2008
An Open Letter to the Obama Health Team
12/15/08
By David C. Kibbe & Brian Klepper
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.
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“...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.
Read More...
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Engage Wtih Grace
11/26/08
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.
Small Business Coverage: A Report from the Trenches
11/25/08
By Brian Klepper
John Sinibaldi, a well-respected health insurance agent in St. Petersburg, Fla., has become prominent in Florida's broker community because he counsels and services a large book of small business clients and studiously tracks the macro trends that impact coverage for this population. And he's active in the state's regulatory and legislative activities.
The other day I dropped him Jane Sarasohn-Kahn's post that reported on the International Foundation of Employee Benefit Plans' survey showing that most employers still want to be involved with health care. John responded with a long description of what the small employers he works with are up against. It's an illuminating, damning piece. I asked him whether I could post it, and he graciously agreed. Read More...
John Sinibaldi, a well-respected health insurance agent in St. Petersburg, Fla., has become prominent in Florida's broker community because he counsels and services a large book of small business clients and studiously tracks the macro trends that impact coverage for this population. And he's active in the state's regulatory and legislative activities.
The other day I dropped him Jane Sarasohn-Kahn's post that reported on the International Foundation of Employee Benefit Plans' survey showing that most employers still want to be involved with health care. John responded with a long description of what the small employers he works with are up against. It's an illuminating, damning piece. I asked him whether I could post it, and he graciously agreed. Read More...
America's CEOs Set Priorities for the Obama Administration
11/21/08
Brian Klepper
Originally Published on The Health Care Blog
This past Monday and Tuesday, The Wall Street Journal convened an extraordinary conference of about 100 CEOs to develop and recommend issue priorities for the new Administration. (See the participant list here.)
This meeting brought together the nation's industry power players. Several Senators and Congressional representatives participated, as well as Rahm Emanuel, the President-elect's new Chief of Staff, and others who advise Mr. Obama.
Based on their business' core focus, the attendees were assigned into four major areas: 1) Finance and the US Economy, 2) Energy and the Environment, 3) American and the Global Economy, and 4) Health Care.
Then in the General Session that followed, the focus groups' recommendations were incorporated into a final list and reranked by all the participants. Here's the graph showing the relative ranking of all issues. Read More...
Originally Published on The Health Care Blog
This past Monday and Tuesday, The Wall Street Journal convened an extraordinary conference of about 100 CEOs to develop and recommend issue priorities for the new Administration. (See the participant list here.)
This meeting brought together the nation's industry power players. Several Senators and Congressional representatives participated, as well as Rahm Emanuel, the President-elect's new Chief of Staff, and others who advise Mr. Obama.
Based on their business' core focus, the attendees were assigned into four major areas: 1) Finance and the US Economy, 2) Energy and the Environment, 3) American and the Global Economy, and 4) Health Care.
Then in the General Session that followed, the focus groups' recommendations were incorporated into a final list and reranked by all the participants. Here's the graph showing the relative ranking of all issues. Read More...
Two Mea Culpas
11/19/08
Brian Klepper
Originally Published on The Health Care Blog
Here's an attempt to recover from two mistakes yesterday. My post on our dismal prospects for real health care reform prompted a couple readers - thanks to Hal Andrews and Fred Goldstein - to take me to task for suggesting that lobbying ought to be abolished.
And Barry Passett - who was a lot closer to the events in question than I was - pointed out that I misstated the reason that the Clinton's reform effort was killed, and in doing so over-simplified the issue.
I wanted to put my clarifications into a post rather than a comment, to give them the attention they deserve. And I've revised yesterday's post to reflect the corrections. Read More...
Originally Published on The Health Care Blog
Here's an attempt to recover from two mistakes yesterday. My post on our dismal prospects for real health care reform prompted a couple readers - thanks to Hal Andrews and Fred Goldstein - to take me to task for suggesting that lobbying ought to be abolished.
And Barry Passett - who was a lot closer to the events in question than I was - pointed out that I misstated the reason that the Clinton's reform effort was killed, and in doing so over-simplified the issue.
I wanted to put my clarifications into a post rather than a comment, to give them the attention they deserve. And I've revised yesterday's post to reflect the corrections. Read More...
