e-CareManagement blog

by Vince Kuraitis and Thomas Wilson, PhD, DrPH

CMS has just released the 2nd Report to Congress evaluating the Medicare Health Support (MHS) program. MHS is Medicare’s most visible and significant demo focusing on chronic disease management.

We’ve been poring over the report and will provide more detailed analysis and implications later this week. This 2nd Report to Congress covers 18 months of data on this 3 year project. It provides far more details and substantiation than RTI’s first report, which only covered 6 months data.

However, there’s nothing in here to change our January 2008 conclusion:  The rumors of MHS’s death have NOT been greatly exaggerated.

Here are the five key findings: Continue reading “CMS Releases 2nd Report on Medicare Health Support”

by Vince Kuraitis and David C. Kibbe MD, MBA

Being big fans of Clay Christensen and his theory of disruptive innovation (DI), we have been awaiting his just-released book The Innovator’s Prescription: A Disruptive Solution for Healthcare .  The book is co-authored by Dr. Jerome Grossman and Dr. Jason Hwang.

We have mixed reactions.

The book is mistitled. It should have been titled "The Innovator’s Diagnosis". The book does a fantastic job at diagnosis (Dx) of problems in the U.S. health care system. It presents many new, innovative analytical frameworks and lenses through which to view the U.S. health system.

However, it’s weak on prescription (Rx): many of the proposed solutions are speculative, ungrounded, and/or defy political reality.

We understand that the very nature of disruptive innovation implies inevitable resistance from organizations that benefit economically from the status quo. But at some point a proposed solution becomes so disruptive that you have to suspend reality to believe that it could be adopted or implemented — and many proposed solutions in this book enter that realm.

Continue reading ““The Innovator’s Prescription”: Christensen’s Book Offers Insightful Dx, Unrealistic Rx”

by Vince Kuraitis and David C. Kibbe MD, MBA

Have you ever heard anyone tell a happy story of how easy it is to get a copy of their paper medical records?

Departing Health and Human Services Secretary Mike Leavitt is laying the groundwork for this same story to apply to access to YOUR electronic personal health information.

Here’s an overview to what evolved into a long posting:

1. Analysis: The Leavitt Framework Uses the HIPAA Privacy Rule as a Baseline for Electronic Access to Personal Health Information
2. Implication: Extending the HIPAA Privacy Rule Could Restrict Your Electronic Access to Your Personal Health Information
   • A.The HIPAA Privacy Rule Should Not Be the Baseline for Governing Access to Your Personal Health Information
   • B. Examples: Extending the HIPAA Privacy Rule Creates Barriers and Confusion
3. Implication: Extending the HIPAA Privacy Rule Protects Incumbents at the Expense of Innovators Like Microsoft and Google
4. Conclusion: The Leavitt Framework Creates Bad Public Policy

Continue reading “Leavitt’s Framework Shoehorns the HIPAA Privacy Rule onto Your Personal Health Information”

The message is clear from Washington – “Comparative Effectiveness” has been proposed as the foundation for coverage decisions in Medicare.  As the feds lead - this will more than likely "trickle down" to the commercial sector.

The Population Health Impact Institute (PHII) has convened national experts to develop a practical, comparative-based system to help purchasers and payers evaluate the methods and results used in all kinds of population health management programs – including medical, case and disease management, benefit design, value-based purchasing and more.

Join us on Thursday, December 18 at 2:00 pm (EST) for a one-hour complimentary webinar to learn more about the PHII Methods Evaluation Process™ (MEP), including the:

Continue reading “Complimentary Webinar on Comparative Effectiveness Sponsored by Population Health Impact Institute (PHII)”

By David C. Kibbe, MD MBA and Brian Klepper, PhD

It seems likely that the Obama administration and Congress will spend a significant amount on health IT by attaching it as a first-order priority to the fiscal stimulus package. We take the President-elect at his word when he recently said:

"…we must also ensure that our hospitals are connected to each other through the Internet. That is why the economic recovery plan I’m proposing will help modernize our health care system - and that won’t just save jobs, it will save lives. We will make sure that every doctor’s office and hospital in this country is using cutting edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year." (December, 6, 2008)

Whether the health IT money is well spent will depend on how it is distributed and what it buys. Most observers suppose that federal health IT investment dollars will be used to help doctors’ offices and hospitals acquire and implement electronic health record systems (EHRs or EMRs). These are commercial software suites for entering, storing and managing patient health data within a practice or health organization.

