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Nov 18 2013

Healthcare.gov and me: I win!

By healthcare industry, politics, technology

Unless you’ve been living under a rock since October 1, you’ve heard that Healthcare.gov, the site where Americans can shop for health insurance, had a rocky start in life. OK, it was an epic mess.

I was one of the people who was eager to jump on the site on October 1, since I haven’t had health insurance since I completed cancer treatment in 2008. That cancer diagnosis and treatment put me in the pre-existing condition pile, which put renewal insurance premiums for my individual coverage at an eye-popping level. You can read the details on that here. On October 1, I hopped on my Mac, and surfed over to Healthcare.gov … and had the same experience everyone else seemed to be having:

healthcare.gov error message image

image credit: forbes.com

That continued over the following seven days, with me developing a nice little flat spot on my forehead from head/desk-ing my way through many attempts per day at getting past the first step of creating a profile on the site. Even when I had completed that process of creating a profile, every time the site announced “Success! Click here to continue.” I clicked “there” and … got a blank page.

On October 8, I realized that I, and the site’s developers, might have missed something. I was using Google Chrome, my default browser, and the dominant browser across the web. Could it be that the dim bulbs that built the Frankenstein that is the Healthcare.gov site optimized the site only for native browsers? I opened Safari, and discovered that yes, they were indeed that dim, because even though the site loaded at the speed of a slug on Quaaludes, it did load. And “Success!” allowed me to continue the enrollment process. No blank pages.

I re-enacted scenes from 1995, when I would log on to Netscape to download email on my dial-up connection: open the page, hit “go,” and then make coffee. When I returned with a hot cup of joe, I’d repeat the process on each subsequent page, working in another tab while the site loaded the next page in the process. I managed to complete the entire enrollment process, save for the last “pull the trigger” step of hitting the ENROLL button, because I wanted to make sure I had the money for my first month’s premium available. Which turned out to be unnecessary, since when I did hit the ENROLL button, I got a message saying that my selected insurer would be contacting me about billing. That conversation happened a few days ago, and I’ve paid my first month’s premium.

As of January 1, 2014, I’ll have health insurance again for the first time since December 31, 2008. WIN.

Here is the upside of what I saw in my voyage through Healthcare.gov:

  • Even though my state is one that announced it “hated Obamacare, would not be building its own marketplace, and we hate Obamacare,” there was a wide array of plans offered to me.
  • I could compare plans side-by-side.
  • Premiums were a wide range, with some surprises: the lowest-premium Bronze Plan had 0% co-insurance (I wasn’t on the hook for a percentage of cost on covered services), with higher premium plans tagged with 25% co-insurance.

Here’s the thing that made me go “WTF?”:

  • Only the Bronze Plans are HSA-friendly. HSA=Health Savings Account, essentially 401(k)s for healthcare. Individuals can sock away $3,300/year (in 2014) of pre-tax money in a dedicated savings account for healthcare costs, with people over 55 allowed to sock away an additional $1,000 for a total of $4,300 in 2014. Since all the Bronze Plans I was offered had deductibles of $5,500 or more, with the plan I selected carrying a $6,350 deductible, it would seem reasonable – fairer? – to allow consumers to fund their HSAs annually to match the level of their deductible.

On the whole, this is a big win for me, and other uninsured people who fell into the “pre-existing condition” bucket. By the way, just being female was considered a pre-existing condition until the Affordable Care Act passed. In spite of the views of Fox News talking heads (all male, of course), gender equality needs to exist in all phases of public life, including health insurance.

Bottom line? I win.

Oct 29 2013

Healthcare Talk: Patients with Power

By healthcare industry, technology

I had the chance to participate in a Hangout on Air with Kathi Browne, who is the founder/moderator of the Google+ Healthcare Talk community. If you’re on G+ and in the healthcare industry, that community is one you want to join – lots of discussion on topics from healthcare policy to social media to patient safety to care quality. It’s invitation-only – if you’d like to join, hit the G+ link above and ask Kathi to add you to the community.

Last night’s (Monday, Oct. 28, 2013) Hangout on Air was a conversation with Bill Guthrie, CEO of Patients with Power, a new web-based platform for shared decision-making for cancer patients and their oncology teams that’s in beta at UCSF’s lung cancer oncology unit and also as a survival-planning tool at Cornell-Weill/New York Presbyterian’s ob-gyn onco unit.

