Health Business Blog

Bob Stone is EVP at Healthways, a pioneering disease management company he co-founded in 1981. In Part I of our interview I asked Bob to share his views on health care reform, in particular:

• Why has there not been fundamental health care reform in this country?
• Will things be different under the Obama administration?
• What should the objective of health reform be?
• Is it realistic for the US to have the best health care system in the world?

In Part II we discuss disease management and the medical home.

Share

David Williams interviews Healthways co-founder Bob Stone Play Now | Play in Popup | Download

Paul Levy of Running a Hospital hosts this week’s Grand Rounds. His theme: When things go awry.

Share

I’m not a pet owner myself, but I’ve always been fascinated at how pet lovers consider their pets to be part of the family. Now MMR Information Systems, which makes the MyMedicalRecords Personal Health Record (PHR) is promoting its product specifically for pets. The company’s PHR already supports pets as family members, but the new twist is to offer consumers a free PHR when they purchase products from Natural Products for Pets.

From PRNewswire via Yahoo!

“Personal Health Records are a centerpiece of this nation’s healthcare initiative. MMR’s MyMedicalRecords PHR service features the ability to store, index and retrieve Personal Health Records and other important documents for up to 10 family members, including pets, in one account, making it a true pet-friendly Personal Health Record for the entire family,” said Robert H. Lorsch, Chairman and CEO of MMR Information Systems, Inc. “As an animal lover I know how important our pets are to a family. I spent nearly 30 years thinking out-of-the-box creating unique sales promotion opportunities starting with my early days working with Microsoft. Using Personal Health Records as an incentive to sell consumer products represents a unique sales promotion opportunity.”

…To celebrate the launch of the program, Natural Products for Pets, based in Canoga Park California, will offer a free Personal Heath Record for up to 10 family members, including pets. NPP will give its retailers a national in-store promotional program offering a free 90-day trial of MMR’s PHR service with a purchase of any NPP product. If a customer keeps the account after the 90 days, they receive a credit for NPP products worth 100% of the cost of the PHR for a year.

The companies are also offering a free PHR and year’s supply of NPP products to Sasha and Malia Obama’s new dog (and its family, presumably).

The personal health record has had a hard time finding a business model and somehow I don’t think this is going to be the magical answer. Somehow I don’t think the Obama dog will be registering any time soon either.

Share

The sixth annual Convergence Forum will bring together leaders from pharmaceuticals, biotech, medical devices and health care services to talk about how those fields can work together better. This year’s event will be held in Newport, RI from June 11 through the 13th.

The focus this year will be on hospitals, payers and health care policy, with speakers including Charlie Baker of Harvard Pilgrim, Paul Levy from Beth Israel and Vinod Sahney from Blue Cross Blue Shield.

The agenda is posted and you can request an invitation.

Share

Was chatting with my mom this afternoon, who’s visiting from Washington, DC. While walking along she told me her trip was fine except that on her ride from the airport in Boston the cabbie was having an animated cell phone discussion the whole way. Attention to the road seemed to come second. This is a particular issue in Boston but it doesn’t have to be that way. I notice in New York City there’s a rule against it, which the cabbies follow.

As we continued our walk we came to a crosswalk near an elementary school. The crossing guard was dressed in her usual uniform and day-glo vest, with white gloves. But we noticed that she, too, was chatting on a cell phone while directing traffic and motioning kids across the street. Interesting.

Share

Today’s New York Times (Online Age Quiz Is a Window for Drug Makers) reveals that RealAge, a popular web-based test that provides tips on how to live better, makes money from pharmaceutical manufacturers. The article is quite balanced, but the overall impression it creates is that RealAge is hypocritical and deceitful: pretending to promote non-medical interventions and acting in the consumer’s interest, while really being a tool of the pharmaceutical industry and hiding that from people taking the test.

