e-CareManagement blog

On the surface, you might think that a press release issued by America’s Health Insurance Plans (AHIP) adopting principles for a patient centered medical home (PCMH) would advance the cause.

But, look further…

The principles endorsed by AHIP only vaguely resemble the Joint Principles of the PCMH endorsed by 4 major primary care physician groups . These groups represent over 300,000 physicians. (See below for a summary listings of AHIP and physicians’ principles supporting the PCMH).

Why?

• Why didn’t AHIP didn’t just endorse the physicians’ principles for the PCMH?
• If there’s disagreement, why didn’t AHIP say “we agree with the docs except for 1)…, 2)…, 3)…?
• Why leave it up to outside observers to have to line up and compare two different sets of principles of a PCMH and try to figure out similarities and differences?
• Where are the doctors in all this? What do the doctors think about AHIP developing their own set of principles for a concept that the docs themselves conceived and are laboring to deliver?

Here are few of my initial reactions to AHIP’s principles for the PCMH:

Continue reading “AHIP “Adopts” Medical Home Principles: Huh?”

Dr. Jaan Sidorov serves up a cornucopia of blogging delicacies in the latest edition of the Health Wonk Review at Disease Management Care Blog. Sample the fare!

By Vince Kuraitis and David C. Kibbe, MD, MBA

Once upon a time, there was a little girl named Goldilocks. Like most Americans, Goldilocks had concerns about achieving just the right amount of data liquidity for her personal health information (PHI).

Until today Goldilocks felt between a rock and a hard place:

"I want my PHI to be appropriately liquid — just the right viscosity. My PHI should be viscous enough to flow to my trusted health care providers to use to improve my health and health care.

“Today my PHI is frozen and inaccessible — it’s too cold.

“But I’m worried about the other extreme — the risks of using a personal health record (PHR). The privacy/security advocates tell me that I should be concerned about my PHI being too hot — like steam that’s vaporized and disperses uncontrollably into the atmosphere.

“How do I get it just right? …not too cold, not too hot?"

What happened today to resolve Goldilocks dilemma? The Markle Foundation’ released its Common Framework for Personal Health Information (PHI).

Dossia, Google, Intuit, Microsoft, and WebMD today joined prominent health care providers, health insurers, and consumer and privacy groups in endorsing a set of practices for new internet services that help consumers track and improve their health. The framework defines a set of practices that can help protect personal information and enhance consumer participation in online personal health records.

The Markle Foundation’s accomplishments in advancing this collaborative framework are nothing short of miraculous!

Let’s revisit Goldilocks and the bears to see exactly how the Framework resolves the PHI too hot/too cold dilemma. Continue reading “Goldilocks: “Markle’s Framework for Networked Personal Health Information is Just Right””

The Ultimate Guide to Google Health: 60+ Tips and Resources — it’s by Jessica Merritt at NursingDegree.Net blog. Really useful and practical! …and it blows away other world famous “how to” guides…    

by David C. Kibbe MD, MBA

The purpose of this post is to help a non-technical audience untangle some of the confusion regarding health data exchange standards, and particularly come to a better understanding of the similarities and  differences between the Continuity of Care Record (CCR) standard and the CDA Continuity of Care Document (CCD). But what I’m most interested in is getting beyond the technical, political, or economic positions and interests of the proponents of any particular standard to arrive at some principles that demonstrate in plain language what we are trying to achieve by using such standards in the first place.

Frankly, I don’t give a hoot about what standardized XML format for capturing clinical data and information about a person becomes the norm in the health care industry over the next several years. I do care that the decision is made by the people, institutions, and companies who use the standards, and not made by a quasi-governmental panel or a group of “industry experts” whose economic or political interests are served by the outcome, and dominated by a particular standards development organization with whom they are very cozy. 

In other words, I do want free and open market forces to be able to operate freely and openly as health information exchange evolves, in part because I believe market forces will work in the direction of continuously improving health IT, whereas in my experience top-down efforts are often protective of established interests and discouraging to innovation.

Herein lies the problem, in my opinion, with the standards adoption process that the Office of the National Coordinator of HIT (ONC) and HITSP have overseen during the past four years.

Continue reading “Untangling the Electronic Health Data Exchange”

….is posted at the Health Affairs blog. Jane Hiebert-White does a great job with a focus on current public policy issues.

 (Apologies to any chimps offended by the comparison).

Grand Rounds — a weekly medical blog carnival — is now posted at the Happy Hospitalist.  Dr. Happy brings home the bacon!

Vince Kuraitis and David C. Kibbe, MD, MBA

We’re not.