The Changes We Need
11/18/08
By Brian Klepper
Originally Published on The Health Care Blog
These are, as the Chinese curse reputedly called them, interesting times.
If the burst of new Democratic health care reform proposals is any indication, a fresh breeze of the Obama campaign's "Yes We Can" optimism is blowing across the nation. Mr. Obama’s team is expected to make health care one of its priorities. First out, though, was Senate Finance Committee Chair Baucus (D-MT), who introduced an aggressive health care reform package that builds on Mr. Obama’s campaign platform of cost controls and extended coverage. Senator Kennedy (D-MA) and Representatives Dingell (D-MI) and Stark (D-CA) are expected to offer proposals soon, and undoubtedly there will be others.
The rub is that Congress’ old-guard lobbying system remains in place. Congress is awash in special interest contributions - $2.8 billion from 15,500 lobbyists in 2007 - that exchange money for influence over policy. When the Democrats retook Congress two years ago, they did not substantively change the lobbying rules.
So it is reasonable to ask whether a new day of governance in the common interest is possible. Can we make progress on health care or on any significant problem - climate change, education, energy policy, finance, the social safety net - without addressing the underlying problem of Congress’ receptiveness to special interest influence? Read More...
Originally Published on The Health Care Blog
These are, as the Chinese curse reputedly called them, interesting times.
If the burst of new Democratic health care reform proposals is any indication, a fresh breeze of the Obama campaign's "Yes We Can" optimism is blowing across the nation. Mr. Obama’s team is expected to make health care one of its priorities. First out, though, was Senate Finance Committee Chair Baucus (D-MT), who introduced an aggressive health care reform package that builds on Mr. Obama’s campaign platform of cost controls and extended coverage. Senator Kennedy (D-MA) and Representatives Dingell (D-MI) and Stark (D-CA) are expected to offer proposals soon, and undoubtedly there will be others.
The rub is that Congress’ old-guard lobbying system remains in place. Congress is awash in special interest contributions - $2.8 billion from 15,500 lobbyists in 2007 - that exchange money for influence over policy. When the Democrats retook Congress two years ago, they did not substantively change the lobbying rules.
So it is reasonable to ask whether a new day of governance in the common interest is possible. Can we make progress on health care or on any significant problem - climate change, education, energy policy, finance, the social safety net - without addressing the underlying problem of Congress’ receptiveness to special interest influence? Read More...
Can Health Plans Explain Why They Aren't Re-Empowering Primary Care?
11/06/08
By Brian Klepper & David Kibbe
Sometimes a whisper is more powerful than a shout. Here's a cartoon from Modern Medicine that shows a Medical Home counseling session between a primary care physician (PCP), a specialist and the health plan. The PCP looks forlorn, while the specialist and the insurer have their backs turned, fuming. It is perfectly true.
Along with changing the way we pay for all health care and creating far greater pricing and performance transparency, we need to turn around the primary care crisis if we hope to substantively improve quality and cost.
Over decades we allowed the combined actions of the AMA, Medicare and the nation's commercial health plans to marginalize primary care, so that now the typical cardiologist makes up to 4 times more than a PCP, and only 7 percent of medical school graduates now enter office-based primary care - not nearly enough to care for the aging boomer population that's growing by leaps and bounds. Read More...
Sometimes a whisper is more powerful than a shout. Here's a cartoon from Modern Medicine that shows a Medical Home counseling session between a primary care physician (PCP), a specialist and the health plan. The PCP looks forlorn, while the specialist and the insurer have their backs turned, fuming. It is perfectly true.
Along with changing the way we pay for all health care and creating far greater pricing and performance transparency, we need to turn around the primary care crisis if we hope to substantively improve quality and cost.
Over decades we allowed the combined actions of the AMA, Medicare and the nation's commercial health plans to marginalize primary care, so that now the typical cardiologist makes up to 4 times more than a PCP, and only 7 percent of medical school graduates now enter office-based primary care - not nearly enough to care for the aging boomer population that's growing by leaps and bounds. Read More...