We agree that some of the federal health IT money should go to purchase EHRs, especially to doctors and hospitals in rural and under-served areas, which otherwise could not afford them.

The Easy, Wrong Solution

The easy solution would be to spend most of the health IT funds on EHRs. The EHR industry has made it easy by establishing a mechanism to "certify" EHR products if they incorporate certain features and functions.

But the easy solution would not be the right one.

Continue reading “An Open Letter to the Obama Health Team on Health IT Spending”

The story you are about to read is true. The names have been changed to protect the innocent.

This is the city: Los Angeles, California. I work here. I carry a badge blog. My name’s Friday.

Click here (short) or here (long) for Dragnet theme music.

A crime of disorderly conduct has been committed. The U.S. health care system is the prime suspect. My partner Gannon and I will investigate. Continue reading “Health Wonk Review — The “Just the Facts, Ma’am” Edition”

This wonderful project is written up in today’s Boston Globe .  Happy Thanksgiving all!

Vince

by Alexandra Drane and the Engage With Grace team

We make choices throughout our lives - where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don’t express our intent or tell our loved ones about it.

This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones “know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they’ve talked to them about their preferences.

But our end of life experiences are about a lot more than statistics. They’re about all of us. So the first thing we need to do is start talking.

Engage With Grace : The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences. And we’re asking people to share this One Slide – wherever and whenever they can…at a presentation, at dinner, at their book club. Just One Slide, just five questions.

Lets start a global discussion that, until now, most of us haven’t had.

Here is what we are asking you: Download The One Slide and share it at any opportunity – with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started.

Let’s start a viral movement driven by the change we as individuals can effect…and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them.

Just One Slide, just one goal. Think of the enormous difference we can make together.

(To learn more please go to www.engagewithgrace.org . This post was written by Alexandra Drane and the Engage With Grace team)

Please read my guest post over at the Center for Connected Health .

“What’s a yabut?” you ask.

Yabut is a term coined by my esteemed colleague, the late Paul Fetrow.  It stands for “Yeah….but….”

Yabuts are the gotchas, the fine print, the details that affect the terms of any agreement.  For example, the telecom companies will tell you its easy to switch carriers now that we have number portability.  Yeah…but it will cost you $175 for an early termination fee.

Yesterday’s post ended with the optimistic observation that Google Health and Microsoft HealthVault have agreed in principle that the platforms will be open and interoperable. (Presumably) you’ll be able to either 1) move all your data from Google Health to HealthVault, or vice versa, and 2) be able to transfer data across networks, e.g., your doctor has signed up with HealthVault and the lab belongs to Google Health, but because the platforms are open and interoperable data will pass across the network and your doctor will get lab results seamlessly.

Again, the analogy here is the telephone network — where you know that you can pick up the phone and call anyone in the world, regardless of the technical networks required to pass your voice.

What are some of the yabuts to Google Health and Microsoft HealthVault exchanging data? In this case yabuts refers to customer lock-in tactics and switching costs that might be imposed. Continue reading “The Yabuts of Sharing Data Between Google Health and HealthVault”

The Election Is Over Edition edition of the Health Wonk Review is now posted at Colorado Health Insurance Insider. 

Thanks Louise!

Will the Microsoft HealthVault, Google Health, and Dossia personal health information (PHI) platforms be able to exchange data?  In our introductory essay announcing the Birth of the Personal Health Information Network (PHIN), Dr. David Kibbe and I posed a critical question:

What will the PHIN look like?  Will there be multiple, non-interoperable, competing networks or just one interoperable network?

