Can you handle the stream?
HealthStreaming is something that I’ve been thinking a lot about lately. We have all kinds of streams of data that help us make decisions these days: blogs, reviews, recommendations, financial data, etc. When I look at the data we’re gathering on the health side, I see a real disconnect: its primarily billing and clinical data built for doctors, hospitals, and insurance companies rather than the information that would help me to understand and improve my health.
Its not a surprising state of affairs: the consumer is not the customer of health care today, and information is gathered to meet the needs of health insurers, employers, providers, vendors (incl. pharma) and researchers. I would assert that most of this stuff in its current form is useless to consumers.
Yet, if we want to capture the experience and personalization we see in other places in our lives, we need to create the HealthStreaming infrastructure that captures and aggregates the data that actually matters for consumers as we all make our own health choices. As we’ve seen with EMR and PHR adoption rates, platforms like Google Health or Microsoft HealthVault are unlikely to take off until the data we want to use follows us with little effort, and killer apps allow us to use them in ways that transform our lives.
continue reading »
Jonathan Kellerman sparked a firestorm of comments with his op-ed in today’s WSJ, titled The Health Insurance Mafia.
His premise, which I’ve been arguing for a while, and which Dr Rich has written about eloquently as Covert Rationing, is that insurance, rather than solving the problems of cost, creates much of the problems we see today.
continue reading »
Theo Francis’s article in the WSJ called “Medicare offers overhaul of hospital reimbursing” contains a number of statements that reflect what side of the carrot/stick equation Medicare’s “solutions” for provider quality will fall.
Medicare proposed sweeping changes to the way it reimburses hospitals, outlining a plan that would essentially redistribute cash by reducing payments across the board and then giving providers a chance to “earn back” money by meeting quality-of-care thresholds.
Its not surprising to see individual providers opting away from Medicare patients with reimbursement not tracking to inflation, and with a 10% punitive Medicare reimbursement cut hanging over their heads, and noise about further requirements for installation of EMRs making their economics look even worse.
Unfortunately for hospitals, demographics dictate that a large portion of their patient population and revenue is tied to Medicare, where these unilateral decisions can be made. (Medicine and Economics blog has a great post on government’s difference from corporations and charity being the ability to use force, Covert rationing blog has a great post on how Medicare/insurance contracting is non-negotiable, and therefore monopolistic and potentially illegal)
continue reading »
As I think about a consumer-focused health world where consumers are truly at the center of their health experience, I see a strong need for information to help them make decisions.
That infrastructure doesn’t yet exist today, and the PHR as an aggregator of data, such as Microsoft’s newly released HealthVault won’t change that. You’re not going to see a critical mass of people go through the trouble of assembling their medical records online, unless they think its going to do something for them. In that sense, it is somewhat comforting that the backers of HealthVault have deep pockets, as it will be a while before consumers move to this platform. What’s missing? The killer app.
In the PC wars, IBM compatible PCs became a standard, not because DOS was better than Apple’s operating system (it wasn’t) but because Lotus 1-2-3′s spreadsheet ran better than the VisiCalc spreadsheet on the Apple II– propelling IBM sales in the crucial business sector.
Until that killer app rises, with incentives aligned with purchasing parties, we’ll see adoption stay at the level of the current Electronic Medical Records systems– nice, but not yet Crossing the Chasm
over into the mainstream.
Fortunately, as mentioned by RWJF‘s Lygeia Ricciardi, the business models of software companies work well with the creation of a platform that creates common data and standards.
Data contained in repositories such as HealthVault’s can form the bases of powerful tools that help individuals make good choices about health behaviors.
continue reading »
Richard Eskow has an interesting article on a post-mortem of Santa Barbara’s RHIO (full report here) done by the California Health Care Foundation.
The authors list many issues for the failure of the experiment: lack of a compelling business case, distorted economic incentives, passive leadership among participants, vendor limitations, software delays, and privacy and security issues as factors that played a significant role in the project’s eventual closure
Overall, it appears the lack of a compelling business case undermined the whole attempt– as participants could not rally around any one defining approach or benefit that would sustainably change any aspect of the business by creating benefits or addressing motivations of specific parties.
