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Tuesday, March 26, 2013

HIT, meet HIX

Robert Laszewski provides a cautionary tale on THCB:
A $910 Million Price Tag For California Exchange: A Dark Omen of Things to Come

So far California has received $910 million in federal grants to launch its new health insurance exchange under the Affordable Care Act (“Obamacare”).

The California exchange, “Covered California,” has so far awarded a $183 million contract to Accenture to build the website, enrollment, and eligibility system and another $174 million to operate the exchange for four years...

For some additional perspective I took a look at what it cost to launch the private insurance marketing site, Esurance. That company sells not only health insurance but also things like homeowners and auto insurance across the country. When I put my zip code into their system along with my age, they offered me 87 different health plans from all the big players in my area. Now granted, the new health insurance exchanges are more complex because they have to interface with Medicaid and the IRS as well as calculate subsidies. But the order of magnitude difference in what it cost to launch esurance compared to the California exchange is pretty big.

Privately funded Esurance began its multi-product national web business in 1998 with an initial $5.5 million round of venture fund investment in 1999 and a second round of $34 million a few months later.

The start-up experience of other major web companies is also instructive. Facebook received $13.7 million to launch in 2005. eBay was founded in 1995 and received its first venture money in 1997––$6.7 million in 1997...

The California Exchange officials also say they need 20,000 part time enrollers to get everybody signed up––paying them $58 for each application. Having that many people out in the market creates quality control issues particularly when these people will be handling personal information like address, birth date, and social security number...
 In that last paragraph: "these people will be handling personal information like address, birth date, and social security number."

Why not just tattoo "defraud me, PLEASE!" on the foreheads of these California HIX officials? What's a Name + Address + DoB + SSN combo worth on the street these days? Hint: upwards of $1,000, by some estimates.

Expect to see an upsurge in "private sector innovation," to be sure.

Pass the popcorn.

Six Months Out Health Plan Execs Say They Doubt Exchanges Will Be Ready

As the Obama administration continues its top secret effort to build federal insurance exchanges in about 34 states while 16 states are doing it on their own, that continues to be the big question.

HHS is using IT consulting firm CGI for much of the work on the exchanges and the federal data hub. CGI has their plate full since they are not only working on the federal exchange but also doing work for the state exchanges in at least Colorado, Vermont, and Hawaii...
And my state, Nevada. They do not particularly inspire confidence.


Changing topics: news of concern on the privacy front:
Mobile location data 'present anonymity risk'
By Jason Palmer, Science and technology reporter, BBC News

Scientists say it is remarkably easy to identify a mobile phone user from just a few pieces of location information.

Whenever a phone is switched on, its connection to the network means its position and movement can be plotted.

This data is given anonymously to third parties, both to drive services for the user and to target advertisements.

But a study in Scientific Reports warns that human mobility patterns are so predictable it is possible to identify a user from only four data points.

The growing ubiquity of mobile phones and smartphone applications has ushered in an era in which tremendous amounts of user data have become available to the companies that operate and distribute them - sometimes released publicly as "anonymised" or aggregated data sets.

These data are of extraordinary value to advertisers and service providers, but also for example to those who plan shopping centres, allocate emergency services, and a new generation of social scientists.

Yet the spread and development of "location services" has outpaced the development of a clear understanding of how location data impact users' privacy and anonymity...
Four data points? The PII re-identifying work of Harvard Professor and ONC HIT Policy Committee member Dr. Latanya Sweeney comes to mind.

In other news...

International Federation of Health Plans
2012 Comparative Price Report
Variation in Medical and Hospital Prices by Country
This year’s survey includes new prescription drug prices in response to increased interest in this area from plans in many countries. We have also added three new non-drug items to our survey: hip prosthesis, knee replacement, and colonoscopy. Prices for each country are submitted by participating federation member plans, and are drawn from different sectors:

• Prices for Canada, New Zealand, Switzerland, and the United Kingdom are from the public sector, with data provided by one health plan in each country.

• Prices for Australia, Chile, the Netherlands, Spain, and South Africa are from the private sector and represent prices paid by one private health plan in each country.

• Prices for France and Argentina are a blend of public and private sector prices with the data provided by one health plan in each country.

• Prices for the United States are calculated from a database with over 100 million paid claims that reflect prices negotiated between thousands of providers and almost a hundred health plans. 

Comparisons across different countries are complicated by differences in sectors, fee schedules, and systems. In addition, for some countries a single plan’s prices are real for that plan but may not be representative of prices paid by other plans in that market. The U.S. numbers are based on an aggregate of over a 100 million paid claims across multiple payers.
I post here just four from the larger deck of slides (pdf). You get the point. The U.S. is clearly the Undisputed Runaway Number One -- in terms of cost.