Decision-making for cancer patients – shared, or not – is a firehose. Patients with Power does what its name promises, it gives patients access to the information they need to make an informed decision, information that’s solidly based in evidence-based medicine since it’s based wholly on National Comprehensive Cancer Network (NCCN) guidelines for cancer treatment. Bill has given me a demo of the tool, and it’s superb. He also did a walk-though last night. Give a watch/listen: //www.youtube.com/embed/FPTIjDwirDI

Sep 11 2013

#HCSM Review 36: Exploring healthcare costs, access, e-patients as experts

By healthcare industry, media commentary, technology

hcsm-triptych.jpg

Welcome to the MightyCasey–hosted edition of the HealthWorksCollective #HCSM Review, a peer-reviewed compendium of timely, on-topic writing about healthcare from across the web.

Last Friday, I put out a call for posts about healthcare costs and/or health insurance innovation for the HCSM community. Here’s the brain candy that flew over the MightyCaseyMedia transom:

First up: an examination of STD occurrence alongside STD testing costs in the New York metro area from ClearHealthCosts.com (@chcosts), written by Sherry Mazzocchi. This is a deep dive into the incidence of STDs across New York City, with snapshots of what consumers actually pay for STD testing at a number of facilities across the region. Runs from $0 (for members of a subscription medical practice) to $600 for women who visit a Westchester County practice. Like Uwe Reinhardt has said for years, healthcare pricing is chaos behind a veil of secrecy.

For patients looking to pierce that veil and direct-pay for their care, ClearHealthCosts’ founder Jeanne Pinder offers up this post – New ways of paying: Cutting out the middleman. Seems like everybody’s looking for a better way to hold down health costs. In a number of cases, that means patient and provider are getting together directly, without the middleman (the insurance company). You could start asking, “How much is that?” and acting on the answer.

With Oct. 1 and the dawn of the ACA’s new health insurance marketplaces, Jeanne Pinder shares What it means to you: Oct. 1 and buying health insurance. Maybe you avoid the topic of health insurance, but you can’t any longer. If you’re not covered by employer insurance, Medicare or Medicaid, you will need to know things about buying insurance (or choosing not to buy it). Her post offers some actionable advice on how to figure out what the marketplace means to you.

From one of my favorite places, Costs of Care (@CostsofCare), comes a post by David Marcovitz titled “A Routine Denial,” about how it feels to have an expensive test declined by your insurer after it’s been done. If you’ve ever been on the receiving end of one of these notices, you know that it feels anything but routine. After the appeals process. David discovered just how chaotic healthcare pricing is. A great read.

Like David, Brave Bosom founder Andrea Downing (@BraveBosom) discovered that she had a genetic predisposition to a disease. In her case, it was BRCA, the genetic mutation that increases risk for breast cancer. Andrea is a leader in the young “previvor” community, and offers up this post on what healthcare reform means for her, for her community, and for other people who have potential destructive dynamite in their DNA. Genetic testing and counseling is a terrific resource; worrying how it might impact your insurance coverage shouldn’t have to be a consideration when you’re making a decision about your health.

ePatient Dave deBronkart (@ePatientDave) is a world-famous (really) patient activist. He’s written two books, and spoken at conferences across the globe. His post “Ratty boxers: what it means to really, truly have no money” resonated powerfully for me, since all e-patient experts face the same challenge: patients aren’t yet seen as experts worthy of remuneration by the healthcare industry. Dave has helped move the needle on that – here’s hoping that his message spreads into the hearts and minds of organizations who are still expecting patients to pay for the privilege of speaking to audiences who need to know what we know: how to make healthcare more human-friendly.

Alan Brewington (@abrewi3010) blogs at PainTalks.com – he’s a guy with chronic arthritis from some rather epic sports injuries. He sent along a post on the pending health insurance exchanges from the front lines in a Red State: Idaho. Titled “Health Insurance Exchange, Idaho, Arthritis, and Me,” Alan’s post walks the reader through an exploration of the new health insurance exchange marketplace, figuring out what kind of coverage is available at what premium cost. As a chronic pain patient, Alan knows more about the ins and outs of health insurance than the average guy his age, and makes some good observations about what it will take for healthcare reform to work.

Closing our cavalcade of #HCSM awesome, here’s a post from Carolyn Thomas at MyHeartSisters.com (@HeartSisters) on how online communities help patients cope, and give them the power to move on. “Discover. Join. Leave.” is a great journey through the life cycle of online patient groups. Some come and stay, others arrive looking for specific help, all make a contribution when they can. Peer-to-peer healthcare is a web, just like … the web. Carolyn tells a great troll-taming story, too – another terrific read.