This question is being answered with the best possible answer:  the PHIN is evolving as one, interoperable network.

Consider 3 scenarios:

• Scenario One: Status Quo — Your Personal Health Information Today
• Scenario Two: The PHIN — Multiple, non-interoperable platforms
• Scenario Three: The PHIN—Multiple, interoperable platforms

In this post, I’ll present  images of these scenarios as a foundation for a series of upcoming posts.  David and I will address questions such as “What’s really different about the PHIN? What elements create the transformative potential that has attracted Internet Titans to health care?”

Let’s take a look at these one at a time:

Continue reading “Picturing the PHIN as One Interoperable Network”

There’s a new house being built in the vacant lot across the street.  It’s the medical home, and it is going to be occupied by several primary care physician families (PCs).

From what’s been said, the PCs are nice folks and will make good neighbors.  They’re friendly, many are Episcopalian, they like white picket fences, and they have barbeques on Sunday afternoons. The neighborhood they’re coming from is not as well off nor as pristine — they’re said to be suffering from urban flight.

The current neighborhood residents are generally quite well off.  They include the Employers, the Hospitals, the Health Plans, the Specialists, and the Disease Management clan.

The long-timers in the neighborhood are aware that parts of the world are not so well off and suffer from spiraling health care costs, inconsistent quality, and frustrated patients who don’t get coordinated care — but they don’t rock the boat too much because the system has generally been good to them.

Here’s the scene: this afternoon the Employers sponsored a pot-luck dinner to welcome the PCs to the neighborhood.  It was a festive event. The party’s over and everyone has gone back to their own houses.

What do the neighbors say about the PCs when they get back to the comfort of their own homes? Let’s listen in on a few discussions.

Continue reading “Disruption in the Neighborhood? The PCs Build the Medical Home.”

The federal government sponsored Certification Commission for Healthcare Information Technology (CCHIT ) is undertaking a certification process for personal health records (PHRs) . The CCHIT PHR Work Group has invited public comment on the First Draft of the PHR Certification Criteria .

The current draft of the PHR Certification Criteria specifies use of the HL7 Continuity of Care Document (CCD) as the only endorsed standard for interoperable exchange of information to and from PHRs.  This is extremely short-sighted.

I wrote a comment to the PHR Work Group explaining why it’s important to adopt BOTH the HL7 CCD and the ASTM Continuity of Care Record (CCR) .  I suspect most professionals commenting on these criteria will be looking through the lenses of health information technology, so I thought it would be important to share a different view — one through the lenses of business strategy and public policy.  Here’s my commentary:

Continue reading “CCHIT Should Support BOTH the HL7 CCD and the ASTM CCR for PHRs.”

by David C. Kibbe, MD MBA

The basic premise of the medical home concept is continuous, uninterrupted care that is managed and coordinated by a personal provider with the right tools that will lead to better health outcomes.

In 2007, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association, released the Joint Principles of the Patient-Centered Medical Home. In this document they state the characteristics of the Patient Centered Medical Home:

• Personal Relationship
• Team Approach
• Comprehensive
• Coordination
• Quality and Safety
• Expanded Access
• Added Value

While these characteristics, in theory, may be achieved without the use of health information technology (health IT), it is also true that their realization is more likely to occur if health IT is successfully deployed. Health IT can be an empowering facilitator to the establishment of a medical home, a fact supported by experience.
What is not obvious are the best ways in which health IT should be deployed to reach the objectives of the medical home desired by patients, providers, and payers. Nor is it clear that "one size fits all" when trying to match health IT products and services with the desired characteristics, and to do so in a manner that is affordable and sustainable across a variety of practice types, large and small.

Rather than attempt to list products or suppliers of health IT, e.g. electronic medical records, EMRs, as single "solutions" to the problem of transforming practices into medical homes, we suggest here that a wiser approach is to describe the capabilities that health IT ought to provide or enhance if a medical practice is to become a successful medical home. This approach has the advantage of being vendor-neutral, allowing for innovation, variation and choice in reaching the goal of the agreed upon medical home principles and characteristics listed above.

