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Friday, January 27, 2012


Yeah, charitably, we
know what was intended. But, really?

That little graphical y-axis faux pas aside, I wouldn't get all that worked up over a relatively weak apparent Pearson-R associated with the depicted U.S. "outlier-censored" linear trend line. I'd want to see median vs "average," for one thing. Yeah, spend more, live longer, of course.

But, I'd drill down deeper (and I'm sure others are doing so).

Not to dismiss the obvious fact the we are not getting our money's worth here, in the U.S. overall. We know that (empirically if not polemically).
to wit

Having just finished contributing to a CMMI "Innovations Challenge" proposal having to do with care coordination via "health coaching" (see my January 8th post), I ran across a cautionary CBO report "Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment" (PDF).

Forthwith, John Goodman PhD posted this on The Health Care Blog: "Why The Pilot Programs Failed"

"Failed?" Dr. Goodman's summary:
  • On average, the 34 programs had little or no effect on hospital admissions.
  • In nearly every program, spending was either unchanged or increased relative to the spending that would have occurred in the absence of the program.
Love this one: "spending was either unchanged or increased relative to the spending that would have occurred in the absence of the program."
Would have occurred? Rather speculative, that one.

OK. Here's the main graph from the CBO report.

So, on cost-containment and acute inpatient re-admissions, the various programs comprised ~ a net wash, with a rather large +/- distribution around the wash. Thought experiment; imagine a vertical center line in the bar graph. Push the image over, and see it as 3-D.

To me the above graphic is conceptually the equivalent of the findings of HEDIS data (regarding which I've written before), e.g.,

At the risk of nominally conflating "apples" with "oranges," it appears that we have long demonstrated ~zero "cost vs quality" for quite some time, no matter what we try, no matter what proxy correlative metrics we proffer, no matter who the payor (like we didn't already know that). But, I want to know what the respondents in the upper left quadrant of the HEDIS graphic (representative of all of the major Chronics, btw) are doing right within the overall shotgun scatter. Similarly, I'd want to study further the "successes" part of the "Pilot Programs."

Spin as "failure"? To just summarily frame an evaluation as "Why The Pilot Programs Failed" could not be more transparently partisan. Perfectionism Fallacy 101 (one which conveniently ignores the pesky fact that most private sector bootstrap or VC-funded initiatives also "fail" in one way or another).


I don't think anyone intends that we do the same thing over and over. For example, a core component of HealthInsight's grant proposal -- in addition to that of "health coaching" for patient self-management support -- is that of "clinic coaching," i.e., workflow analysis and re-design training for clinic staffs, with a specific emphasis on optimizing HIT use, through which to improve care and outcomes while reducing the FTE burden of HIT use. This maps right to the observations made by Messrs Weed in "Medicine in Denial" (we will head back Down in the Weeds' shortly).


ONC: Health apps among big trends of 2012

By: Brian Dolan | Jan 30, 2012
Last week Dr. Farzad Mostashari, the National Coordinator for Health Information Technology at the US Department of Health and Human Services, penned a column on his top five health IT predictions for the year ahead. Not surprisingly, Mostashari expects consumers to use eHealth to get more involved in managing their own health. “I believe this year we will see consumers and patients use information technology to become better informed about their health and more engaged with their own care than ever before,” Mostashari writes. “In large part, this will happen because it’s becoming easier for consumers to electronically access their own information. Personal health records are becoming easier to use as more data holders make it possible to download information through tools like Blue Button. Many health care providers are setting up patient portals which are directly connected to their EHRs. The Medicare and Medicaid EHR Incentive Programs already require providers to give patients access to their electronic health information, and I anticipate future stages will build on that notion. And the work that is being done on standards and interoperability will help make consumer access to their health information more seamless and more useful.” Mostashari also noted his office’s push to encourage developers to create more meaningful health apps through its series of app challenges that it puts on through Health 2.0, which received a $6 million grant to conduct the challenges. “In addition, developers are coming out with more apps for mobile devices that make it easier for consumers and patients to get information about different diseases and track their own health over time. Along those lines, several Beacon Communities have launched txt4health, a consumer engagement campaign that uses cell phone text messaging to deliver information about diabetes care and management,” Mostashari writes. “ONC will diligently keep encouraging the marketplace to develop mobile apps and other consumer-friendly platforms that get patients engaged by sponsoring challenges like the Healthy Apps Challenge. Once consumers start to see their own information, they will be more empowered to be partners in their own care and come to expect that providers will use health IT as a tool to help deliver high-quality care.”...
Yeah, but, a lot of this "innovations" stuff has distinct vestigial wafts of the era of a decade ago.

As I recently observed in the comments in "The Entrepreneur’s Dilemma,"
why, it's

More thoughts on this shortly, which, for one thing, is gonna take me Back Down in the Weeds'...


So, I got to this link in the wake of reading a couple of articles on health care at

Yeah! Yet another "innovation" effort, I guess, this one by Forbes contributor Dan Munro. So, we're just supposed to summarily "recommend," "tweet," or "invite" without knowing any details? "Share the news"? WHAT "news"?

I clicked on "Like Us on Facebook" to perhaps learn more.

Only to get this.

Whatever. In fairness, their "blog" link works.


Dr. Kent Bottles reports on the recent CMS Care Innovations Summit over at The Health Care Blog.

PS- one more "Oopsey" for your HIT enjoyment:

1 comment:

  1. Hi Erica, I really like your presentation with information.Thank you for your kindness!

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