How big a network will the Health Internet (aka National Health Information Network) be?

My BOTE (back-of-the-envelope) calculation is that this network could consist of about 301 million nodes.  Here’s my math (pls. clarify or amplify):

• 300 million individuals in U.S.
• 700 K doctors
• 5 K hospitals
• 295 K — other B2B healthcare entities

Very rough…but I hope you get the point.

So let’s put into perspective press releases from Google or Microsoft announcing that they have developed new “partnerships” (i.e.nodes in the network) for Google Health or Microsoft HealthVault. As an example, today Google announced partnerships with APWU Health Plan and Harvard Pilgrim Health Plan.

(more…)

One bad deal can ruin your day.

Today, LifeMasters filed for Chapter 11 bankruptcy protection.  According to its press release:

“The Chapter 11 filing is the most efficient path for the company to restructure liabilities that are a result of Demonstration Projects previously performed under contracts with the Centers for Medicare and Medicaid Services (CMS), ” said George D. Pillari, President of LifeMasters. Mr. Pillari, named President of LifeMasters today, is a Managing Director of Alvarez & Marsal Healthcare Industry Group, LLC and had been working with the company and its board as a restructuring advisor prior to the filing.

During the last four years, LifeMasters participated in three CMS Demonstration Projects aimed at testing certain disease-management techniques in fee-for-service Medicare and Medicare/Medicaid dually eligible populations. Eight other disease management, health insurance and pharmaceutical companies also participated in these projects. LifeMasters’ involvement in the CMS projects ended earlier this year.

CMS contends that LifeMasters, like other participating organizations, was unable to demonstrate success based on CMS’ study design and measurement methodologies. Similar to its claims against other Demonstration Project contractors, CMS contends that LifeMasters is required to repay to CMS any fees earned in excess of savings generated during the multi-year projects. “Rather than endure a costly and time-consuming legal path to challenge CMS, we have chosen to restructure our CMS and other liabilities through the Chapter 11 process,” Mr. Pillari added.

LifeMasters expects no disruptions in its services to clients and believes it has ample cash on hand to emerge from Chapter 11 as a viable health improvement company.

A Modern Healthcare article contains a link to the bankruptcy filing:

• In one checkbox, the company estimates it has $10 to $50 million of assets
• In another checkbox, the company estimates it has $100 to $500 million of liabilities (to all creditors, not just CMS)
• It lists CMS as it’s largest creditor — $125 million

What happened? First let me acknowledge that I don’t have first-hand specifics of the current bankruptcy filing.  However, many bread crumbs have been dropped along the trail…

(more…)

Over the past few days, several of my respected colleagues have written excellent blog posts essentially asking “Does Google Health have life?”

• Scott Shreeve — CLEAR! Shocking Google Health Back to Life
• John Moore — Is Google Health Irrelevant?
• Will Crawford — Future of Google Health

I share their observations and sentiments.  I see Microsoft HealthVault as a serious business strategy while Google Health is more like a hobby (one of probably hundreds at Google).

Are there reasons Google should stick around healthcare? Absolutely!  Off the top of my head, I can think of five:

1. Google brings unique competencies to health care information seeking.
2. Google Health is doing a good job on a shoestring budget.
3. Healthcare is ripe for disruptive innovation.
4. Microsoft needs competition.
5. Microsoft HealthVault and Google Health are more complementary than competitive.

Let’s take these one at a time. (more…)

As demonstrated by e-CareManagement blog readership, there has been a lot of interest in LifeCOMM.  My first blog post on LifeCOMM in 2007 has been single the most commented on post and the second most widely read blog post.

It’s taken me a while to sift through my thoughts and feelings about saying “Goodbye” to LifeCOMM. At first I was deeply disappointed, but after further reflection think that LifeCOMM wasn’t the right type of platform for today’s consumer mobile health market.

Disappointment

My first reaction was one of disappointment. (more…)

We’re not.

From the Kansas City Business Journal :

Google Inc. has approached Cerner Corp. about a partnership, but Cerner officials don’t sound eager to entangle themselves with the Web-search Goliath.

That’s because the proposed partnership relates to Google Health, the personal health record site launched earlier in May in beta form.

The overture hasn’t led to substantive talks, Cerner President Trace Devanny said, because Cerner doesn’t see much value in Google Health or HealthVault, a similar site that Microsoft Corp. launched in October.

Cerner CEO Neal Patterson referred to the sites during a May 23 shareholders meeting as "electronic shoeboxes," requiring consumers to do much of the data importing and updating.

Why is Cerner dissing Google? Let’s take a look at Cerner’s current business model: (more…)

In brief, Healthways position is that the Centers for Medicare and Medicaid Services (CMS) is statutorily required to expand into Phase II of MHS if Phase I is “successful”. While I’m very sympathetic with Healthways predicament and their frustration with CMS, I’m not optimistic that their tactics are likely to work.

