Halloween and Health

In deference to the holiday, today's post will be of a slightly different nature than the usual fare -- a slightly different tone before we return to election mania.

Preventative medicine is vitally important. That is something that I believe few will quibble with. Emergency rooms are expensive; that has also been well established. Chronic conditions such as obesity and type 2 diabetes absorb a huge amount of the funds in the health care system, an amount that proper prior behavior can reduce drastically. And Halloween? Halloween is just fun, right?

Like all good things there is dark side to Halloween, and I am not just talking hordes of kids on a massive sugar buzz. The Center for Disease Control has a page up on their web site that details a wide array of health and safety tips ranging from "be careful with toy swords," to advice on substituting health snacks for candy. It's comparatively short and presented as a bullet list, but a good starting point.

The one I really got the most out of this season was a piece by Samara Felesky-Hunt, for The Calgary Herald. Since massive snowdrifts of candy are about to blow through homes across the country her tips for reducing the impact are well timed.

[...] for now, you're dealing with the candy. Here are a few tricks to have up your sleeve before your kids are out of the door on the Halloween neighbourhood prowl.

Have a healthy dinner first. Having a well-balanced dinner with lots of veggies sets the tone for the whole evening. If you send them out with their tummies full, they're less likely to eat candy along the whole way. A healthy dinner -- or even a quick peanut butter sandwich with carrot sticks -- will help to prevent sugar highs and nasty tummy aches later.

The list goes on and is worth a look. You can strike a blow against diabetes, obesity, and sugar fueled hyperactivity all at once. (Hint: look under Sources below.)

SOURCE: "CDC- Halloween Health and Safety Tips" 10/08
SOURCE: "Halloween doesn't have to be unhealthy" 10/30/08
photo courtesy of C.J. Sorg, used under its Creative Commons license

Will Health Care IT Get a Leg Up Under the New President?

One thing that both of our current contenders for the Oval Office have in common is the fact that they both support the use of information technology to help fix our broken system. Since every poll I have seen for the past year agrees that reform is vital, and this approach is one that is central to George C. Halvorson's views on the subject, I would say this is a very good thing.

For analysis, I would like to avoid the usual round of health care publications and instead take a look at Information Week where Marianne Kolbasuk McGee is at it again -- writing intelligent and insightful commentary about IT and health care, that is.

Regardless of the outcome of the presidential election, there's potential for a lot of change in the health care industry in the next four years. Barack Obama and John McCain have very different visions when it comes to health care reform, but there is one thing they both have in common, and that's an emphasis on using technology to digitize patient records and eliminate paper-based processes that are inefficient, redundant, costly, and potentially deadly.

Now we all know that implementation of these sort of systems is a costly scenario, one that many providers balk at. As we watch the bizarre and disturbing ups and downs that Wall Street and the economy have been undergoing, one could easily assume that costly measures like EMRs would be back-burnered while other more seemingly pressing issues get funded.

At least one Senator disagrees:

"We need to make money available for direct grants" and via other avenues to promote the deployment of IT in health care, said Massachusetts Sen. John Kerry (and Democratic presidential nominee in 2004) during a keynote speech in Boston yesterday at a technology symposium put on by the Center for Connected-Health, a division of Partners HealthCare, which operates several Boston area hospitals, including Mass General and Brigham & Women's.

Health care reform can't be deferred by the weak economy because health care is such a big part of the economy -- or $1 out of every $6 dollars spent in the United States, says Kerry. Addressing the health care system's big cost issues will "help the economy move," he says.

One-sixth of the economy. A perversely incented system, to use Mr. Halvorson's words, that is rife with redundancies and top heavy with bureaucracy is one sixth of the American economy. This fact alone should help put things into perspective. For an excellent summation of the situation and the options before us, go take a quick moment and read Ms. McGee's latest. As always, it is a highly informative gem of a column!

SOURCE: "Could Health Care IT Get A Boost Next Year?" 10/28/08
photo courtesy of Violator3, used under its Creative Commons license

The Obama Plan: Economists Speak Out on Forbes

Forbes brings us an interesting piece by a pair of research associates at the National Bureau of Economic Research. The topic, unsurprisingly, is health care and the approach taken on the subject by the Democratic nominee for U.S. president.

The first of the pair, David M. Cutler, is the Otto Eckstein professor of applied economics at Harvard's Department of Economics and Kennedy School of Government, and is also an adviser on health care to Barack Obama. I think we can guess what side of the issues he comes down on. The second one, J. Bradford DeLong, is a professor of economics at U.C. Berkeley.

Between the two, they have crafted a exploration of why their chosen candidate is the one who can save the current health care system. I'm just going to point out two ways in which Sen. Obama's plans agree with our own George C. Halvorson's analysis of the current health care crisis.