From the Kansas City Business Journal :

Google Inc. has approached Cerner Corp. about a partnership, but Cerner officials don’t sound eager to entangle themselves with the Web-search Goliath.

That’s because the proposed partnership relates to Google Health, the personal health record site launched earlier in May in beta form.

The overture hasn’t led to substantive talks, Cerner President Trace Devanny said, because Cerner doesn’t see much value in Google Health or HealthVault, a similar site that Microsoft Corp. launched in October.

Cerner CEO Neal Patterson referred to the sites during a May 23 shareholders meeting as "electronic shoeboxes," requiring consumers to do much of the data importing and updating.

Why is Cerner dissing Google? Let’s take a look at Cerner’s current business model:

Continue reading “Cerner Disses Google Health. Surprised?”

The latest edition of the Health Wonk Review has been posted at InsureBlog…it’s straightforward, concise, no schtick.  Thanks to Hank Stern!

Since the AMA has issued some “real” numbers relating to the RUC’s recommendations for valuing the Patient Centered Medical Home (PCMH), I’ve added a fourth part to this series.

The June 2 issue of American Medical News provides payment scenarios for a medical home:

Continue reading “Extra: Will $87 Per Hour Rescue Primary Care?”

This third and final post in the series addresses questions about the future of the Patient Centered Medical Home (PCHM):

• What’s problematic about using the RUC methodology with the PCMH?
• What’s the optimal level for a PCMH care management fee?
• Should primary care leaders pull the RUC out? How? 

What’s Problematic About Using the RUC Methodology with the PCMH?

There are at least two reasons for not having the RUC methodology seen anywhere in the same county country as the PCMH. First, the RUC methodology doesn’t account for technology and services needed for optimal care management. Second, the RUC methodology is conceptually flawed.

1) The RUC methodology doesn’t account for technology and services needed for optimal care management. Here’s what the RUC recommended methodology for the PCMH pays for: Continue reading “The Medical Home: Pull the RUC Out”

Today’s post (#2 in a series) tackles several questions:

• What is the American Medical Association/Specialty Society RVS Update Committee (RUC)?
• What is the RUC’s role in the Medicare Medical Home Demonstration project?
• How are people reacting to RUC recommendations for PCMH reimbursement levels?

What is the American Medical Association/Specialty Society RVS Update Committee (RUC)?

The AMA formed the RUC to act as an expert panel in making recommendations to CMS on the relative values of Current Procedural Terminology (CPT) codes using the Resource Based Relative Value Scale (RBRVS).

The RUC is composed of 29 members, only 5 of whom are primary care physicians.

The RUC  has come under severe criticism as being an enemy of primary care. For example… Continue reading “The Medical Home Hits the RUC”

The honeymoon is over.

Prior to April 29, 2008, reviews of the Patient Centered Medical Home (PCMH) model  had been uniformly enthusiastic and positive.

Today the PCMH model is hitting reality — someone’s going to have to bring home money to pay the bills. On April 29 the American Medical Association/Specialty Society RVS Update Committee (RUC) released a  report making recommendations relating to payment levels of care management fees for the PCMH.

This report has stirred cries of confusion and outrage. I’ll elaborate on these cries in the second posting of this series, but if you can’t wait, read here, here, here, here, here, here, here, and here.

Welcome to a series of three blog postings discussing the PCMH, care management fees, and the RUC report.  I can’t claim to smooth the uproar, but I hope to frame the issues so that they can be understood and discussed constructively.

The series will address numerous questions. This first post:

• What is the PCMH care management fee?
• Why is the PCMH care management fee important?
• Why are people confused?

The second post:

• What is the American Medical Association/Specialty Society RVS Update Committee (RUC) ?
• What is the RUC’s role in the Medicare Medical Home Demonstration project?
• How are people reacting to RUC recommendations for PCMH reimbursement levels?

The third post:

• What’s problematic about using the RUC methodology with the PCMH?
• What’s the optimal level for a PCMH care management fee?
• Should primary care leaders pull the RUC out? How? 

Continue reading “The Medical Home: Confusion Over Care Management Fees”

Earlier this week Healthways issued a press release describing their progress in pursuing a Phase II Medicare Health Support (MHS) project.   Read Dr. Jaan Sidorov’s blog commentary for additional background.

In brief, Healthways position is that the Centers for Medicare and Medicaid Services (CMS) is statutorily required to expand into Phase II of MHS if Phase I is “successful”. While I’m very sympathetic with Healthways predicament and their frustration with CMS, I’m not optimistic that their tactics are likely to work.

In making the case, Healthways CEO Ben Leedle quoted the legislation authorizing MHS.

