Policy: The California Plan

If you've been listening to NPR, reading the NYT or the WSJ - you've been inundated with information about California's new health initiative.

In short, the plan would (WSJ, January 9):

1) Mandate coverage for all Californians,
2) Employers with more than 10 workers who don't provide medical coverage would pay 4% of their payroll into a state fund to offset costs to the State,
3) The plan would levy a tax of 2% on doctors and 4% on hospitals to further fund the State's insurance plan.

The only problem is we still don't know how much the program will cost, how they will cover the large number of illegal immigrants in the region, and how - exactly - this will ensure costs are contained over the long run. Given the major supporter of the program is Blue Cross of California...who called the plan "bold and visionary"...I think it's fair to say that insurers plan to do pretty well in the deal...unlike the providers being asked to foot part of the bill.

So who's got a reasonable plan underway?

I still think Tennessee may lead the pack (with the Governor a former Health Plan Exec)...and Vermont as a sleeper pick. Any others out there?

I'm still looking for a plan that deals with controlling costs and helping insure the uninsured...

I'm Back

My apologies to everyone who has had to drop me from their RSS feeds or has been diligently visiting only to see the aging posts on this blog. I had committed myself to finishing a paper for publication before further "blogging"- but, unfortunately, between work and the holidays - I only recently got it out the door.

For those interested, the paper is entitled "In-sourcing and Out-sourcing: Designing a Path Forward for Graduate Medical Education in Lower Income Countries," and while currently under review by a certain journal, I will be presenting my findings at the Comparative and International Education Conference in Baltimore, February 25th - March 1st.

Since most of the readers here are domestic to the US, I've haven't posted many international topics related to health and society - but if someone is particularly interested in the topic - let me know and I'll broaden the context of the site.

Again, my apologies for the extended delay. While things will be busy this quarter, I hope to at least post weekly.

Thanks for your patience!

Renewal: Health Care and Politics

It's one week from mid-term elections...

...and I have heard only a whisper regarding health care reform and the plight of our uninsured. I live in Tennessee - with one of the most hotly contested Senate races in the country - and neither candidate managed to even bring up the subject in the two televised debates I saw.

Anyone experiencing something different? Any theories on why politics has gone deaf on the subject?

My sad theory is that those disenfrachised by the System, lose faith in the System, and consequently lose all interest in participating in the System. As the disenfranchised participate less and less, the system cares less and less about them...and the cycle deepens itself.

Perhaps I'm asking too much from our leaders and too little from my fellow citizens.

Please take the time to vote next Tuesday...and think of those who weren't able to make it.

Innovation: (Blog) RED

"We are the people we've been waiting for."

Soon, I hope, you'll be seeing the above words everywhere you make a meaningful purchase. For those of you who haven't heard, Bono and Bobby Shriver (of the Global Health Fund) have just publicly launched the (RED) campaign - including the above mantra - encouraging major brands to donate some of their profit from key product lines tin an effort o help fight HIV and AIDS in Africa.

Having spent some time as an administrator for a rural hospital in Masvingo, Zimababwe - I have followed the AIDS epidemic in Africa quite closely...but was worried that this would simply become another cause...another ribbon...that became a fad and was lost again - making us feel like we had made a contribution while millions still quietly died a continent away.

Then I read the campaign's manifesto:

I can't remember the last time I read somthing so succinct and unabashedly transparent.

Then I went to the GAP to make my first (RED) purchases...and they were sold out. Talked to the chipper person at the front of the store and found out they had sold out twice in this, thier first week...both within 30 minutes of getting their shipments.

Then I went online...and they too were sold out of most sizes and colors. When was the last time you went online and they were sold out of nearly everything?

So I sit here quietly, hoping that this innovation becomes a new business model for things yet unseen. I hope our consumerism can be transformed into something other then our attachment to ego and vanity. I hope that our own health care system can take a lead from those more willing to take risks in new ways that help people other than ourselves.

Here's to (RED).

PS - For all you other bloggers out there...check out the (Blog) RED and think about adding a link to the (RED) campaign. Thanks for the consideration.

Innovation: Quietly working behind the scenes...