If you’d like to participate in the HealthWorksCollective #HCSM Review – click this link to look at the schedule, and find out how to get on the list. Thanks for reading, and I’d love to hear your thoughts in the comments!

Jun 11 2013

Did someone say “palooza”?

By healthcare industry, politics, technology

I’m still recovering from the month of May. I was all up in the healthcare, pretty much 24/7, which differs not-much from my usual roll, other than that in the period of three weeks, I was in DC for eight of 21 days, May 14 through June 5, attending HM13 (the annual meeting of the Society of Hospital Medicine, which I covered for The Hospitalist magazine podcasts) and Health Data Palooza IV as just-me on a Consumer Circle scholarship.

What I saw and heard at both conferences made me hopeful for the future of healthcare … sort of. As inspiring as both of them were, I found the SHM conference more of a hope engine for just-e-patient me than the rah-rah tech-fest that was #hdpalooza. Granted, HM13 was organized and run by the medical society that has a big upward swing on its membership, and on the income of said members, which means that there was a breadth and depth of content that wouldn’t be available at non-clinical conferences.

hm13 logo

I got plenty of mental floss out of both of them. Here are the high (and low) lights:

  • Hands-on practicum at HM13 featuring portable ultrasound guided bedside procedures for the hospitalist. You have not lived until you’ve seen a hospitalist put a central line in a Costco chicken that’s tricked out with liquid-filled tubes serving as major blood vessels. Training that is both fun and practical transmits sticky knowledge. And I’m not taking the grape juice that was cast in the role of blood for this session.
  • Dr. Alberto Puig’s History of the Physical Exam HM13 breakout session offered laughter (imagine doing a pelvic exam on a standing patient fully garbed in Victorian bustle-wear), horror (doctors assessed health status for centuries by *tasting* patients’ urine; and let’s not forget those lovely leeches), and a whole lot of thought-provoking questions about what a physical exam means, and how important touch is to the practice of medicine.
  • Cognitive Diagnostic Error workshop, where a team of patient safety experts from UPenn demonstrated the risks of thinking too fast in clinical situations. Slower thinking is harder, but it will prevent mis-diagnosing and other medical errors.
  • Meeting Dr. Gordon Guyatt, the man who coined the phrase Evidence Based Medicine, and watching him shred study after study using funnel plots of the study’s data. Eye-opening doesn’t begin to describe that particular HM13 experience.
  • A cost transparency workshop! At a hospital medicine conference! Led by Dr. Chris Moriates from UCSF, this session showed the power of shared decision-making across the clinical team *and* included the patient/caregiver in the equation. We’re winning!
  • health data palooza iv logoBest of the Best at Health Data Palooza? AthenaHealth CEO Jonathan Bush’s keynote, where he was by turns hilarious, pointed, inspiring, and infuriating – all good things, as far as I’m concerned. His best line? “Obama was right. There, I said it.” After which he went on to again call the feds on the carpet for lack of testicular fortitude when it comes to setting up a national health data system. He has a great post on The Health Care Blog about his time on the platform, and his message.
  • Biggest disappointment of #hdpalooza? Atul Gawande moderated a panel on the new payment models emerging from Obamacare. Given his writing on healthcare costs, I hoped for a vibrant discussion on how health IT systems are enabling better cost visibility and management, for both the system (providers/payers) and users (patients). Twas not to be. What the session amounted to was a single visual involving CME credits for clinical folks in the audience being at risk if any panelist wound up mouthing commercial messages, accompanied by a round-robin of words into microphones from a sausage party of dude-panelists. Even for an IT geek, this was a snooze-fest of epic proportions. Huge disappointment.
  • Channeling the late Richard Dawson in a game show session called Family Feud’n, where providers and payers battled over what patients said they wanted as value from the healthcare system … well, it was eye-catching. It was funny, in parts. Mostly, I wondered what the hell they were trying to accomplish. Healthcare providers and healthcare payers are forever set in opposition? Patients are just objects, the “product,” and don’t get a voice other than in surveys? I call #fail on that one …
  • Illuminating Disease at the Speed of Light session was a highlight, with researchers and data modelers teaming up to show how data visualization can accelerate progress in clinical studies of disease. I was riveted, and I’m not even a full-on big-data geek.
  • Worst part of both conferences? The running from pillar to post to attend the sessions I most wanted to see, followed by sitting in said session for up to two hours. Seriously, what is up with healthcare conferences that make us sit on our keesters when getting up and moving around would feel so darn good? Conference organizers should start figuring out how to do “walking sessions” that mirror the rise of walking meetings and standing/walking workstations.