For a moment, let’s get legalistic and look closer at this legislation.  What exactly is CMS required to do? (I’ve put the more relevant wording in bold). Continue reading “Healthways Fights an Uphill Battle on Medicare Health Support Phase II”

 The Healthcare Unbound Conference is a highlight of my year and I always look forward to it!

What’s so special about this conference?

First, the caliber of the people attending.  It’s a stimulating mix of high-level clinical, technical and business types.  The energy is flowing and many people have told me how much they like to go just for the networking.

Second, the caliber of the conference organizer.  I’ve worked with many conference planners, and Satish Kavirajan is not your ordinary conference organizer.

Satish really knows his stuff and he’s a pleasure to work with.  I’m impressed how from a year in advance of the first Healthcare Unbound in 2004 he delved into the substance of the topics.  He read every link and every report I sent him, he talked with experts in the field, he asked deep questions about how best to structure a session or find the right mix of people for a panel.  In addition to many years of conference experience, Satish has an MBA in finance from Columbia — not your typical conference organizer.

Finally, there’s the caliber of the faculty.  Here’s the list of session titles and keynoters for Day 1 of this year’s Healthcare Unbound Conference:

• The Personal Health Information Network (PHIN): Opportunities and Implications for Healthcare Unbound. Vince Kuraitis, Better Health Technologies and David C. Kibbe, The Kibbe Group; American Academy of Family Physicians
• Healthcare Everywhere - How the New Culture of Wellness Is Opening the Door for Healthcare Unbound. Liz Boehm, Forrester Research
• A Behavioral Economist, a Roboticist, and a Healthcare Unbound Advocate Walk Into a Bar: Meanings for the Rest of Us. Mike Barrett, Critical Mass Consulting
• Keynote (title pending). Jay Srini, University of Pittsburgh Medical Center
• From Mainframe to Personal Healthcare: A Progress Report on Addressing Technology, Policy, and Cultural Challenges. Eric Dishman, National Chair, CAST; Intel Corporation
• The Internet of Bodies. Don Jones, Qualcomm
• Google Health Overview. Jerry Lin, Google
• Continua Health Alliance:  The Next Generation of Personal Telehealth is Here! Dave Whitlinger, Continua Health Alliance; Intel Corporation
• Microsoft HealthVault Overview. David Cerino, Microsoft
• Disruptive Healthcare Innovation - Changing the Rules of Diabetes Management by Marrying Wireless and Clinical Innovation in the Healthcare Ecosystem. Anand Iyer, WellDoc; In-Building Wireless Alliance
• Improving Health Outcomes and Lowering Costs Using a Distributed Care Management Model. Larry Leisure, iMetrikus

I hope to see you at the 5th Annual Healthcare Unbound Conference! Please consider attending, sponsoring and/or exhibiting.

Daniel Goldberg of the Medical Humanities Blog has posted the latest edition of the Health Wonk Review. Daniel puts a unique slant on his writing:

As I see it, the key role for a medical humanist – if they wish to be consistent with an ethos of medieval and Renaissance humanists – is to focus on the translation of theory into practice. 

…and he throws in some humor to boot.  Great reading!

My colleague Dr. Dave Rearick asked me to review his recent book, Good Health is Good Business.  I’m pleased to recommend it enthusiastically.

While the book is targeted at small to medium size employers, the lessons go far beyond this audience.

By the end of the 3^rd chapter, Dr. Rearick had convinced me of two conclusions that I’d describe as indisputable, but uncomfortable:

• The only way employers are going to control their health care costs is to influence the health of their workforce.
• You (the employer) need to take charge

What’s uncomfortable here?  Continue reading “Book Review: Good Health is Good Business”

Google Wants to Index Your DNA, Too Business Week; April 18, 2008

A few years ago I remember reading a vivid description of how much information is contained in one person’s genetic code:  a stack of phone books high enough to reach the top of the Washington Monument.

David C. Kibbe, MD, MBA and Vince Kuraitis

Drs. Mandl and Kohane begin their recent article in NEJM with the statement that “large corporations are seeking an integral and transformative role in the management of health care information,” and then warn that this “will profoundly affect the biomedical research enterprise.”   

At issue for the authors is who controls the information about you and me, our health and healthcare data. Without coming right out and saying it directly, they worry that data in the hands of consumers and patients made possible through PCHR service providers like Google and Microsoft could be dangerous to the nation’s health because of  “commercial interests”.  

So, they are warning us, too.

But, let’s examine the presumption that your personal health information is safest in the hands of the medical establishment (incumbent service and health care provider organizations and the biomedical research enterprise). The real question that their article in NEJM begs is:

how good a job of stewarding our health data is the medical establishment doing?

