Neupert On Health : access

Another milestone on the journey forward…

pnblog — Tue, 23 Jun 2009 03:43:00 GMT

Over three years ago, we started on a journey -- to empower consumers with tools to help make better health decisions and drive better health outcomes. We believed that the simplest, easiest way to start was to give consumers their data in a secure and private way, and allow them to share it from provider to provider, keep it in one place over time, and learn about it in order to make better daily health decisions. That simple idea was the beginning of HealthVault.

Back then, there were a lot of objections. Consumers don’t want their data. Consumers can’t understand their data. Their data might actually do them harm…blah…blah…blah…

But fortunately, things have shifted. Consumers have made it pretty clear that they want to be involved in their health – as evidenced by looking at social networking sites like PatientsLikeMe, the raw numbers of health Internet Searches, or research reports like The American Public on Health Care: The Missing Perspective, released by the CEG, Accenture and IOM:

· 78% of American favor giving doctors the ability to share access to their medical records if done with their permission.

· 66% said that they see the value in including their own information anonymously in a large database to help researchers.

And I’m happy to say for a number of reasons that consumer products like HealthVault and GoogleHealth continue to gain market traction.

Today marks another milestone – the first Industry-wide initiative to establish a “Declaration of Health Data rights” to support patients’ rights to access and share their own health information – https://healthdatarights.org will go live tonight, along with blog posts and endorsements from thought leaders and organizations across the country.

While we’re making change, and it's great to see so many organizations and thought leaders coming together, it’s important that we not stop here…that we continue to move forward—specifically by ensuring that consumer access to their data is included in the definition of “meaningful use.” While I’m optimistic about what I see -- what’s been laid out seems to focus on driving real outcomes improvement in the health care system -- we will not be successful without further refinements. Consumers cannot just be given access to data in static form, but must be provided with an electronic copy of their data so they can easily share it, use it, add to it -- creating a lifelong health data asset. In the end, consumers are the ones accountable for their own health.

And the debate rages on…about access…

pnblog — Wed, 10 Jun 2009 05:01:00 GMT

I think we’d all agree that the healthcare debate continues to intensify. Many say it has entered a new stage as conversations move to proposals -- with Senate Democrats recommending a bill that will amplify the debate even more -- to decide if the US will adopt universal coverage.

Access seems to have replaced change as the word of the day. Everyone seems to be focused on it -- including Peter Orszag and Virginia Postrel. There’s no doubt that access is important -- but addressing access prior to reengineering the system is like adding passengers to a sinking ship. And in this case, the ship is going down in a sea of red -- the growing debt that will be incurred.

What we really need to do is what I highlighted in my contribution to the Washington Post’s new Daily Dose Panel Blog, Diagnosing and Treating the Health Non-System.

It’s not just about access. There are multiple symptoms and ailments that interact with one another. The three principal "diseases" are:

· Access (too many uninsured people)

· Value (too much spending for the health results delivered)

· Ignorance (at every level - who really pays for health, misaligned incentives, true costs, quality measures, transparency and more)

The most important to fix is value -- how do we improve health outcomes for the same or lower economic cost? Why is this most important? Everyone acknowledges that health spending is already in an economic crisis -- both in the near term and certainly in the long term (Medicare's unfunded liability exceeds $36 trillion!). Even if everyone in the country woke up tomorrow morning with health insurance coverage, it still would not address the hard economic truth -- we must get more value, as measured by better health outcomes, for every dollar we spend on health. The recent article in the New Yorker illustrates this particularly well.

The whole operating framework surrounding the health delivery system requires re-engineering to realize value. We need a system that supports and rewards innovation in health around new drugs, new devices or new procedures. Today, this innovation happens on a small scale, at times producing great results. But what we need is broad-scale innovation around health delivery for chronic disease management (which accounts for 70% or more of total spending) as well as prevention and wellness.

The reason this innovation and re-engineering isn't happening right now in the delivery of health services is because of the inflexibility in the payment system and misaligned incentives -- largely the result of Medicare rules and regulations driven by Congress today.

Each of us pays for health care (taxes, lower incomes, cash) whether we realize it or not, but as consumers, we’re rarely informed and engaged with our own health. We can’t get the basic data we need to make the right daily decisions.

I believe that Congress must focus on building an operating framework of rules and regulations that aligns physician and hospital payment with health outcomes and encourages innovation on how best to deliver it. This is evidenced by an amazing statistic I read this week. In June 2008, the Congressional Budget Office estimated that up to one-third of 2006 spending – roughly $700 billon or nearly 5% of our GDP – did not improve health outcomes. And we want to add more people into this system?

Health Reform

pnblog — Mon, 22 Sep 2008 07:35:51 GMT

I have spent some time over the past several weeks to read and get educated about various health reform proposals. As can be expected - there is a lot of dialog on this topic given the political season. Health Affairs has some good articles up if you want to get informed about the Presidential candidates proposals. Maggie Mahar has a great post up at The Health Care Blog detailing some current thoughts of one of my favorite economists on the topic, Prof. Uwe Reinhardt.

However, the more I consider and read about the topic, the more skeptical I get about the prospects that we will have meaningful reform anytime soon...which is a real problem. I am concerned by both the lack of understanding and by the politics! I guess I am an naive idiot for being surprised.

I am generally biased towards market based capitalism and individual rights and accountabilities. But as we all know -- markets have and require rules to properly function in setting prices and allocating resources (prime reasons why they are more effective than alternative economic forms). Look at Russia today -- without the rule of law -- they can't sustain their autocratic economy.

In the U.S. Health 'system' - we sometimes have the worst of both worlds. As Prof. Reinhardt points out -- there is no legitimate reason to tie one's health insurance to employment -- it has perverse consequences. We have rigid rules on the supply side (what Medicare will pay for, how Medicaid reimburses and so on) -- which contribute to a lack of innovation on supplying economically cost effective services (tele-medicine for example). Consumers are also legitimately confused on the demand side -- neither knowing what things cost or why they need to think about providing for their future health like they have to provide for their future retirement income.

The political debate is often framed around covering the un-insured. While an important consideration -- it is not the most important issue. The most important problem is how to create a framework where we get more value out of the current spend on health. This is the key economic and policy question. If we can improve the value delivered (health outcomes/economic inputs consumed) -- then there will be more dollars available to cover the disadvantaged (social, economics, genetics). If we can't improve the former (value delivered) there is little chance we can afford the latter (more coverage).

Many smart folks realize this -- but they have not figured out how to make this argument effective with political soundbites (neither have I). So the current political dialog is shallow and does not help frame the real debate we will have to have in the coming years.

The meltdown of the U.S. financial markets is instructive to health IMHO. Not that hospitals or doctors are using leverage inappropriately, as in the financial sector. But rather that the rules and incentives matter, that transparency matters (does anybody really understand pricing in hospitals?) and that a system out of whack (imbalances -- such as docs leaving private practice) ultimately leads to a systemic problem. Many recognize the 'system' is sick, many even understand how the trends are getting worse not better - but there is not a clear path forward because of the incredibly gargantuan, yet fragmented nature of the 'system'. Hence my current skepticism towards progress.