PatientsLikeMe: A New Disease Management Tool?

October 31, 2008 — Fred Fortin

Ben Heywood, co-founder and President of PatientsLikeMe, recently participated in live chat session (see transcript) hosted by the World Health Care Congress. I was particularly interested in his several comments related to the value of his site to disease management programs now sponsored by health plans and other health care organizations.

I think one of the areas we have expanded into earlier then we thought was in the payer/health plan space. Payers are looking at PatientsLikeMe as a lighter-weight disease management platform. A peer-based DM, sort of like an online version of AA (the most successful peer-based DM program around) . . .

The discussions we are having is around offering PatientsLikeMe as a service to their (health plan) members – we have seen some strong anecdotal evidence that patients are using healthcare more efficiently by learning from other patients experiences and data.

We think that using our site makes patients more compliant – we are working on several pilots to prove this out. . .

Our business model is really about engaging industry into these communities – so one consideration as we look at new diseases is for whom this will help make better products. First and foremost, we need to make communities that help patients – so that is always our first consideration. . .

We get a lot of amazing feedback from out users from… depression patients who say using the site keeps them out of the hospital to a patient in MS that said that the site saved her life as her doc over-prescribed one of her medication. . .

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Starbucks Health Care?

October 22, 2008 — Fred Fortin
Starbucks at the Forbidden City in Beijing (cl...

Image via Wikipedia

The thought came to me this morning as I was hitting the local Starbucks: Why couldn’t local retail health care be this easy and this prolific? The inventory of products is limited but the need for them is widespread. You walk in at your convenience, get your needs met and leave. And the hours are meant to make the product available almost 24 hours a day. I know, I know there are retail clinics popping up in malls and pharmacies. Yes all to the good. But, I want these franchises, like Starbucks, on street corners, in book stores, at train and subway stops, kiss n’ride parking lots, highway rest areas, next to local bars, in sports stadiums, at beach stands – you name it – where people spend their time and can be lured to make impulsive decisions that benefit their health rather than destroy it. Between every Starbucks and Jamba Juice would stand a local med-check station.

Just call me a health care populist.

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Now That’s Bike Power!

October 21, 2008 — Fred Fortin

Thanks to BArPH:

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New Study: Costs of Moving to ICD-10 Diagnostic Codes for Providers

October 21, 2008 — Fred Fortin

Conclusions from a new study on the transition to ICD-10 diagnostic codes:

If ICD‐10‐CM were to be mandated as the code set to replace ICD‐9‐CM, it would have a significant effect on both the business and clinical processes of physician practices and clinical laboratories.  The impact is expected to be greater than the impact of the NPI changes or the initial HIPAA changes,because virtually every aspect of the business – documentation, quality measures, coverage andpayment policies, etc., would be affected by the of changing the coding of diagnoses to a greater specificity.

This change will have some one‐time costs, such as training for most staff, changes to superbills to include ten times as many codes, upgrading IT systems for the new code set and changing templates, and reviewing insurance plan contracts for changes to payment  and coverage.  The size of a practice and vendor costs play a major part in the   overall cost of this transition.  Total costs can be expected to range anywhere from around $83000 for a small three person practice to the millions for the very largest practices. In addition to the one‐time costs involved, there will also be permanent additional costs. The greater specificity of the ICD‐10‐CM code set will require more specific documentation in provider records.  This will take physicians additional time, adding about 3‐4% to their  workload.  Again, this is a permanent increase.

For clinical laboratories, besides the changes in IT systems and training, they will be faced with additional difficulties of getting the correct code from ordering physicians.  While a relatively small problem today, any increase in incorrect or missing coding will have a significant impact on both their workload and cash flow.

Physician practices and laboratories face additional issues which will delay their implementation. Much of their documentation and insurance decisions are driven by the coverage and reimbursement policies of health plans. These policies will change to be based on the more specific ICD‐10‐CM codes.  Practices will have to wait to see these changed policies before making their business process changes. Therefore, much of their work will have to wait for health plan decisions.

Should the change be made, it can be expected that there will be a significant learning curve for providers in the documentation and coding of diagnoses in ICD‐10‐CM. This will cause payment delays and claim rejections, probably for at least a year. The cash flow of practices will thus be negatively affected.

See my previous post on ICD-10 codes here. Thanks to Government Healthcare IT.

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New China Health Reform Plan “Impenetrable”

October 20, 2008 — Fred Fortin

Reports on Chinese citizen reactions to the new health reform plan released for public debate are now out:

CCTV newsman Bai Yansong said in an TV interview that apart from the complaints people had about the medical system in the past, they now have to face another issue: Trying to understand the newly released reform draft. “I am personally convinced that many people won’t be able to offer any opinions for the simple fact that they are not able to make sense of it”, Bai said. “The funny thing is that it’s impenetrable after putting all the Chinese characters together,” and the first reaction to solicitation would be “not understandable.” He also pointed out four flaws of the draft:

-too much medical terminology causing trouble for ordinary people
-twisted wording along with sentences with confusing punctuation
-dry and meaningless language
-too general and hollow due to its form of expression

The Chinese government’s response is that it’s expected that “ordinary people aren’t able to make sense of it,” and they are planning to “publish a friendlier version of questions and answers concerning central issues of the new reform after collecting the most frequently asked questions.”