This is a key reminder emerging from this failed experiment– that innovation happens because it helps one party compete better. This is why innovation occurs at the fringes, rather than for the masses. Change is hard, and unless someone benefits enough to grow and change the way the marketplace works, nothing is going to happen.
continue reading »
The RWJF has published the 9 finalists for its Disruptive Innovations in Health and Healthcare competition.
They have some interesting entries, although I think they significantly constrained their field by focusing on nonprofit organizations only.
Nonetheless, some interesting ideas, so vote for your favorites.
http://www.changemakers.net/en-us/competition/disruptive
I was discussing disruption and marketing with a friend of mine. As is sometimes the case, when one’s friends lean toward academic & entrepreneurial types, we started talking about innovation. Clayton Christensen’s work on disruptive change came up, and reminded me of a simple truth: Customers look to satisfy needs.
Customers want to “hire” a product to do a job, or, as legendary Harvard Business School marketing professor Theodore Levitt put it, “People don’t want to buy a quarter-inch drill. They want a quarter-inch hole!”
It strikes me that one of the core issues with the health system today is that we focus on systematic, top-down costs combined with delivery and payment asymmetry. We have fragmented networks of providers looking to maximize reimbursement. We have payors ranging from government to employers to insurance companies. We have lost track of why people are paying for medical care to begin with–or we are shortchanging the other expenditures that serve the same “jobs” as health.
So lets step back and think about what jobs people are “hiring” health practitioners and products to do. In many cases, this has nothing to do with wonky goals like “universal coverage”, “quality ratings”, or “cost-efficient care”. Most people care not about cholesterol or C-reactive protein or PSA levels until the heart attack or cancer words spring up. So what are people looking for when they go to the healthcare system for help?
Some pleas from my days on the wards and clinic come to mind for me:
continue reading »
For those who think that profit doesn’t help to advance the cause of healthcare, we have an illustrative example from the diabetes world: older, generic medication is often ignored for “new and improved”– there simply is no incentive to continue to test, promote, or learn about the generic medication.
In this case, recent research (in the wake of the Avandia mishaps) that metformin was, in fact, not only cheaper but also had fewer side effects. Better and cheaper normally results in a better market share– except in pharmaceuticals where post- patent expiry, all attempts to promote a good drug disappear.
It’s an interesting dilemma, and we again see strange dynamics created by the third parties in US healthcare– this time pharmaceutical distributors (Merck Medco, Cardinal Health, McKesson). In any other business (including OTC pharmaceuticals), companies can take similar or commodity products and create brands (think about how different the oil sold by oil companies is). Do Tylenol (acetaminophen) or Bayer (asprin) have any special qualities that keep others from producing them? Clearly no, but they have a consumer brand nonetheless and are able to generate profits created through strong branding– which keeps consumers aware of the heart protection and pain relief properties of these leading compounds, and also results in modest innovations like capsules, gelcaps, and Cool Caplets. There are also some examples in Europe, where brands can be created around generics– and why Hexal commanded a strong valuation when purchased by Novartis a few years ago.
It is only where generic substitution happens with any company’s compound, as we see in the US, that we see zero investment in the promotion of the molecule. This is the tragedy of the commons– since promotion would benefit all at cost only to the advertiser and it is unclear how the advertiser would gain share, no one advertises.
continue reading »
John Goodman makes a very interesting argument pointing to 3rd party payment as a primary cause of the lack of innovation in health services. He highlights a lack of incentive for more efficient care, as it is combined more often with financial penalty instead of reward.
“There is no systematic reward for excellence and no penalty for mediocrity. As a result, excellence tends to be the result of the energy and enthusiasm of a few individuals, who usually receive no financial reward for their efforts.”
However, Goodman takes two aspects: price and quality too far. In citing the retail clinic, he claims that transparent pricing and quality of service allows success outside of 3rd party payment.
However, in discussions with Linda Hall Whitman, former CEO of MinuteClinic, this example falls somewhat short. 3rd party payment was a key to the financial viability of the MinuteClinic, including significant funds from BCBS MN. MinuteClinic’s success was based instead on SUPERIOR service combined with SUPERIOR quality at half the price.
There appears to be three approaches that consumer-focused innovation can improve upon to drive real adoption: 1) Out-of-pocket price, 2) Expected quality of care, 3) Expected level of service.
Hi Vijay,
continue reading »