Archive for Uncategorized
by John Goodman
December 1, 2008 at 4:23 pm · Filed under Uncategorized
(John C. Goodman, Ph.D., Dr. John Goodman is president and founder of the National Center for Policy Analysis. Known as the “Father of Health Savings Accounts,” Dr. Goodman is the author of nine books; his book Patient Power is credited with setting a pro-free-market agenda for solving health care problems. He also has authored numerous editorials in The Wall Street Journal, USA Today, and many other newspapers and appears regularly on television, including Fox News, ABC, NBC, CBS, CNN, and CNBC. Dr. Goodman regularly briefs members of Congress on economic policy issues.)
With Tom Daschle slated to become the next HHS Secretary, there has been a mad rush to get a copy of his book, Critical: What We Can Do About the Health Care Crisis, which apparently no one had previously read. Since booksellers can’t possibly meet the demand, here is my brief attempt to satisfy your curiosity.
The main ideas: Medicaid expansion, Federal Employee Health Benefits Program (FEHBP) for everyone who wants to enroll, Medicare for the nonelderly as a FEHBP option, a play-or-pay mandate for individuals, income-based, refundable tax credit subsidies (both at work and away from work), a play-or-pay mandate for employers, electronic medical records, a national health board (”to establish a single standard of care for every other provider and payer”…covering every disease from cancer to diabetes and even depression), preventive care, dental health, mental health, long-term care, home care, community health centers and combating obesity.
Not on the list: Health Savings Accounts, although Daschle was once an advocate, and even cosponsored HSA legislation.
Not on the list: Single-payer health insurance, but only because it is not politically practical.
Not on the list: Any way to pay for any of this. (The issue is not, can we afford reform? The issue is, can we afford not to?) I’m not kidding.
by John Goodman
November 25, 2008 at 12:07 pm · Filed under Uncategorized
Almost $200 million over four years, and to read the media accounts you would think this is a bad thing. I suspect it is a good thing - for the patients and for the taxpayers. Aspirin was never approved by the FDA and many experts think that under today’s ridiculous rules it probably couldn’t pass.
Link: http://www.ncpa.org/sub/dpd/index.php?Article_ID=17297
by World Health Care Blog
November 21, 2008 at 3:34 pm · Filed under Uncategorized
The World Health Care Blog is pleased to welcome posts from John Goodman, PhD, President of the National Center for Policy Analysis. Dr. Goodman maintains “The John Goodman Health Blog” on the NCPA Web site. Dr.Goodman will be a featured presenter at the 4th Annual World Healthcare Innovation and Technology Congress, Dec. 8-10 in Washington, D.C.
by World Health Care Blog
November 20, 2008 at 5:54 pm · Filed under Uncategorized
The World Health Care Blog is pleased to welcome Don Simborg, M.D. as a contributing writer. A featured speaker at the World Health Care Congress Leadership Summit on the Road to Interoperability, Dr. Simborg is Co-founder and Board Member, Health Level 7 (HL7);Founding Member, American College of Medical Informatics; Chairman, Executive Team, Anti-Fraud Project, ONC; Board Member, Foundation on Research and Education, American Health Information Management Association (AHIMA). Please view his recent post on “Is it Politically Correct Now to Focus on Healthcare Fraud?”
by Jaan Sidorov
November 20, 2008 at 10:56 am · Filed under Uncategorized
by Jaan Sidorov of the Disease Management Care Blog
Among its many good qualities, the patient centered medical home (PCMH) has been lauded as the means to primary care. Yet, assuming the PMCH has plenty of merit by itself, what does that have to do with rescuing primary care?
Simple question, but the answer is more complex. Most reasonable observers agree that primary care is hard work and undervalued. The demoralized physicians leaving primary care are not being replaced in sufficient numbers by medical school graduates, leading to shortages in many areas of the country. While the causes for this are myriad, supporters of the PCMH suggest it can reverse medical student disinterest and help the current cohort of primary care physicians to hang in there.
Will it? In this day of slavish devotion to evidence-based health care, just where is the evidence for this contention? There are no surveys of what rank and file community-based primary care physicians actually think about the patient centered medical home. In particular, we don’t know how well it will address the physicians’ lifestyle concerns or their income expectations.
There are plenty of studies on what they believe ails their profession. Physicians are unhappy about the loss of clinical autonomy, the number of hours they work and their inability to obtain services for their patients. Being responsible for any gatekeeping services is also a dissatisfier, as well as being under pressure to see a minimum number of patients per day. For younger physicians, income is a more distant consideration, compared to personal satisfaction and fulfillment outside of work.
And just what is it about the medical home that will fix these problems? Just because there is a medical home doesn’t mean high cost radiology services will not continue to come under preauthorization, that drug formularies will not put continue to put certain medications out of reach, that restrictive physician networks won’t be used or that managed care organizations won’t continue to bluntly prod physicians to achieve HEDIS benchmarks. Keeping patients away from the emergency room or the hospital requires a zealous amount of hustle that goes well beyond the 8-5 business day.
Much of the supplemental payment for the extra services of a medical home are calculated to cover the expense of those extra services such as health information technology, staff that manage care management services and the additional physician time necessary to oversee the primary care site team. It’s only after these costs are met that physicians are expected to be rewarded. We don’t know what their price point is.
The support for the medical home by rank and file primary care physicians may be overestimated. True, there are reports that the PCPCC and TransforMED pilots underway have been enthusiastically received, but this represents a small fraction of the docs out there who may not be representative of the usual mainstream doc. The point is we don’t know how they will react and, without more data, we cannot be sure that if we build the support for the medical home that they will come.
We also need to vigorously look for other solutions to what ails primary care outside of the unproven assumptions surrounding the PCMH.
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 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.
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