Still glaringly missing from all of this rah-rah is the actual, real-world voice of the patient – HM13 can be (somewhat) forgiven for that, since it’s a medical society annual conference. I will note that, in all my interviews for HM13 podcasts, the question, “How can patients help?” was warmly welcomed by everyone asked, and answered with enthusiasm and insight. Figuring out how to break the walls down between clinicians and patients – “gimme my damn data,” two-way edition – using health IT systems as the wedge seems to be a place to start. But letting patients help there is utterly crucial.

Speaking of sitting too long … time for a bike ride to my polling place to vote in today’s off-year election primary in my state. I’m voting for a guy who’s worked on opening up health data. Win/win … ?

Mar 08 2013

Snowflakes and bitch-slaps at the ePharma Summit

By healthcare industry, technology
WEGO pills pharma images

I had the great good fortune of being asked (by WEGO Health) to participate on a panel titled Social Media for Pharma: A Match Made in Heaven or Hell?at the ePharma Summit in New York (#epharma) earlier this week. When the opportunity presented itself, I asked to be registered for the whole event so I could do my fly-on-the-wall thing by attending some sessions and schmoozing in the exhibit hall.

What did I learn? I learned something I already knew: pharma, and healthcare in general, talks a good game at the corporate level about “engagement” when it comes to patients. However, their use of the word tends to run along engagement-as-shiny-object-syndrome lines; in other words, passive message consumption is the desired model, since two-way dialogues are problematic, with pharma afraid of FDA bitch-slaps in the form of warning letters and healthcare in general sweating bullets about the powerful bitch-slap known as the HIPAA violation, given the $1.5M fine potential.

I understand their aversion to drawing the gimlet eye, and the ire, of the feds when they’re considering how to communicate with their marketplace. Pharma is a conservative, slow-to-innovate business that’s focused on shareholder value and ROI for said investors, given that they can spend billions developing a new drug for market before they can sell the first pill of said wonder drug. At least, that’s what pharma balance sheets and annual reports tell us.

Pharma is anxious to open dialogues with its customers – the real customers, patients – but isn’t sure how to go about doing that without winding up in deep kimchee with federal regulators. That was the purpose of the panel I was on: to let pharma know what kind of conversation patients were looking for, and what we’d like to hear from the pharma industry. Our group members were:

We all said that we would welcome some real dialogue with pharma: not sales language, but human language. Stop telling us to “ask our doctors about” – which is useful, but only half of the conversation equation. Pharma should ask patients how and if they – pharma and its products – are actually helping. The snowflakes in the post title aren’t the snowflakes that flurried a bit in New York on Thursday, they’re from my exhortation from the podium (and everywhere else):

“If we’re all snowflakes, unique in our genomic makeup and completely different from any other human on the planet, where’s my snowflake medicine?”

I know that snowflake medicine is not only possible, it’s here: pharmacogenomics is a new science, but it’s in commercial use and has been for a few years. I’d like to know why it isn’t part of every single prescription decision, but I’m an impatient early adopter. I know that pharma is still operating on a population health model, but that is so 20th century, dudes. Real innovation is already happening, yet pharma’s business model is still in “find the blockbuster drug that works OK in 60-70% of the population with Disease X, and we’re in the money!” mode.

My prescription for pharma execs is to read Eric Topol‘s The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care– that will both scare them to death (no more population-based medicine) and show them the map to the future (agile development of targeted therapies). Give me and everyone else our snowflakes: many of us are literally dying to get hold of ’em.

My takeaway from #epharma? Patients are still seen as exotic creatures by pharma, but I sense that they’re anxious to learn more about us beyond our diagnoses. My recommendation: Look for influencer patients in the health communities that use your products. Open a one-on-one dialogue with them, ask them how your products are perceived. Explore opening up some private-channel community conversations (NOT on social media!) that can involve your clinical team, doctors who prescribe your products, and the patients that take them. Listen and learn.

If you need help wrangling internet and social rules for pharma out of the FDA, tell us – patients – what you want to accomplish, and let us storm the castle. Embrace the snowflakes. Avoid the bitch-slaps. Help create better global health. Patients are the only real blockbuster drug left in the 21st century.

Thanks for listening.