An Impending Hanging: Will Health 2.0 Be Compromised By The Economic Downturn
10/21/08
Brian Klepper
From The Health Care Blog
Nothing focuses the mind like an impending hanging. -- Samuel Johnson
I've been preparing for tomorrow's 3rd Health 2.0 conference in San Francisco, where I'll join my pals Matthew, Indu Subaiya, Jane Sarasohn-Kahn and Michael Millenson amid a Who's-Who cast of health industry luminaries. I spent part of Monday reviewing the attendee and sponsor lists, impressive indeed, testament to how seriously this topic is being taken throughout health care.
The meeting is sold out at 950 participants. It's worth remembering that, before the first Health 2.0 conference 13 months ago, Matthew, who with Indu took enormous professional and personal financial risk to pull this off, told me he'd be surprised if 75 people showed up. There were almost 500, many of them with genuine influence. Read More...
From The Health Care Blog
Nothing focuses the mind like an impending hanging. -- Samuel Johnson
I've been preparing for tomorrow's 3rd Health 2.0 conference in San Francisco, where I'll join my pals Matthew, Indu Subaiya, Jane Sarasohn-Kahn and Michael Millenson amid a Who's-Who cast of health industry luminaries. I spent part of Monday reviewing the attendee and sponsor lists, impressive indeed, testament to how seriously this topic is being taken throughout health care.
The meeting is sold out at 950 participants. It's worth remembering that, before the first Health 2.0 conference 13 months ago, Matthew, who with Indu took enormous professional and personal financial risk to pull this off, told me he'd be surprised if 75 people showed up. There were almost 500, many of them with genuine influence. Read More...
Health Care and the Broader Economic Crisis
I used to worry that the economic turmoil resulting from health care's relentless cost explosion would cascade into all other economic sectors. Now it appears that the credit crisis could push health care over the edge. The silver lining is that a sudden spike in the pressure on health care organizations could facilitate a transition to the meaningful reforms that are necessary to resolve the crisis.
Chastened and More Sober, Harry & Louise Return
A clever new ad sponsored by powerful DC-insider groups features a reformed Harry and Louise, this time hoping that Congress will make the changes that they opposed during the Clinton years. But reform is unlikely unless the nation's most powerful power-brokers - non-health care business - galvanize and mobilize to drive it.
From Description to Action: The Future of Health 2.0 Tools
Health 2.0 ventures will rapidly evolve from merely describing biological, clinical and financial processes, to using knowledge and data to recommend action.
Health Systems' Ferocious Challenges
07/22/08 Filed In:Hospitals & Health Systems
America's health systems are facing an increasingly hostile marketplace. Keeping our hospitals intact will require changes in how we treat them and how they manage themselves.
A Hat Tip To Dr. Benjamin Spock
05/02/08 Filed In:Physicians | Influencers
Dr. Benjamin Spock was one of the most influential physicians of the 20th Century, not only in how babies were cared for, but later, in his prominent opposition to the US' war in Viet Nam.
The State of Employer-Sponsored Health Coverage
New data make it clear that America's employer-based health coverage system is increasingly in shambles, providing adequate coverage to a rapidly diminishing percentage of the population. We can fix it or replace it but, for the good of the nation, we need to do one or the other. To let it languish causes enormous unnecessary suffering and cost.
An Open Response To HHS Secretary Michael Leavitt
Under the Bush Administration, HHS officials keep telling us how they support health care pricing and performance transparency. But in withholding Medicare physician data from public scrutiny - they have followed the AMA's advice that doctors have a right to privacy - they demonstrate that their interest in transparency is selective.
Knowledge Like Clear, Clean Water, Muir Gray on Health Care's Progress
Sir Muir Gray's vision of the challenges we now face in health care - he is Chief Knowledge Officer of Britain's National Health Service - merits attention by anyone seriously interested in the topic.
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On Corporate Health Care: An Exchange with Maggie Mahar
In a response to my article on the emergence of corporately-run worksite clinics, Maggie Mahar argues against for-profit health care, and I clarify my position.