In making the case, Healthways CEO Ben Leedle quoted the legislation authorizing MHS.

For a moment, let’s get legalistic and look closer at this legislation.  What exactly is CMS required to do? (I’ve put the more relevant wording in bold). (more…)

Google Wants to Index Your DNA, Too Business Week; April 18, 2008

A few years ago I remember reading a vivid description of how much information is contained in one person’s genetic code:  a stack of phone books high enough to reach the top of the Washington Monument.

Medicare Finds How Hard It Is to Save Money, The New York Times; April 7, 2008

For One Company, Role in Medicare Experiment Has Hurt Stock, The New York Times; April 7, 2008

The Internet and digital technologies have transformed many aspects of our lives over the past twenty years.  We can get cash at ATMs all over the world; we can book our own airline reservations; we can shop and get best prices over the Internet.

Why hasn’t this happened in health care?  Something is missing.

Recently, major global information and communication companies have announced their intention to bring their technologies and business models to health care.  While the creation of Google Health (GH), Microsoft HealthVault (HV), and Dossia (sponsors include Intel, Wal-Mart, AT&T) are important news items by themselves, what’s more important is what they represent collectively — a new Personal Health Information Network (PHIN). The PHIN and applications developed around the PHIN will fill in many missing pieces and bring health care into the Information Age.

For example, suppose you just found out you have high blood pressure – that’s not uncommon.  Suppose you could easily submit information about your condition using the Google Health platform to receive a service that does the following:

• informs you whether there are clues in your medical history that point to a cause for your high blood pressure
• explains why being overweight can be a contributing factor
• tells you in easy-to understand language what the top number and the bottom number mean (”140 over 90″)
• explains which laboratory tests are necessary
• alerts you to the possibility that one of your prescription or over the counter  drugs could be making your high blood pressure worse
• advises you about the usefulness of using non-drug approaches to treatment
• tells you which treatment drugs have the greatest efficacy and safety for your specific circumstances
• tells you if any of those generics high blood pressure drugs are available at Walgreens for $4 a month
• offers to provide you a map with several Walgreens stores in your city that carry those $4 a month medications

…and many more possibilities we have not yet begun to imagine!

This essay:

• Is the first in a series of articles we’ll be writing to describe the PHIN and why it’s important — expect about a dozen follow-up posts.
• Is an overview of the basic idea — think executive summary or long abstract
• Introduces some new concepts, which we’ll try to simplify and define.  We understand that some of this is not easy reading. ….so we suggest you refill your cup of coffee and settle in. (more…)

A High Level Comparison

Google Health and Microsoft HealthVault Personal Health Information (PHI) Platforms

There’s still not much information available about the specifics of GH, although they did release sketchy information on the Official Google Blog.  I’ll comment on a few of the particulars. (more…)

But, what DOES work?

One key lesson emerging from MHS is the need to integrate and engage physicians and other local care providers…easier said than done.

MHS is just one of many experimental approaches being tried by Medicare.  Other approaches include the medical home model, Medicare Advantage plans, Special Needs Plans (SNPs), P4P, and a variety of other Medicare demos and pilot projects.  I’ve been critical of Medicare’s lack of transparency lately, but I applaud their innovation and experimentation.

While we definitely don’t have all the answers, I’d like to bring your attention one company that I believe has the right strategy and mindset: HealthSpring.  HealthSpring owns and operates Medicare Advantage plans in Alabama, Florida, Illinois, Mississippi, Tennessee and Texas and also offers a national stand-alone Medicare prescription drug plan. 

HealthSpring recently conducted an Investor Day meeting with financial analysts.  You can read the entire transcript of the meeting here — warning, it’s about 35 pages long.  I’ve culled through this presentation to dig out some best practices that HealthSpring is employing. 

(more…)

Without pointing fingers, it’s obvious that investors were surprised by the news.  What happened?

(more…)

While Google has not “officially” announced the details of GH, they’ve left a lot of clues. In this essay I’m going to play a combination of detective and tea leaf reader — deciphering existing clues and making some educated guesses about where GH is headed….it’s very exciting.

I get truly inspired when I see a business model that 1) is exceptionally powerful, and 2) offers dramatic benefits to humanity. Google Health is just such an animal.

Let me be clear. I am not speaking for Google; I don’t work for Google. This posting is my collection of inferences drawn from the clues provided about GH and from my general knowledge of health care and business. So when I write “GH will ______”, recognize that this is me putting together clues and applying my best judgment.

Here’s an overview:

• The Current Market Structure for Personal Health Information (PHI)
• GH’s Anticipated Technology Model
• Three Leverage Points
• GH Will Be Disruptive
• Concluding Thoughts

(more…)

Here are a few of my initial impressions:

(more…)