I haven’t paid much attention to RealAge but after having a look at the site today I don’t see what the big deal is. Maybe it’s just that I know how these sorts of sites work, but actually I think the disclosures are rather clear. Actually they are clearer than most sites’. The Times article focuses on the privacy policy, but I don’t agree that’s the place to look:

RealAge’s privacy policy does not specifically address the firm’s relationship with drug companies, but does state, in part, “we will share your personal data with third parties to fulfill the services that you have asked us to provide to you,” and it adds test results to its database only when respondents become RealAge members. Some critics, however, charge that consumers do not have enough information when they join.

I clicked on the About RealAge tab, which begins with a page on the company’s offerings. At the bottom of that page (and also along the lefthand column) is a link to the Business Overview, which includes the following statement:

RealAge Messaging
Permission-based e-mail provides relevant, sponsored, direct-to-consumer messages to targeted segments of its member base. These messages educate members about health conditions, prevention, and available health products, as well as motivate the members to improve their health choices, talk to their healthcare provider when appropriate, and seek out relevant health products and condition-specific medications when needed.

Of course the drug companies are going to be customers. After all drug companies are customers of almost every consumer-oriented health or medical website. RealAge doesn’t pass any information about consumers to the drug companies or other customers. It simply channels emails to consumers in its database based on parameters drug company and other customers specify. I have no problem with this approach at all.

To me the RealAge business model is similar to the model of newspapers like the New York Times itself. That means the Times newsroom has editorial independence, while the business side sells advertising. When I brought up the online version of the Times article on my computer, an advertisement for a Toyota appeared above the article and for NuvaRing birth control appeared alongside. On the bottom were Google Ads for Oparh’s Reservatrol (which looks like an attempt to ripoff Oprah’s name), I Stopped Aging Process, and 2009s Top Wrinkle Creams. This is pretty sleazy stuff. I’d much rather get a targeted email from Pfizer.

One issue, of course, is that in a newspaper the ads and editorial content are visible side-by-side, whereas on RealAge they are separated in time and space.

Share

Under the HITECH part of the Federal stimulus package, physicians and hospitals will have the opportunity to earn close to $20 billion of bonus payments starting in 2011 for “meaningful use” of “certified” EHR systems. Those terms will need to be defined soon for providers to invest with confidence.

Luckily Dr. David Blumenthal, the incoming National Coordinator for Health Information Technology, has written a perspective in the upcoming New England Journal of Medicine that sheds a bit of light on the subject. The article (Stimulating the Adoption of Health Information Technology) is free online.

One of HITECH’s most important features is its clarity of purpose. Congress apparently sees HIT — computers, software, Internet connection, telemedicine — not as an end in itself but as a means of improving the quality of health care, the health of populations, and the efficiency of health care systems. Under the pressure to show results, it will be tempting to measure HITECH’s payoff from the $787 billion stimulus package in narrow terms — for example, the numbers of computers newly deployed in doctors’ offices and hospital nursing stations. But that does not seem to be Congress’s intent. It wants improvements in health and health care through the use of HIT…

[CCHIT certifies EHRs today, b]ut many certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for ONCHIT. Similarly, if EHRs are to catalyze quality improvement and cost control, physicians and hospitals will have to use them effectively. That means taking advantage of embedded clinical decision supports that help physicians take better care of their patients.

So it’s becoming pretty clear:

• Certification will include existing CCHIT functional requirements and ease of use elements
• Providers will need to use the information in EHRs to improve how they take care of patients, not just document the information better. Physicians may be wary of typical embedded decision supports (those annoying popup windows that docs tend to ignore) but there is a big opportunity to take advantage of more advanced add-ons such as those offered by Anvita Health and SimulConsult

Time to get going!

Share

Wenchypoo hosts the latest edition of the Cavalcade or Risk Blog Carnival.

The filter to get included in this one was pretty tough. Not only was my entry about the risks of antifreeze-colored drinks rejected, but the host took the time to rag on it in the comments section! (No hard feelings.)