Rebuilding the Medical Home: What Walgreens Surely Sees
In March 2007, Walgreens suddenly acquired the two largest worksite clinic firms. Combined with their convenience care clinics, this gave them more than 500 primary care sites nationally. They estimate that there are 7,600 employer campuses in America with 1,000 or more employees onsite. Is this the beginning of the true corporatization of primary care. And if corporations come to own primary care's referral base, can't they capture all of health care?
Loving Our Children
03/14/08 Filed In:Sex Education | Public Policy
New data clearly show that one in four American teens have at least one sexually transmitted disease. One in seven have more than one. A refusal to confront this news directly by changing the abstinence-only sex education policies of the last decade is tantamount to child abuse.
The Myth of Health Care Consumerism
03/13/08 Filed In:Consumerism
Contrary to the prevailing wisdom, most people surveyed say they absolutely won't use the Web to investigate a health condition and then change their behaviors accordingly. But they will do something their sister-in-law tells them. What does this mean for the future of consumerism?
Health Care and the Gathering Storm
02/28/08 Filed In:Economics
Developments in the larger US economy don't look good for health care, its largest sector.
Cognitive Dissonance and HHS' Position on Medicare Physician Data
02/03/08 Filed In:Public Policy | Physicians
Just as it launches a new program aimed at allowing local organization access to physician profiling information, HHS has blocked access to that same information by a national consumer group.
PlumpyNut
Plumpy'Nut, a nutritional bar that can mean the difference between malnourishment and thriving in the world's poorest regions, is an example of the good we can do if we simply care to do it.
Families USA Health Action 2008: An Alternative Plan
Families USA is an impressive organization that has built a formidable platform over the year through its base, consumers. But to achieve the reforms it advocates for, it must leverage that platform with the one group that has enough strength and motive to bring meaningful reforms to fruition: large employers.
Families USA Health Action 2008: Don Berwick MD on Everything
Through patience, an ability to articulate need and solutions, and diplomacy, Dr. Berwick has facilitated tremendous quality advances in hospitals across the country. And that lends him enormous authority to urge the process on. At the Families USA meeting, he described his vision.
Families USA Health Action 2008: Tony Fauci MD on Global Health
01/28/08 Filed In:Global Health | Public Policy
Dr. Tony Fauci's work is inspiring because it is global health activism in the cause of peace, security and prosperity.
Families USA Health Action 2008: Tom Daschle on Reform
01/27/08 Filed In:Public Policy | Reform
Former Senate Majority Leader Tom Daschle delivered a satisfyingly comprehensive and thoughtful reform proposal that made it clear he's aware of the deep challenges involved in actually getting change accomplished.
Families USA Health Action 2008: Nancy Pelosi's Address
01/24/08 Filed In:Public Policy | Reform
Nancy Pelosi made a major health care reform speech at the Families USA Health Action 2008 Conference. If this is the most complete vision the Democrats have, then we're in trouble.
At Families USA Health Action 2008
01/23/08 Filed In:Reform | Public Policy
The health care consumer advocacy organization Families USA invited several bloggers, including me, to attend their Health Action 2008 Conference in late January 2008. It was the chance to observe the health policy goings-on from the perspective of a very well-supported and well-intentioned group with great connections. I wrote several pieces there, though I doubt they appreciated my perspective.
Four Big Trends
Four relatively little-noticed trends will have profound, positive impacts on health care. Health 2.0 is using the Web to bring patients much better knowledge and data about all aspects of health care. The lawsuit by the advocacy group Consumer Checkbook to get HHS to make Medicare physician data public has the potential to make physician performance profiling easy. Come October, 2008, Medicare and most commercial health plans will stop paying hospitals for avoidable errors like "never-events." And though its slow, we're making steady progress toward the establishment of a national health care "comparative effectiveness" agency.
Leveraging the Doctor As A Trusted Authority
Doctors have the stature and authority to create tremendous good through public policy. Why don't they use these assets?
On Practical Reforms
01/08/08 Filed In:Reform | Public Policy
We know a great deal about what works and what doesn't in health care, and what structural reforms are critical to re-establish stability and sustainability to our health system. But most policy-based reforms are ideological instead.
Jack LaLanne
Fitness guru, teacher, showman, true believer, Jack LaLanne taught millions of Americans that their bodies were indeed their temples and that anyone could be fitter.