A group of health care, technology, and medical device companies have formed an organization called the Continua Health Alliance.

While perhaps far from the glamorous world iPod nanos and self-parking Merzedes Benz', Continua is developing interoperability standards for remote diagnostic and monitoring medical devices. With players such as Baxter, Dell, Oracle, Motorola, Pfizer, Samsung and others - its a complete "who's who" of the technology and medical worlds - finally coming together to meet the lifestyle needs of patients throughout the world.

Still not excited?

Well the first devices are set to reach the market in 2008...with a flurry of activity expected in 2010 and 2011. Philips is already out with Motiva.

Still not worried (if you're a provider)?

Imagine a world where there are half as many physician visits (given check-ups will be growingly unnecessary) and visits to the hospital only occur when they're absolutely necessary (given the device will alert you when to go to).

On the other hand...

I wonder how many people are avoiding going to both the physician and hospital when they are desperately in need of help? Perhaps remote monitoring will have the opposite effect - generating more and more business as people realize how unhealthy they really are.

Certainly the obesity epidemic would support the above hypothesis.

Either way you slice it, it's a great time to be in Health Care.

P.S. Only costs 5k for your organization to be a contributing member of Continua...may have to put that on my to do list.

Innovate: You Tube in Health Care

Anybody out there wondering if their hospital will end up on You Tube?

I did a quick search using the key word "hospital" and got over 10,000 results. Here is just one example.

Only a matter of time before people start taking their camcorders in during their stay to provide their own commentary on hospital services...and then...broadcast it to the world.

On the other hand...given You Tube's democratic model...how about hospitals getting the upperhand and posting their own "patient stories"...

Every day I am more convinced that success in health care is about embracing the possibilities and using them to tell better stories and build more robust business models...disruption in the health care field is just around the corner...and I say bring it on - we'll be better for it.

Policy: American Hospital Association Up In Arms

Earlier this week the American Hospital Association protested CMS' recent request to tie outpatient reimbursement rates to quality reporting on inpatient procedures. Their rational appeared to be...and I quote:

"We are troubled by CMS’ proposal for many reasons: First, it simply makes no sense to link
outpatient payments to inpatient measures of quality. Second, linking a reduction in the
conversion factor to the submission of inpatient PPS data that have already been reported and
made public does nothing to further CMS’ stated goals of encouraging hospital accountability
and quality improvement. Third, linking payment to data submission that predates the outpatient PPS rule is unfair and tantamount to retroactive rulemaking. Fourth, in linking outpatient payments to the reporting of quality data, CMS has exceeded its statutory authority."

For the actual letter to CMS...click here. Its 27 pages...just in case you thought you could make a quick read between meetings.

And while I probably don't follow the AHA like I should (nor give them enough credit for the work they do)...it would be great to see how AHA and CMS could work more closely together, in a unified manner, that might more forcefully engage the industry in quality innovations.

One of these days a group of providers will decide to compete based on quality and adequately "sell" quality to their physicians, payors and patients...then, perhaps, we'll start to see some movement to transparency and true, sustainable, improvements in quality.

Innovation: Harvard Finally Joint Ventures with their Physicians

Even Harvard is not immune...from having to joint venture with their physicians to remain competitive.

Will other academic centers across the country be forced to follow their lead? Looks like hospitals and physicians will have to come together in one shape or another.

Policy: Public release of Hospital Charge Data

First, let me point out another great set of commente by BC in response to my last posting. His comments are thorough, well-reasoned, and comprehensive in review of the Citizen's Action Report.

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In the news today, Minnesota hospitals released their charges (gross prices) for 50 inpatient and 25 outpatient procedures. The charges are prices before discounts to managed care providers and are built to cover costs for basic services, nursing, technology and supplies. Physician charges are not included on the site. The Web site also displays hospital volume, average length of stay, average charge per day and average and median charges for each procedure. The website is in response to a Minnesota law passed in 2005 requiring hospital price transparency. The state is one of at least nine to publish hospital prices online, according to the National Conference of State Legislatures. Click here to view the site.

While there are numerous factors in building charges that are both local and regional in nature...its at least interesting to see how one state is bringing price information to the masses.