Ryan’s “vouchercare” is a false choice

Paul Krugman spends time today ripping Paul Ryan once more. Ryan’s plan is to limit government spending way off into the future (starting with people who are now 55) by giving them a flat Medicare voucher and then telling them to try it on for size in the individual insurance market. The joke is that there is a rational way to try to introduce some consumer-choice competition into Medicare. Essentially there are two alternatives to dealing with the mess that is Medicare. Oneâ€"try to manage Medicare spending both with a global budget (the IPAB) and with specific restrictions on care that’s delivered that’s wasteful or unnecessary (via changes in FFS payment). That’s essentially the route the ACA goes. Two, give recipients a voucher that lets them choose between competing entities that can’t charge more than the value of the voucher and actually are mandated to compete on the correct things (outcomes, service, etc) like they do in Holland and in Alain Enthoven’s theories. That’s rational managed competition under a global budget, and the winners in that would look more like Kaiser and Group Cooperative than today’s insurers. Ryan’s idea is just to subsidize the dysfunctional private marketplace and to repeal the minor restrictions the ACA puts on health insurers while he does itâ€"a sure-fire recipe for disaster.

There is of course another alternative. Just to let Medicare continue to spiral out of control on both costs and the quality of services it provides, and Ryan’s plan basically does that without a safety net

The NYTimes gets sensible on privacy

Today I got pretty depressed. I saw a link that 13 tech companies were funding a seminar put on by Deb Peel’s Patients Privacy Rights.org (and no I’m not helping with a link) It’s a big pity that sensible companies have been pressured into funding that organization and worse that somehow despite the gibberish Peel has spoken in so many places she’s accepted as being the main face of consumer concerns about privacy. Of course I’ve had my say about her in the past. However I was a little heartened by this Milt Freudenheim NY Times article which after decrying the “epidemic” of personal health information violations had both David Brailer and Wes Rishel basically saying, 1) yes there will be breaches, 2) no, that’s not a reason not to go electronic and c) we need a system that bans the illegitimate use of the dataâ€"rather than punishes the accidental breach. And no Deb Peel in sight. Well done NYT.

Medicare should pay less & differently

Easy to say. Rita Redberg from UCSF points out in the NY Times that Medicare pays for loads of procedures that we know are a waste of money. After all the COURAGE trial a while back showed that stents were a waste of money, and we put in more stents now than when the data were released. This shouldn’t be much of a surpriseâ€"we ignore the evidence all the time in making health care decisions. Brian Klepper in his wonderful but probably ineffective crusade to abolish the RUC shows that CMS (and therefore Medicare’s) payment methodologies are fundamentally flawedâ€"yet we can’t fix them either. So it’s easy to say Medicare should pay less and pay differently but the political will is just not there yet. It’s lucky the Chinese are so generous.

High costs cut drug use…and not in a good way

This pretty interesting study from Avalere Health confirms what several others have shown. If you add a user fee to any medical procedure people use less of it. And of course their decision to use it less is not based on whether it’s medically necessary or not; it’s based on how much it costs and what their income is. The difference with this study is that it’s about the use of expensive cancer drugs which are increasingly oral, now that oncologists aren’t being rewarded as much for delivering them via infusion. Co-pays of $500 or more saw “abandonment” rates of 25% or more. Other factors creating increased rates of abandonment included lower income (duh) and whether the patient was covered by Medicare or commercial insurance. The study was (of course) funded by a gaggle of drug companies. They didn’t fund the (non-existent) parallel study of which of these drugs actually did the cancer patients any good, but it’s not logical that cost should be the determi nant of whether a drugâ€"especially presumably a life-saving oneâ€"gets used.

Maybe there really is mobile health after all

OK, I’m kiddingâ€"but Ford Motor Co is excited enough about its new collaboration with WellDoc that it wanted to fly me to Detroit to take a look at it. (I declinedâ€"perhaps they should move their headquarters to San Tropez). Welldoc is a pretty interesting Web & iPhone based diabetes management tool (here’s a interview video I did with CSO Chris Bergstrom last February). Now Ford has put it in the car. Apparently they believe that it’ll interact with pollen counts and automatically turn on the AC (or at least this is what the “Wheels” blogger on the NYTimes took away from the meeting). But what is interesting is that they’ve integrated the speech to text version of Ford’s Syncâ€"which is the internal bluetooth system that allows people to talk to their car. It’s experimental, but it wouldn’t surprise me to see this in many more carsâ€"at least by the time I buy my next new one in 2024.