First, let's take a glance at one of my favorite topics, Electronic Medical Records. Via the Forbes article:

One element of reform is information: Doctors, patients and administrators simply do not know enough about which treatments work and which are ineffective or harmful. An estimated one-third of medical costs go toward care with no value. Obama proposes to jump-start the long-overdue information revolution in health care with $50 billion to computerize the medical system and spread the word about best practice.

If you have any questions on why this is important, I suggest using this blog's internal search function and looking for "electronic medical records." I have written extensively over the past year on the subject from a variety of angles. Let it suffice to say that administrative costs -- the dreaded paperwork that elicits groans from almost everyone -- is one of the areas where spending can most easily be curtailed. To make it a true win-win scenario, doing so will increase efficiency of treatment across the board.

A second element is to fix perverse incentives in medical care. Doctors and hospitals today are paid for performing procedures, not for helping patients. Insurers make money by dumping sick patients, not by keeping people healthy. Obama proposes to base Medicare and Medicaid reimbursements on patient outcomes in a coordinated effort to drive the entire payment system toward paying for improved health rather than just more care.

Perverse incentives is exactly the way Mr. Halvorson puts in in his book, Health Care Reform Now!. There is a vital need to switch from the pay by treatment attitude to results-oriented incentives. With over 9,000 billing codes, there is not one for a cure. That speaks volumes.

The article goes on to cover other health care issues that we return to consistently here: the massive importance of prevention, accessibility of care, affordability of coverage, and more. A very nicely presented piece, and since it is penned by economists, it is of additional interest as we watch the DOW bounce up and down like a rubber ball.

Good reading!

SOURCE: "Obama Can Cure Health Care's Ills" 10/28/08
photo courtesy of bobster1985, used under its Creative Commons license

Oval Office: One Week Away

It is one week until Americans everywhere cast their vote for the future of our nation and the future of its health care system. This is an historic year and one in which the choices we make are of incredible importance.

With that in mind, I'd like to point you towards a piece from USA Today that is great for an overview of the candidates' plans. Composed by the publication's editors, it endorses a strongly bipartisan approach similar to the one that Sen. Ron Wyden has proposed.

Nonetheless, it does help dispel some of the fog of rhetoric that has surrounded the claims on both sides since the election cycle began. Citing highly pertinent, impartial sources like The Annenberg FactCheck and the Kaiser Family Foundation, and deconstructing the media/advertising spin, it does a pretty concise job of laying everything out for the thoughtful voter.

Ultimately, the best health care plan might combine elements of both McCain's market-based reforms with mandates to make sure that everyone has access to coverage. Given how contentious the campaign has been, that might seem far-fetched. But Sen. Ron Wyden, D-Ore., has a plan to do just that.

Even if Democrats pad their congressional majorities on Nov. 4, many of the tough issues that this nation faces won't be solved without bipartisanship. Health care reform is no exception.

Certainly well worth examining. Follow the Fact Check link when you read it.

SOURCE: "Health care Rx: Mix up McCain's and Obama's plans" 10/27/08
photo courtesy of Jeff Milner, used under its Creative Commons license

Reaching Across The Aisle on Health Care

There has been a stealth campaign running in the background during the sturm und drang of the U.S. presidential race. It has been a campaign for health care orchestrated by the terminally ill Sen. Edward M. Kennedy involving a tremendous bipartisan effort to craft a universal health care bill for presentation to the new President in the beginning of 2009.

Jeffrey H. Birnbaum of The Washington Times reports of the stupendous selection of people involved in what Kennedy is calling the "cause of his life":

The discussions, which started in June, included 14 roundtable meetings in the Dirksen Senate Office Building. These were attended not only by Kennedy aides but also by staffers, both Republicans and Democrats, from the Senate committees with jurisdiction over health care. Those include the Budget Committee, the Finance Committee and the committee that Mr. Kennedy leads, the Committee on Health, Education, Labor and Pensions.

Also attending was the entire panoply of interest groups with stakes in the cost and availability of health coverage. These included the AFL-CIO, the Business Roundtable, the U.S. Chamber of Commerce, the National Federation of Independent Business, the National Retail Federation, the Federation of American Hospitals, the American Medical Association, America's Health Insurance Plans, Families USA, AARP and the Consumers Union.

Mr. Kennedy's staff has started to meet regularly with a small group of people representing each facet of industry as well as consumers. Kennedy aides said they have not drafted legislation but probably will do so soon.

Kennedy has remained in touch with the closed door proceedings via regular telephone updates from his staff. In addition, he is spending several hours a day on the phone with other Senators as he pushes to bring this bipartisan effort to fruition. Much like the efforts of Sen. Max Baucus which I have written about in earlier postings, this is an effort to bring all sides together. It would seem from the reports that I am starting to get that Sen. Kennedy's efforts are involving a much broader group of participants than any thus far.

Sidelined for weeks due the diagnosis of brain cancer and the subsequent treatment, Kennedy is nowhere near out of the running. As best as can be determined by the Washington Times article above, his audacity in having universal health care as a goal has drawn together lobbyists and consumers, providers and insurance companies, conservatives and liberals. I have a feeling that the next president will be presented with something truly unique and American when this bill is finalized and hits his desk.