Feb 12 2013

Medical Monopoly: Medicine has a major image problem

By healthcare industry, media commentary, politics, technology
image credit: Alec

When you hear the word “monopoly,” does it fill you with a warm and fuzzy feeling? (Unless you’re Hasbro, you really should say no, unless you’re a cyborg.)

Healthcare is a monopoly. We can’t DIY cancer treatment, or surgically repair a broken hip for ourselves, so we have to go to the medical-industrial complex to regain our health if we wander into the weeds, health-wise. We also have deep difficulty accessing pricing information. I’ve talked about that here over the last few years. Maybe not a monopoly in the financial-reg sense of the word, but it sure is mighty like a game of Monopoly.

This “chaos behind a veil of secrecy” (all credit for that phrase belongs to healthcare economist Uwe Reinhart) has created the impression in healthcare customers that there’s no way to tell what something will cost before you buy it. You checks the box and takes yer chances. No Get Out of the Hospital Free cards. No pass-the-admissions-counter-collect-$200 option. That’s a rotten way to run a railroad (one of the original monopoly industries in US history), and an even worse way to run a hospital.

Dan Munro wrote about this, and the star-chamber cabal that actually sets the prices in healthcare, the RUC, on Forbes.com yesterday. I’ve talked about the RUC myself. And the search for price transparency, which seemed such an outlier activity just a couple of years ago, is now popping up in the Well blog on the New York Times site, as well as on Reuters. The Reuters piece has the addition bonus of quotes from my buddy Jeanne Pinder, founder of ClearHealthCosts.com. (Yesterday was a big day in medical price transparency.)

This is the central reason I registered the hashtag #howmuchisthat with Symplur, the healthcare hashtag registry. We all have to start demanding that prices be visible, and that the RUC stop cabal-ing around with our lives and our wallets. As more and more people are finding themselves with high-deductible health insurance, asking how much things cost before you make a healthcare decision will become the norm. If a healthcare provider can’t answer that question, s/he will find that s/he’s seeing the patient panel sinking fast, along with practice revenue.

Get with it, medicine. Remake your image, and your brand, to be clear as glass and user-friendly. Outcome metrics along with pricing would be really nice, too.

Jan 01 2013

2013 Manifesto: short and salty-sweet

By healthcare industry, technology

Last year’s look-ahead for 2012 was a 5-point manifesto. Reviewing progress against that list, I see that I did pretty well, with only #2 falling a little short – which is not a bad track record.

This year, I’m keeping it tight. I’m going with a 2-rule manifesto.

Rule #1: Be accountable

We’ve all got metrics to measure ourselves against. Revenue, connections, sales, errors, accomplishments – all of those are important. The trouble comes when you focus too much on one area, which usually means that other important metrics wind up taking a back seat.

If you focus exclusively on incoming revenue, you might miss some mistakes that will cost you at least some of that revenue. If you concentrate only on building more connections in the industry, you might lose some long-term relationships that are just starting to ripen.

For me, accountability this year will be tied to two metrics: raising the revenue gained from the speaking side of my business, and widening my marketing net beyond the mid-Atlantic region. Tracking both will be easy, and each will challenge me to focus very tightly on activities and outreach that will move my game-plan forward. Accountability – at least here at Mighty Casey Media – will be baked in to the spreadsheet I’ll use to track that game-plan.

What accountability will you bake in to your 2013 goals? How will you track your progress? Who will you report to? That last one is a challenge for me, since I’m a solo-preneur. Stay tuned, since one of my accountability check-boxes will be reporting progress here, on the Mighty Mouth Blog.

Rule #2: Laugh more, bark less

That’s a purposeful scrambling of the “wag more, bark less” bumper sticker I see … everywhere. My version of wagging is laughter. If I’m laughing, there’s less risk that I’ll be screaming. Given that one of my core purposes in life is working to effect positive change in the healthcare industry, I can wind up screaming pretty easily if I don’t keep myself in check.

Barking = screaming in my world. We’re all about avoiding the screaming wherever possible. That does not mean that I’ll dampen my ferocity. Hell to the no. What it does mean is that I’ll find ways to wrap the bitter medicine in a big lump of maple sugar. “Bitter medicine” is hard truth about how healthcare has to shift from paternalism and a gold-rush mentality; the lump of maple sugar (and my biggest challenge) is finding the humor that will make that medicine go down … without resorting to barking.

Those are my Simple Rules for 2013.

Happy New Year.

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