Yeah. But, let the reflexive angry chorus loudly ensue -- clamoring that the U.S. in fact has "the best health care system in the world" (facts and cogent data notwithstanding), and that these internationals are nothing more than a bunch of America-hating Socialists trying to tear us down.

Re-read that Commie Steven Brill, perhaps: "Bitter Pill: Why Medical Bills Are Killing Us."

What do I know? "It's Out Of Your Scope."
NY Times "Room for Debate," March 26th
Re-engineering Health Care

Nice series. See what you think.

apropos of quality in medicine...

Evidence Thresholds
Published by Steven Novella under Homeopathy,Science and Medicine

Defenders of science-based medicine are often confronted with the question (challenge, really) – what would it take to convince you that “my sacred cow treatment” works? The challenge contains a thinly veiled accusation – no amount of evidence would convince you because you are a nasty skeptic.

There is a threshold of evidence that would convince me of just about anything, however. In fact, I have been convinced that many scientific claims are likely to be true – sufficiently convinced to act upon the conclusion that they are true. In medicine this means that I am convinced enough to use them as a basis for medical practice...

Is it time for a meaningful use time out?
March 27, 2013 | Jeff Rowe, Editor, EHRWatch

Nearly 50 percent of HITECH funds have been paid out, and policymakers are gearing up for meaningful use Stage 3. So is it time yell “Stop!” and assess the health IT landscape?

According to one doctor, it is. Describing himself as “a ‘geek’ physician who runs a solo, private practice and the creator of one of the older EMRs,” he claims the enthusiasm for health IT is based on largely unsubstantiated claims.

He makes two main arguments. First, “Many HIT proponents justify their promotion of HIT via analogy. They posit that just as the incorporation of information technology (IT) improved the productivity and efficiencies in many industries, they contend the widespread implementation of HIT will result in many benefits to society at large. While I acknowledge that well designed HIT systems can help physicians/hospitals run their businesses more efficiently, there is no scientific evidence to conclude that this will translate into a reduction in the cost of healthcare.”...
This is a recurrent assertion of late. "No scientific evidence"? Yeah, let's have 20 more years of "analysis paralysis," that'll be much better.

EHR incentive funds often reinvested in IT
March 26, 2013 | Paul Cerrato - Contributing Writer
With no federal rules telling providers how they can spend their meaningful use (MU) incentive checks, practices and hospitals have their options wide open. While many are investing in more technology, that’s only the tip of the proverbial iceberg.

Acacia Internal Medicine Specialists in Phoenix, for example, has used part of its check to invest in a community room to hold wellness classes, and to hire a tai chi teacher. But the prevailing trend is to use the money to fund more IT growth and pay down debt incurred while putting in the software and hardware needed to qualify for MU in the first place.

“Most of our clients are considering the incentive funds paid as an offset for funds they are spending in advance to qualify for meaningful use and to pay for anything additional they will require to meet Stages 2 and 3,” wrote a member of a hospital technology group on LinkedIn in a discussion about how hospitals will use their MU dollars...

A recent analysis reported in Health Affairs came to the conclusion that EHRs are a money-losing proposition for most physicians. Julia Adler-Milstein, PhD, from the University of Michigan in Ann Arbor, and her associates, surveyed 49 community practices and projected that the average doctor “would lose $43,743 over five years; just 27 percent of practices would have achieved a positive return on investment; and only an additional 14 percent of practices would have come out ahead had they received the $44,000 federal meaningful-use incentive.”
My first Nevada MU attesting doc had to sell his practice to a hospital system within about 5 months. He made CNN Business over that unhappy outcome.


Lynn Bennett of sent me a nice email shout-out and heads-up a short while ago.
Today I came across your blog and must say that the informative content of your blog is worth reading. I enjoy your blog, and would love to share our infographic “10 Potentially Devastating Public Health Threats” with you. If you find it relevant, I hope you will consider it for posting at your blog or sharing with your readers through social media channels. Please let me know if you are interested.

Very nice. Wonder how "interexhangeable" Health IT can help here? Some things are already in play, e.g., Rx abuse mitigation via e-Prescribing and HIE, better coordination of care for the difficult Chronics like DM, HTN, obesity, dementia, and sentinel capability for syndromic surveillance, etc.

Can't find out much about this company (if it even is a real "company"). WHOIS search doesn't provide much, and their website doesn't have any "About Us" links. Bit of a yellow flag there. Maybe Lynn can clear that up for me (i.e., that this is not simply some front out there fishing for "public health program students" and getting paid by the sign-up. Stay tuned.

More to come...

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