SOURCE: "Kennedy secretly crafts health care plan- Turns 'cause of his life' into '09 bipartisan bill" 10/24/08
photo courtesy of diggersf, used under its Creative Commons license

Report: Community Based Prevention = Health Cost Savings

Prevention is generally acknowledged as a key factor in fighting chronic health issues. I don't think there is anyone who would dispute the fact that quitting smoking, while incredibly hard to do, vastly reduces your chances of lung cancer among other nasty illnesses. (I pick smoking as my example here because I am on day 22 without nicotine right now.)

Since these chronic issues consume so much of the expenditures made on health care, it is only natural that prevention should come to the fore as we attempt to craft a new system. As obesity and diabetes statistics skyrocket this becomes more and more obvious. What is interesting is a new report that has just been released which addresses a species of prevention not often spoken of in debates: Community-Based Disease Prevention.

Via MarketWatch:

In its report - commissioned by The California Endowment -- entitled Prevention for a Healthier California: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, the Trust for America's Health (TFAH) and Prevention Institute and the Urban Institute find that an investment of just $10 per person per year in proven community-based disease prevention programs to increase physical activity, improve nutrition, and prevent smoking and other tobacco use could save California's health care system more than $1.7 billion within five years. This represents a return of $4.80 for every dollar spent.

Furthermore, in 10-20 years the savings could grow to more than $1.9 billion annually, which would be a return of $5.40 for every $1 invested.

Wow. Encouraging numbers. Granted, like most things, implementation is a whole different ball game, but it still provides a goal to shoot for. One thing is confusing though. What exactly is "Community-Based" disease prevention?

Community-based disease prevention programs are things that impact health outside of the doctor's office, such as planning communities to have sidewalks to encourage walking; keeping school athletic facilities open after normal school hours so that youth have a safe haven to engage in physical activity; making fresh fruits and vegetables easily available in communities where there are few or no supermarkets; and implementing local ordinances that prohibit smokers from lighting up in public areas, among many others.

I have no trouble seeing the positive effect such measures could have on both individual health care and on the collective financial bottom line. Of course, much like herding cats, it will be an adventure getting the majority of people to actually utilize or participate in these programs, options and efforts once they are in place.

As always the variable is human behavior, although with so much to gain if may well be possible. I guess we will have to wait and see.

SOURCE: "Report Finds Community-Based Disease Prevention Saves California Money and Improves Californians' Health" 10/23/08
photo courtesy of kcjc009, used under its Creative Commons license

An Injection of Interaction

Health 2.0 is not just a concept, it is also an LLC. A quick glance at the links I've just provided should illustrate the difference handily.

The LLC is currently hosting their Second Annual Health 2.0 Conference , examining the plans offered by our candidates as well as the effects of the chaotic economy on health care and how social technology fits into the overall picture. Evidently, there is quite a bit of interest since as of last Friday night they have had to add another room to the conference where the proceedings may be watched on a large screen due to attendee demand. It is a sign of how vital this conversation is when we see people shelling out money to sit in an adjoining room watching a video feed.

One of the biggest themes at the event is the way in which the methodology is shifting. Social media-driven approaches need to engage with the patient base in ways entirely unprecedented within the medical industry.

Lidija Davis of The New York Times reports:

The rules of engagement however, as Clay Shirky pointed out in his keynote on Wednesday, are changing.

According to a study released today by Edelman [PDF], trust and confidence are inversely proportionate to demand for health care. With an aging population, behavior-related chronic conditions, and expensive innovations, companies must help people address their specific personal health concerns with thorough, transparent and specific information.

Additionally, the financial meltdown is aggravating an already weak health system as people forgo or postpone essential health care due to loss of insurance or inability to pay.

The answer, according to the survey, is engagement: "Effective health engagement can build trust, and conversely, trust is the key to deeper engagement," said Nancy Turett (Edelman).

Interactivity in the name of the game is the modern day. Online access is becoming less and less optional as time goes by, and companies are starting to realize this. The consumer of 2008 has high expectations learned from their use of services like online banking and websites such as eBay and Amazon. As belts tighten during the economic downturn, more and more people will be taking a closer look at their health expenditures trying to find ways to reduce their capital outlay.

A good example on the corporate end is Aetna. The company is working on a system to allow their customers to transfer their existing health records to Microsoft's Health Vault, an online EMR option. Other big players in this aspect of the industry are WebMD, Google, Yahoo and Microsoft all of whom have programs worth watching. (Ms. Davis' article linked below has more detail and quotes from each them.)

Transparency note: The Health 2.0 Conference has Kaiser Permanente as its Flagship Sponsor. This blog's affiliation with Kaiser Permanente can be viewed on our About page.

SOURCE: "Health 2.0: Rules of Engagement " 10/23/08
photo courtesy of zaldylmg, used under its Creative Commons license