Share

Botox Frees Muscles for Stroke Patients in the Know is an excellent example of how informed and motivated patients, physicians, drug companies, payers and the mainstream media can work together. The New York Times article describes how a stroke patient was emancipated from a crippling situation after 9 years:

Her left arm was twisted up near her neck, making it difficult to pull on a blouse, and her fingers curled so rigidly that her nails buried themselves in her palm. When she finally learned to rise from her wheelchair, her contorted left leg had the so-called horse gait of many brain-injury victims — she stepped toe-downward, and then fought to keep her foot from rolling over.

Now, with injections of botulinum toxin every three months, she says, “I’m completely transformed — I drive, I volunteer, I take art classes.” Her fingers are so relaxed that a manicurist can lacquer her nails red.

So what was involved?

• A segment from Dr. Max Gomez on NBC that let the patient (Francine) know that there were alternatives to her original neurologist, whom she called “Dr. Bad News” for his consistently negative pronouncements
• A patient who was willing to break away from her existing regimen and travel to find a doctor who would try something new
• A neurologist willing to try something a bit different and funky –which involves injecting botulim toxin using electromyography to help guide the needle to the proper spot
• Drug companies (in this case Allergan, Solstice Neurosciences, and Merz Pharmaceuticals) which sponsor the experimental treatments
• Medicare and private insurance companies, which generally are willing to provide reimbursement

I admit I don’t have any real expertise in this area beyond what I’ve read in the newspaper. But this strikes me as an aspect of the American medical system worth preserving. When people lament the possible shift to government-dominated health care this is the kind of thing they’re worried about losing.

According to the article only about 5 percent of those who could benefit from such treatment receive it, so there’s certainly room for improvement. And this kind of approach has a lot of drawbacks including its cost and the opportunity to push therapies that don’t work.

I’d like to see incentives for physicians and drug companies preserved so that innovative approaches are pursued. It would also be useful to find ways beyond drug company marketing to spread useful approaches more widely once they are validated. A concerted rollout of evidence based medicine, including point of care reference materials and decision support tools, could help.

Share

In the last few years reporters have started to mention whether those involved in car crashes were wearing seatbelts or drinking. Editors have decided the information is relevant and could have an impact on policy and personal behavior. Of course there’s also the ticklish element of laying blame on a dead person. It might be time for the mainstream press to start doing something similar with deaths that have something to do with the medical system.

A couple of examples in today’s Boston Globe brought this to mind.

A brief item (Teen, 16, dies in accident on I-89 in N.H.) on page B5 (not indexed by the Globe site that I can find anyway)

Anthoney Wilkerson, 16, was riding without a seatbelt in the backseat… when the SUV veered to the left and overturned… Wilkerson was pronounced dead… The driver, Michael Richardson, 48, and the front-seat passenger, Angenetta Cairo, 35…were wearing seatbelts and were uninjured…”

That’s pretty stark, but it tells the story.

Meanwhile, the Globe printed a much longer obituary from the Associated Press (Jade Goody, 27, star of British reality TV) that tells very little about her death and who’s involved, even though there is arguably more to learn from it. I first heard about this unfortunate case when I hosted Grand Rounds last month. The Blog That Ate Manhattan submitted a post entitled The Tragedy of Jane Goody:

Unlike Eva Peron, whose death from cervical cancer occurred in the years before we had access to screening, Jade did get pap smears.

Jade had more than one pap smear, starting in her teens. At one point, she was even treated for precancerous changes of the cervix. And went on to have more follow up smears after that.

But when those follow up smears showed a recurrence of abnormal cells, Jade ignored letters that were sent to her advising her to come in for follow up and treatment.

Why? Because she was scared…

And now Jane Goody is going to die.

There are a couple of points here that the newspaper could have covered. In particular:

• Jade’s responsibility to follow up on letters she received
• Whether Jade’s doctors or the NHS as an entity were sufficiently active in following up. For example, whether someone should have reached out by phone

The car crash and Jade’s death are quite different. After all Jade is a public figure, Anthoney isn’t. Because of medical privacy issues I don’t think there’s much chance reporters will start asking questions about cause and responsibility in medical deaths on a regular basis. Still, it might be good if they did.

Share