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.

About three weeks ago Cain Brothers Investment Bankers released a report that foreshadowed the collapse of HMO stock prices that has occurred over the past few days.  The report was entitled: FAREWELL TO A TIME OF PLENTY? Health Plan Strategies for Growth in a More Challenging Market. 

Here are a few highlights from the report: (more…)

Jessica Hupp at RN Central writes a thought provoking article titled 20 Surprising Ways Wal-Mart Clinics Will Affect US Healthcare.

#20 is “Decreased Continuity of Care”.  I think this one is debatable, and I’ll offer as #21 “Increased Continuity of Care”.  

Jessica writes:

With traditional doctors, patients have charts and medical records, but at in-store clinics, diagnosis is a one-off deal. Problems that could be caught over multiple visits and diagnosis could go unearthed unless the patient works to inform practitioners.

I’m picking up on a split in the thinking of companies running the retail clinics.

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Last week I did the major annual tune-up of my presentation on Disease Management Megatrends for the MCOL Future Care Web Summit. 

I’m pleased to share a copy of the PowerPoint presentation with you, and I hope you find it useful and provocative.  You can view and/or download a copy here (6MB).  This version contains 77 slides, which would be about the length I’d use for a 3 hour workshop; you’d see a more compact version for a conference keynote, Board summary, or management strategy session.

fyi, the DM Megatrends are:

MAGNITUDE: We are just scratching the surface of chronic disease challenges.
INTEGRATION:  The 50 year tide is shifting toward integration, away from specialization.
MEDICARE: While Medicare has endorsed the need for chronic disease management, disappointing results from recent demo projects make future direction unclear.
PROVIDERS: Care providers have woken up to DM opportunities and threats; they are promoting the medical home and the Chronic Care Model.
MAKE, ASSEMBLE, BUY? Fewer are buying as health management becomes increasingly strategic.
TECHNOLOGY:  DM in your home and your pocket.
BEHAVIOR CHANGE: DM is moving from a medical to a social model; behavior change has become the Holy Grail.
CLINICAL AND ECONOMIC ROI:  Round one is over, DM wins; Round 2 has just begun.
WILDCARDS! (employers, P4P, retail clinics, CDHPs, elections)

Comments are always appreciated.

Last week was a podcast of DM Megatrends…next week — the movie.  Brad has signed, Angelina is waffling.

Over the past week I’ve been doing a major tune-up of my presentation on Disease Management Megatrends for the annual MCOL Future Care Web Summit. 

More typically, DM Megatrends is 45–90 minute presentation with accompanying PowerPoint slides.

As part of the Web Summit, the good folks at MCOL asked me to do a short podcast on highlights of this presentation. They’re allowing me to share it with you… click here to save or listen to the podcast.

fyi, the DM Megatrends are:

MAGNITUDE: We are just scratching the surface of chronic disease challenges.
INTEGRATION:  The 50 year tide is shifting toward integration,  away from specialization.
MEDICARE: While Medicare has endorsed the need for chronic disease management, disappointing results from recent demo projects make future direction unclear.
PROVIDERS: Care providers have woken up to DM opportunities and threats; they are promoting the medical home and the Chronic Care Model.
MAKE, ASSEMBLE, BUY? Fewer are buying as health management becomes increasingly strategic.
TECHNOLOGY:  DM in your home and your pocket.
BEHAVIOR CHANGE: DM is moving from a medical to a social model; behavior change has become the Holy Grail.
CLINICAL AND ECONOMIC ROI:  Round one is over, DM wins; Round 2 has just begun.
WILDCARDS! (employers, PHRs, P4P, CDHPs)

by David C. Kibbe, MD MBA

Dear Colleagues:

Thursday I attended a wonderful one day conference, entitled “Health 2.0 — User Generated Health Care.” One of the most interesting events of 2007. Held in San Francisco. I had a chance to talk with Adam Bosworth and Missy Krasner of Google, with Peter Neuport of Microsoft, and with David Brailer, among many others. It was particularly good to see Drs. Walter Lim and Rick Chan, with the Ministry of Health in Singapore, who came all the way from Singapore for the event. I was on the final reactor panel with Esther Dyson, Lee Shapiro of Allscripts, and Jay Silverstein of Revolution Health, representing the American Academy of Family Physicians (AAFP).

How to describe this event? (more…)

One of the most valuable exercises I sometimes go through with clients is a road-kill autopsy (RKA) — examining what went wrong with a business model or a policy that has been driving down healthcare highway ahead of where we are today.

I hope we can learn a lesson from the progress (or lack thereof) of Consumer Driven Health Plans (CDHPs).  More specifically, how did CDHPs get so politicized in the first place, and how can health care information technology (HCIT) and chronic disease management continue to maintain bipartisan support?

(more…)

What impact will CDHPs (consumer driven health plans) have on patients with chronic conditions? Jason Shafrin of Healthcare Economist blog refers to a recent study examining this important issue:

The authors also found that increased cost sharing led to a slight increase in hospitalizations. However, when the subpopulation of individuals with chronic health conditions is examined, large increases in hospitalization rates are found. This means that individuals with chronic health conditions forego office visits and drug purchases due to the increase in price, but this decision will worsen their health and thus increase the chance they are hospitalized.

My colleague John Riedel and I have spoken a number of times on the impact of CDHPs on chronic DM.    You can view a recent copy of our PowerPoint presentation — “CDHPS + DM = Population Health?”.

CDHPs are a wildcard as to their ultimate impact on chronic care.  On the one hand, CDHPs and DM are eye-to-eye about the need for high-quality:

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Translation  Todays blinding flash of the obvious (BFO): How can you expect pay-for-performance (P4P) programs in Medicare to work with out a designated physician quarterback (QB)?

Please allow me to elaborate.

P4P programs are based on two assumptions:

1. Patients are assigned to a physician or a practice that will have primary responsibility for their care, and
2. That a meaningful fraction of the care physicians deliver is for patients from whom they have primary responsibility

Wouldn’t you expect that this would be problematic for older (Medicare) patients who see multiple doctors over time? How can you assign accountability for performance to one doctor when the patient is seeing a number of doctors for a number of care episodes? (That’s the BFO part for me.) and wouldn’t you expect this to be even more problematic for patients with multiple,chronic conditions?

Shouldn’t somebody study this to figure out whether P4P is doable in Medicare? Well, they have. (more…)

Practice Fusion (PF) has announced a deal with Google to provide a free electronic health record (EHR) to physicians. The EHR will be supported by ad revenues from pharmaceutical companies, insurance companies and others. Read more here.

What’s the connection to care management and chronic disease? EHRs and personal health records (PHRs) are wildcards in the care management equation. You can look at this two ways: 1) The lack of EHRs and PHRs is a potential rate-limiting step toward true population health management, and/or 2) Management of chronic diseases and conditions promises to be a killer application to justify the costs of EHRs/PHRs.

There are many positives about the Practice Fusion EHR. Offering it for “free” to physicians addresses one major barrier to adoption. PF describes their offering as “interoperable”. It will be web based — a promise of ubiquity. What company wouldn’t salivate at the prospect of a partnership deal with Google. Finally, the web site speaks of a PHR coming late in 2007; an integrated PHR/EHR would be a very powerful offering.

However, for now IMHO, the negatives surrounding the PF EHR will prevent significant market traction: (more…)