Much of the health care policy debate in this country as well sits on a similar sea of non-comprehension by “ordinary people.” I remember the proposed Clinton Health Security Act in the early 1990s. It was also an impenetrable tome of jargon and fragmented presentation. Maybe it comes with the territory. If it does, then the hacks and not the wonks will rule.

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Armstrong to do the Giro d’Italia

October 14, 2008 — Fred Fortin

This is so sweet. The Giro is a great race. No matter whether he wins or not; no matter whether he does the Tour de France as well, the man will generate massive interest in cycling again and for cancer awareness.

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ICD-10s: Sometimes “Pay-Me-Later” is a Better Strategy

October 14, 2008 — Fred Fortin

From Healthcare IT News on ICD-10 Codes:

The American Health Information Management Association leadership wants to be clear: Even though it will cost millions of dollars and the process is likely to be disruptive, U.S. healthcare must embrace a new, expanded code for diagnostics and billing.

Proponents like AHIMA and the American Hospital Association say the new code will bring the healthcare system into the 21st Century. It will also replace an ICD-9 code set that is broken.

“It could have serious, serious ramifications for our healthcare data,” said Sue Bowman, AHIMA‘s director of coding, during this week’s AHIMA convention in Seattle.

“It’s pay me now or pay me later,” added Jill Dennis, AHIMA‘s senior vice president.

With all the financial stress burdening health care, and the economy in general, why push for the 2011 implementation deadline? The cost to payers and providers will be in the billions of dollars not millions. And we aren’t even able to take full clinical and electronic advantage of the ICD-9 codes at this point! Also HIPAA’s 5010 changes will in addition cost the health care system millions as well. Let’s give the stakeholders at least some space and time to adapt and do it right.

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China Opens Medical Reform Plan to Public Debate

October 14, 2008 — Fred Fortin

Xinhua reports today that China’s long-awaited health care reform plan was released for public debate and promises to cover all urban and rural residents by 2020. Medical reform has been deliberated by authorities since 2006.

The reformed plan clarifies government’s responsibility by saying that it plays a dominant role in providing public health and basic medical service. “Both central and local governments should increase health funding. The percentage of government’s input in total health expenditure should be increased gradually so that the financial burden of individuals can be reduced,” the draft said. The plan listed public health, rural areas, city community health services and basic medical insurance as four key areas for government investment.The plan also promised to tighten government control over medical fees in public hospitals and to set up a “basic medicine system” to quell public complaints of rising drug costs. The basic medicine system includes a catalogue of necessary drugs that would be produced and distributed under government control and supervision. Its goal is to ensure accessibility to a range of basic medicines and to prevent manufacturers and businesspeople from circumventing existing price controls.

We’ve been following China’s developments on health care reform for a while now (here, here, here, and especially here). The process has been slow but deliberate with significant research and policy debate on the role of private insurance, for example. China is taking the long view. The question is whether it will be too long for the millions now without health care, and too centered on government bureaucracies to deliver that care.

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The Challenge of the e-Patient

October 13, 2008 — Fred Fortin

Conclusions from e_Patients: How they can help us heal healthcare written by Tom Ferguson, MD and the e-Patient Scholars Working Group ( Supported by a Robert Wood Johnson Foundation Quality Health Care Grant):

e-Patients are driving a healthcare revolution of major proportions.
The old Industrial Age paradigm, in which health professionals were viewed as the exclusive source of medical knowledge and wisdom, is gradually giving way to a new Information Age worldview in which patients, family caregivers, and the systems and networks they create are increasingly seen as important healthcare resources. But the emerging world of the e-patient cannot be fully understood and appreciated in the context of pre-Internet medical constructs. The medical worldview of the 20th century did not recognize the legitimacy of lay medical competence and autonomy. Thus its metrics, research methods, and cultural vocabulary are poorly suited to studying this emerging field. Something akin to a system upgrade in our thinking is needed—a new cultural operating system for healthcare in which e-patients can be recognized as a valuable new type of renewable resource, managing much of their own care, providing care for others, helping professionals improve the quality of their services, and participating in entirely new kinds of clinician-patient collaborations, patient-initiated research, and self-managed care. Developing, refining, and implementing this new open-source cultural operating system will be one of the principal challenges facing healthcare in the early decades of the 21st century. But difficult as this task may prove to be, it will pay remarkable dividends. For given the recognition and support they deserve, these new medical colleagues can help us find sustainable solutions to many of the seemingly intractable problems that now plague all modern healthcare systems.

( Thanks to ICMCC)

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In the Woods and Off the Grid

October 12, 2008 — Fred Fortin

I’ve been hiking in Yosemite National Park as well as Sequoia National Park for the last week. Being here forces you to go cold turkey when it comes to online communications. So it’s a good detox site for us net junkies. Just avoid the rock slides and all. But right now I’m in San Francisco – internet Mecca – and am looking forward to participating in the Institute for the Future’s Health Horizons Fall Conference on Reinventing Health Care in a Mobile World starting Tuesday October 14 at the Fairmont Hotel. No rock slides there I hope.

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