Continue reading “Is the Medical Establishment the Best Guardian of Your Medical Data?”

Vince Kuraitis and David C. Kibbe, MD MBA 

Tomorrow’s edition of the New England Journal of Medicine contains an article entitled “Tectonic Shifts in the Health Information Economy”.  While we have not yet fully digested this article, it’s clear that the authors’ description of the “Health Information Economy” closely parallels our initial description of the Personal Health Information Network (PHIN). 

The main thrust of the NEJM article is to discuss implications (good and bad) relating to clinical research. The NEJM article is also highlighted in a New York Times piece entitled “Warning on Storage of Health Records.”

In anticipation of our webinar tomorrow sponsored by Healthcare Informatics, we wanted to bring these articles to your attention ASAP. 

As a first pass at discussing these important articles, here are a few highlights from the NEJM article.  Whether you prefer the label the “Health Information Economy” or “Personal Health Information Network (PHIN)”, these excerpts describe the potential magnitude of the tectonic shifts: Continue reading “NEJM and NYT Discuss “Tectonic Shifts” of a Personal Health Information Economy”

Writing in ZDNet, Mary Jo Foley ponders the question of whether it might make sense for Microsoft to link HealthVault (HV) and Amalga.

I’ll take this a step further and ask “Could a linkage between HealthVault and Amalga become a centerpiece of Microsoft’s broader health care strategy?”

Continue reading “Could a Linkage Between Amalga and HealthVault Become a Centerpiece of Microsoft’s Healthcare Strategy?”

• What are companies like Google, Microsoft, and Dossia (sponsored by Intel, Wal-Mart, AT&T and others) hoping to accomplish in health care?
• What is the emerging Personal Health Information Network (PHIN) and why should you care?
• What’s the Continuity of Care Record (CCR) Standard, and how is it destined to become an initial focal point of data exchange initiatives?
• Why is the PHIN potentially disruptive to many business models? What types of companies or organizations could be affected the most?
• What are opportunities and threats to major health care players — hospitals, physicians, health plans, enterprise HIT vendors, ambulatory HIT vendors, and others?
• What specific actions can you take to be a leader in advancing the PHIN and positioning your company for success?

In a recent blog posting, David C. Kibbe, MD, MBA and I wrote an overview of our vision for the PHIN. 

Now, for the first time, we look forward to discussing our vision for the PHIN. This Healthcare Informatics webinar will be held:

Thursday, April 17, 1 PM Eastern, 10 AM Pacific.

Click here for details….read “Event Info” to see a more specific description of the webinar.  Get a 15% discount by using Promo Code VK15.

Here’s a diagram of the PHIN as we see it today:

(click on the picture for a larger version)

The Speakers

Continue reading “Healthcare Informatics Webinar: Google, Microsoft, & Dossia Create the Personal Health Information Network”

While not providing anything close to the “final answer”, The New York Times does a good job summarizing the onoging Medicare Health Support (MHS) fracas.  To borrow from one of my colleagues, it’s more “enlightened ambiguity” about the ultimate fate of the MHS beached whale. 

Medicare Finds How Hard It Is to Save Money, The New York Times; April 7, 2008

For One Company, Role in Medicare Experiment Has Hurt Stock, The New York Times; April 7, 2008

Our colleague Dr. Aniruddha Malpani, MD has posted a diverse and enlightening latest version of the Medicine 2.0 Blog Carnival. 

Dr. M summarizes 4 major influences which will help patients to regain control over their healthcare:

1. Patients will keep their own medical records using a PHR ( Personal Health Record)

2. Information Therapy can be prescribed to them, tailored to their needs, based on their medical problems captured in the PHR

3. Web 2.0 technologies will allow them to form social communities to help and support each other

4. We can deliver this information to them 24/7 through their mobile, wherever they may be, whenever they need it!

I’m amazed how quickly creative and convergent thinking is crossing international boundaries.

The Continua Health Alliance is doing a good job in getting remote patient monitoring (RPM) devices to become plug-n-play — where devices and peripherals from different manufacturers complying with Continua Guidelines will be able to talk to one another.

Continua’s work-to-date is a necessary, but not yet sufficient effort to make RPM devices mainstream.

Knocking down the barrier of device-incompatibilty exposes the bigger barrier of lack of data interoperability among RPM technologies and between RPM devices and health care IT systems.  Jonathan Edwards, research VP and lead telemedicine analyst for Gartner, nails the issue:

Continue reading “Data Incompatibility Remains A Barrier to Remote Patient Monitoring (RPM) Devices Reaching the Mainstream”