WHCC 2008 Potpourri

I am flying home and trying to catch up on all my notes so that I can get back to work. It has been a good 2.5 days, and I got some business done, learned several things, and met a bunch of interesting people. Not bad. I have a few more interviews to write up, but I want to throw some of my notes out there so that you can pick up some of the other comments / thoughts that I captured.

• Michael Leavitt (Secretary, Department of Health and Human Services) spoke at the end and talked about several things:
  • He told the story of someone saying “the great thing about healthcare standards is that there are just so many to choose from” and went on to talk about how problematic that was.
  • He talked about 4 things:
    • Standard quality measures
    • Standard cost-of-care groupings
    • Interoperable EMRs
    • Incentives to seek value
  • He said “the billing system in healthcare is insane”. And had an analogy that I am sure many traditionalists thought naïve about what buying a car would be like if it had the same billing process as healthcare…starting with making a purchase with no price available.
  • He said that things are so bad that “people with average intelligence and limited patience can’t understand healthcare pricing”.
  • He talked about moving to a value-based system and compared it to video games. He said we are at Pong today and need to evolve through Donkey Kong and Pac-Man to get to Wii. (Nice vivid analogy)
  • It was refreshing to see a government official very passionate about the dilemma. He talked about ongoing cost increases as the most serious economic threat to our country. He talked about how there is an inflection point in every generation where we have to prove ourselves and healthcare reform is ours. He said we have three options:
    • Fight change and fail
    • Accept change and survive
    • Lead change and prosper (which is what he called upon us as Americans to do)
• In a session yesterday, there was talk about:
  • DASH – Dietary Approach to Stop Hypertension – where EMC talked about saving $1,000 per participant.
  • The Prochaska change model looking at different stages of change and moving from awareness to education to supportive environment to changing behavior to sustaining change.
  • Engaging consumers through education, motivation, access to reliable information, reinforcement, and support. But the speaker lost me when she claimed that consumers don’t engage since they assume their physician is taking care of their health. What consumers are these?
  • I liked the analogy of “supersizing” referring to the fact that healthcare often delivers more than needed.
  • I was a little shocked in watching a video which made three suggestions that I didn’t agree with:
    • Patients should go to hospitals with the most experience (what about the best outcomes)
    • Patients should always go to the health plan website (since they don’t trust this source is that really the default answer)
    • You should call your MD first at 3AM. (are they really going to call you back to triage you)
  • I liked the positioning that “there is no free lunch” to make the point that there is a tradeoff between spending. Sure you can have more health benefits, but we will have to limit benefits elsewhere. The speaker also compared healthcare to giving someone a “platinum charge card” and that there needed to be education about how and when to use it responsibly.
  • And, I believed it but was surprised to hear one speaker say that when they educated their members about what questions to ask their physician that physicians complained saying they didn’t have time to answer all these questions and see all their patients. (Now there’s a systemic problem.)
• One of the best speakers (who deserved a longer dedicated session) was Reed Tuckson from UnitedHealth Group. He spoke with Peter Neupert from Microsoft about “Achieving a Consumer Focus”:
  • He talked about changing the question from what is the best hospital in Chicago to what is the best hospital for me based on my preferences and my conditions.
  • He talked about segmentation and targeting communications.

“Data is only exciting if you can do something with it.” [Reed Tuckson]

• He talked about two challenges literacy and longitudinal view of the patient. He said today’s students don’t know “diddly squat about science.”
• There was a good discussion with the moderator about whether people perceive the Internet to be secure or whether that is still an issue.
• Peter provided two differences that he thinks makes healthcare security still an issue:
  • Work about discrimination if the information were to be misused
  • Work about insurability if the information were to be misused
  • Both of these being a much bigger deal than having your bank account compromised
• There seemed to be consensus that consumers wouldn’t mind de-identified healthcare information being shared for the purpose of public health research which is clearly a benefit of aggregating data, but Peter clearly pointed out that HealthVault’s data belongs to the consumer so they would have to opt-in.

“Today’s system is broken and fragmented…you can’t track a patient through the system.”

• In a session on Massachusetts with people from BCG, Tufts, Harvard Pilgrim, and the Commonwealth Health Insurance Connector:
  • What should come first was the question – access, quality, or payment? Great discussion.
  • The typical uninsured was a 37-year old male who was “just starting to think they weren’t invincible”.
  • This will be an interesting example of a stick. People who don’t have coverage will be penalized $75 a month on their taxes for 2008.
  • They were able to offer 50% more benefits at 50% of the costs.
  • The deficit issue is mostly due to too many people signing up (and I suspect too many employers taking the smaller penalty to get out).
  • They talked about most reform being historically killed by either the broker community or the managed care community and that they needed to get a broker representative more involved versus simply having a broker advisory role today.
  • They mentioned the website several times – www.maconnector.org. They compared it to Travelocity.
  • They also talked about www.notinvincible.org.
  • Today, more people are choosing the higher premium plan options but that will likely change as they push the last people in their under a penalty model.

Sorry for the long mix of stuff, but I think it will cause you to think and share some of the experience. I have to write-up my last interviews later today.