Wellpoint gets aggressive on inpatient payment changes

We’ve heard a lot of whining over the years from private insurers about how they have to pay more because Medicare pays less. But now Wellpoint is going to essentially use the ACA as cover to put all of its hospitals on a pay for performance planâ€"obviously related to the ACO ideas we’re hearing from CMS. The WSJ reports that all hospitals in Wellpoint’s networks are going to be paid future increases based on a formula for outcomes, patient safety and patient satisfaction. Thus far private insurers have been laggards in that they haven’t really mixed up payment schemes to incent better behavior by providersâ€"even though nothing was stopping them. They always claimed they would eventually. Maybe eventually is now.

Sorry, been busy!

You may have noticed that I haven’t been hanging around THCB much this week so far. Well I have a great excuse. This is my wife Amanda and our new daughter Colette. She was born on Sunday at 6 am and mom and baby are doing very well!

Where is there mHealth, really?

Health 2.0 aficionados will know that I’ve been railing against the term “mobile health” or “mHealth” for about three years. Health 2.0 is simply the next thing in health technology, and will remain so (whatever that might be). Sure we have a definition, but it’s about what’s happening not how it happens. Calling something mHealth traps it to a device, in particular a cell phone, and ignores the rest of the ecosystem of the technology and culture that the cell phone is but one part ofâ€"that’s the concept we call “unplatforms.” mHealth is like talking about cooking in the kitchen and only talking about the fridge. It’s damn important but you need a stove, a sink and more to make it all work.So if you have a mHealth strategy, as Susannah Fox might quote LOLcats, “URDoin it Rong”.

However, the place where it makes sense to talk abut mHealth is where there are only cell phones, and that place is large tranches of the rural developing world. This came up for me twice yesterday. once in a long chat with DataDyne’s Joel Selanikio who has a really cool product called EpiSurveyor that works not via SMS but via an app on simple phones and enables very cheap and easy data collection. The other was in a high profile announcement by Johnson & Johnson (a major funder of text4baby btw), which via its Babycenter subsidiary is introducingâ€"with USAID, State Department & the mHealth Allianceâ€" $10m program supporting the use of cell phones for maternal health in developing countries.

So for the health worker in the rural Bangladeshi village, lets have an mHealth strategy. For those of us in the developed world, we need an overall strategy to deal with data and applicationsâ€"whatever devices they are using.

Big community hospital CEO pay-out. Normal, criminal, both?

Salinas is a poor-ish rural California town down Highway 101 from Silicon Valley, and the financial contrast between the two is similar to that between Beverly Hills  and Bell, a California city where officials’ salaries sparked national outrage and then arrests. Now it turns out that the CEO of the local Salinas community hospital got a $4m retirement pay-out and a $150,000 a year pension and managed to stay on in his job for another two years at $668,000 a year and when he retired last week he got another payment of nearly $900,000. Can we expect the same in the Salinas case as in Bell? I doubt it because that would expose to the world that there are thousands of community hospitals all over America paying their CEOs the same kind of moneyâ€"ignoring the $1 million + salaries most AMCs dole out.  Can running a 300 bed hospital really be that difficult?

Feds on the Web: Medicare relaunches caregiver site

I’ve been impressed by the efforts of CMS and others in the Federal government to develop helpful websites. Medicare has just relaunched its Caregivers website. It’s got a nice variety of stories, links and resourcesâ€"including links to multiple partners offering support communities and other help. While the Physician Compare site had problems (and is a much more complex effort), I thought that Healthcare.gov was a good start to the complex world of finding health insurance, and the Health Indicators Warehouse is another good start at releasing masses of data in a usable format (FD Health 2.0’s Technology Guide is linked to as part of the site). Everything here can and will be improved, and much of this will be built on by the private sectorâ€"and that’s the way it should be. But given the scorn poured upon government, lets recognize the strides made.