Mark Cuban brings us an important public announcement to make sure you get your colonoscopy as suggested by the public health folks. On his blog he describes how most people tend to view the procedure:
Like every guy, the thought of being violated by a long tube is at the very bottom of the list of things I want to do on a summer day. I could live with having to take all the laxatives that lead up to the procedure, That’s just more time to get my reading done. But the tube up the outdoor, that’s scary.
I was definitely nervous. Despite doctors and nurses telling me it would be a breeze, I was naturally skeptical.
The ability for physicians, researchers, and the public to have access to representative information is required for all to make real decisions about health options and treatments. One of the core frustrations with the current system is that the information is not available– locked away in paper charts, cluttered internet searches, unpublished study results, or provider “preferences”.
To summarize, the information:
can’t be aggregated
can’t be found easily
isn’t released
isn’t put on the table for consideration, despite being an acceptable option
As we think about the fragmented components of our system, different solutions jump out, but most really only address one or two of these issues with information. While I see people with technical solutions to the first two (EMRs to aggregate the info, and health 2.0 companies are working on the improved distribution of health information), I see more issues with items 3 and 4, as they deal with the mindsets and incentives of players in the current system.
We’re starting to see requirements for companies to at least register the studies they are doing (rather than just submarining those with initially poor results) led by people like Catherine DeAngeles, editor of JAMA. While significant information also lies behind insurance company, employer, hospital, and DM company doors, the healthcare transparency movement, with Michael Leavitt on the bully pulpit looks like a start in the right direction.
The more insidiuous issue is providers giving patients the appropriate set of recommendations for the patient– uncolored by pharmaceutical company incentives (see speakers fees, No Free Lunch), personal moral/religious constraints, personal gains from reimbursement (EPO use), or restrictions due to rebate tiers (formularies). I think its valid to profit from one’s personal approach to giving care (as opposed to many of the universal healthcare folks), but that consumers should have full disclosure when they select their physician which filters being used.
The WSJ reports that a bipartisan group of several key senators, including Democrats Edward Kennedy (MA) and Hillary Clinton (NY) and Republicans Orrin Hatch (UT) and Michael Enzi (WY) have reached a deal to create a legal pathway that clears the road for generic biotech drugs, which they coin “biosimilars”.
This has been a long time coming, but is a needed reform to create a “generic” for the biotech industry– where patents are beginning to expire but replacements are not legally available.
Furthermore, broad experience in the formulation of these drugs can only help train entrants as they move up the value chain into full biotech pharmaceutical innovators.
The Feds released information on some real outcome measures today, as reported by the WSJ and the NYTimes.
The caution with which this information is being released through the Hospital Compare tool to the public highlights that it will be a very long time before the current system embraces transparency. It also highlights how hard it is to get a meaningful set of numbers, as there is tremendous debate around how meaningful death rates are given severity of cases accepted.
The report used caution in determining which hospitals ranked high or low.
Thanks to David Hogberg for highlighting Stuart Browning’s On the Fence films. I thought Stuart created an interesting analogy of the single payer in showing its impact in East German automobiles and Canada’s healthcare system.
The WSJ’s health blog highlights why consumers can’t recognize high value care in the health system.
The article discusses the increasing rate at which insurers are reimbursing for care at retail clinics such as RediClinic and MinuteClinic. The article mentions that 40-50% of care is reimbursed by insurance. In speaking to Linda Hill Whitman, former CEO of MinuteClinic, she put the figure much higher– in the 80-90% range.
I recently switched to an HSA plan. And thank goodness…its saving me $350 a month vs. my gold-plated COBRA.
I needed a medication for the first time today. Had my doctor call in a Retin-A prescription and went to the pharmacy to pick it up. Under insurance my co-pay would have been a standard $20-30 no matter where I went. Now I’m responsible pre-deductible…and the cost of $192 for a 50mg pump version blew my mind. (I keep forgetting I just saved $350/month)
Ok…so here’s where the normal consumer is now upset about the cost of care. But lets look objectively at my cost: $90ish a month for my policy, $200/month going to my HSA pre-tax, $192 for the month spent this month…vs. $450/month in premiums, $30 co-pay (post-tax…lets call it $50 pre-tax). So this month, with one long-lasting prescription, I’m spending ~$300 vs. $500…and I’m spending the time to shop to bring down the price of the meds (costco sells the 45gm non-pump version for $125). Overall savings…at least $200 and I’m looking for cheaper alternatives…sounds like consumerism is working…its the experience that needs work.
What’s really frustrating is how long it took to figure out what everything cost and to shop for the meds by digging into websites and calling pharmacies. What needs to happen is for all that to go online and be searchable…
Alli (pronounced ally) is a “new” over the counter (OTC) diet drug that previously was available as prescription Xenical, as reported by the WSJ and the NYTimes.
It works as a “fat blocker”– blocking absorption of fats into the intestine. This leads, not surprisingly, to side effects caused by unabsorbed fats: foul smelling gas, oily leakage (hence the caution to bring an extra pair of dark pants), and issues absorbing fat-soluble vitamins.
Reports on its efficacy aren’t great, but clear benefits accrue to 20%, at least while they take the pill:
• One in five will lose 10% or more of body weight • Half will lose less than 5% of their body weight
The Robert Wood Johnson Foundation has set up a contest for disruptive solutions in healthcare. It’s great that the foundations are starting to put some money behind solutions. Its a tad disappointing that the HealthShoppr prototype won’t be ready by the deadline. However, for some reason, the foundations tend to deemphasize funding for for-profits (Omidyar Network changed to supporting for- and non- profits with a social mission…but that’s another conversation.)
I’ve also provided a link to the RWJF pioneer portfolio blog in my blogroll.
Note: There is an update on the state of the contest (Deadline July 18).
Its an interesting set of complaints and it brings up how poor service is in healthcare today. In a system build on the needs of insurance companies and employers, its no wonder how poor the experience has been for consumers of the system.
This highlights the need to bring to the fore (and reward!) docs that do this right. MDVIP appears to be building its network of primary care providers to guarantee great service for a pretty hefty up-front service fee. On the cost side, poor service quality is driving consumers across the border to low-cost, largely undifferentiated services with unclear quality. The Mexican option may be what results if healthcare continues the insurance-driven race to the lowest cost provider.
Our mission then, is to adjust the system to reward docs, but do it in ways that the average individual can afford.
