

Interview/Podcast with Steven Burd, Safeway 

Matthew Holt interviews Steven Burd, CEO of Safeway in a discussion of the role of employers in health care in the future, and what the next year in health care politics would bring.

Safeway’s Steven Burd’s “very solvable” problem 

David Williams weighs in on Burd’s remarks.

Unintended consequences of quality measurement and incentives

Emily DeVoto shares her notes and opinions on a session chaired by Thomas Valuck, MD, JD, Director, Special Program Office for Value-Based Purchasing, Centers for Medicare & Medicaid Services (CMS). Panelists included Brent James, Vice President for Medical Research and Executive Director of the Institute for Healthcare Delivery Research, Intermountain Health Care; and Tom Sackville, Chief Executive, International Federation of Health Plans and former British Minister of Health.

Interview/Podcast with Reed Tuckson, UnitedHealthGroup

An interview with Reed Tuckson, Executive Vice President and Chief of Medical Affairs at United HealthGroup, in which he shares his views on the future of expanding coverage, changing the market, and the politics of health care.

Employer Demands for Health IT

David comments on a panel discussion between former Michigan Governor John Engler (now CEO of the National Association of Manufacturers), Applied Materials’ Global Compensation and Benefits head Bob Hartley, and NCR’s Matt Quinn. They “did an admirable job of describing why employers should take a role in encouraging the adoption of health care IT as part of today’s Employer CEO/CFO Summit track.”

Transparency on health care quality and costs: are they connected?

Emily reports on the David Gergen-led panel discussion on transparency and the quality of health care. The panelists: Peter Lee, President and CEO, Pacific Business Group on Health and Mike Straube, CMS Chief Medical Officer and Director, Office of Clinical Standards & Quality.

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