The list below of Empowering Health IT for the Medical Home is not intended to be complete or exclusive. Over time it may expand or be modified according to the evolution of both the concept of the medical home and the technologies themselves. This flexibility is necessary in a time of constant change. However, we believe this is a reasonable description of the health IT that will empower medical practices to become medical homes in the near future.

We define Empowering Health IT for the Medical Home as computer hardware, software, and related technology that provides or enhances: Continue reading “Empowering Health IT for the Medical Home”

I’ve been critical in the past when CMS has been silent in explaining their thinking, so I’ll start this post by congratulating CMS on sharing a flood of details about the upcoming Medicare Medical Home Demonstration project.

An email from CMS arrived in my inbox this morning at 2 am.  That email notified me that they have updated the MMHD homepage .  A quick click lead me to 8 new documents containing 155 pages of newly available details on the MMHD.

If you have time to read just ONE document, take a look a this PowerPoint summary of the MMHD — it’s so fresh that it’s dated October 28, 2008.

Based on a quick perusal, here are some highlights about how the MMHD will be structured. To separate fact from opinion, I’ve put brackets [ ] around my commentary:

Continue reading “Finally! CMS Provides a Flood of Details About the Medicare Medical Home Demo”

Jason Shafrin of Healthcare Economist provides “700 billion reasons to read the Health Wonk Review ”.

Read about how the bail out might affect health care from the POV of:

• Wall Street
• Health Insurers
• Healthcare Reformers
• Doctors
• The Uninsured
• Kids

This morning the Disease Management Care Blog brought an interesting toolkit to my attention. It was published by AHRQ in August 2008, so it’s very recent.

This toolkit describes how to implement the Chronic Care Model (CCM) in your medical practice. The CCM is embedded in the Patient Centered Medical Home (PCMH) model and can be consider a foundational element of the PCMH.

I would call this toolkit “The Medical Home for Dummies, Vol. I”, but then I’m sure the Dummies copyright police would knock on my front door, so I won’t.

Here are a few more details:

Continue reading “Implementing a Medical Home — Akin to Do-It-Yourself Brain Surgery?”

Pay them to do it, take money away when they don’t — make hospitals accountable for their role in avoiding unnecessary readmissions.

Mark E. Miller, Ph.D., Executive Director, Medicare Payment Advisory Commission testified recently in front of the U.S. Senate Committee on Finance. He opened his remarks by stating:

The health care delivery system we see today is not a true system: care coordination is rare, specialist care is favored over primary care, quality of care is often poor, and costs are high and increasing at an unsustainable rate.

About a quarter of Mr. Miller’s testimony focused on an issue that hasn’t received much attention: avoidable hospital readmissions . Here are some key excerpts:

Continue reading “What’s the Best Way to Get Hospitals Involved in Care Coordination?”

“Why can’t we all just get along?”  Rodney King

The Megatrend: Collaborative Care Management Networks (CCMNs)

It’s been quite a while since I spotted a new Disease Management Megatrend, but here’s one that’s long overdue:

Collaborative Care Management Networks will be necessary to achieve optimal care coordination.

The trend in a nutshell:  payers (and others) are recognizing that optimal care coordination will require collaboration among health care stakeholders. This CANNOT be achieved with yesterday’s proprietary IT and business models.

CCMNs will share many — perhaps all — of the following elements:

Continue reading “Megatrend Spotting: Collaborative Care Management Networks”

Personal health records (PHRs) are evolving toward becoming Personal Health Record Systems (PHRSs).

…that’s my key takeaway from attending the Robert Wood Johnson Foundation (RWJF) Project Health Design (PHD) conference in Washington D.C. on September 17. The conference was entitled  A ‘Report Out’ from Project HealthDesign and Forum on Next-Generation PHRs .

A PHD Fact Sheet capsulizes the evolution from PHRs to PHRSs:

Continue reading “From PHRs to PHRSs”

In a little less than three weeks, DMAA: The Care Continuum Alliance will open its 10th annual meeting , in Hollywood, Fla. - a notable milestone for an organization that has evolved with its membership over the past decade.

I’ll be there, presenting with Dr. Victor Villagra on the "March toward Data Interoperability" and the outlook for disease management.

The content this year promises to be among the best yet, with a new track on the medical home and a keynote on population health and the medical home by American Academy of Family Physicians leader Bruce Bagley, MD, and Patient-Centered Primary Care Collaborative Chair Paul Grundy, MD.

Other tracks include innovations in care, HIT, engagement and behavior change and public-sector programs. You’ll also get an outlook on the November elections and the implications for health care reform from former U.S. Sen. John Breaux, political analyst Charlie Cook and health policy expert Ken Thorpe, PhD.

The Forum site has all the details and information on discounts still available for members of DMAA and partner organizations, including the Case Management Society of America, the National Association of Chronic Disease Directors and others.

Where would one expect to find CMS’ latest thinking on the upcoming Medicare Medical Home Demonstration project? The obvious answer would be “on the Official CMS MMHD home page ”, but you’d be wrong.

CMS has issued a Medicare Medical Home Demonstration Payment Contractor RFP available on the Federal Business Opportunities website. Thanks to the Google Alert service for digging this out.

For the casual reader, the details of the MMHD are taking shape nicely. CMS and its advisors have obviously spent a lot of time planning for this tremendously important project. If successful, the MMHD can salvage primary care from the jaws of death, rationalize reimbursement policy, and set the world right. Other than that it’s business as usual.

For those of you interested in how the details are unfolding, read on…

The MMHD Payment Contractor RFP has links to 20+ documents, most of which are mumbo jumbo contracting details. Here’s where I found the most useful information describing MMHD developments:

• Statement of Work (SOW), authored by CMS
• Design of the CMS Medical Home Demonstration , authored by Mathematica Policy Research, the Center for Health System Change (CHSC), and the National Committee for Quality Assurance (NCQA); June 19, 2008

Continue reading “Details “Emerge” on the Medicare Medical Home Demonstration”

CMS announced today that all 10 participating groups in the Physician Group Practice (PGP) demonstration achieved quality targets, and that the groups are sharing $16.7 million in incentive payments. The program rewards providers for improved outcomes delivered to Medicare patients with congestive heart failure, coronary artery disease, and diabetes.

This goes a long way in explaining Medicare’s seeming lack of enthusiasm for past or future disease management demos with DM companies and/or health plans.

Congratulations doctors!

UPDATE: The doctors might have batted a thousand for quality improvements, but only .400 for getting bonuses.  See  Practices hit Medicare P4P quality targets, but bonuses still fall short , AMNews; September 8, 2008.

Last week my esteemed colleague Dr. Jaan Sidorov and I conducted a webinar for WRG on Patient Centered Medical Home (PCMH) developments.

The process of updating a PowerPoint forces one to collect one’s thoughts, and I’m glad to share with you the PowerPoint slides along with a few highlights about the evolution of the PCMH. The highlights: Continue reading “Medical Home PowerPoint and Latest Perspectives”

From the August 6 edition of HISTalk — Healthcare IT News and Opinion:

"Re: UHG. Was at the Healthcare Quality Conference yesterday in Boston. Got to talking to a United Health exec who informed me that they have signed an agreement with Google Health and have a pending agreement with HealthVault. This backs up UHG’s previous statement that member records would be made portable. Individual made mention that the Google Health relationship extends beyond just claims records transfer and includes a technology partnership regarding UHG’s OMX."

Commentary: Among health care incumbents, health plans are experiencing the greatest heartburn over the emerging Personal Health Information Network (PHIN).

On the one hand, existing health plan IT and business models have been proprietary and closed. Here’s how a typical health plan might state their POV:

Continue reading “Heartburn Relief: UnitedHealth Joining Google Health and MSFT HealthVault?”