The Public Is Educated In Health Care 101

The Kaiser Family Foundation puts together some interesting work that can help keep a perspective of the reality of what is going on in this industry. The politics, the complexity, and the individual self-interests have made this all very confusing to the average citizen. Over the past 10 months they’ve been given a lesson in Health Care 101 whether they wanted to take the class or not.

Here’s Where We Stand Today:

Kaiser’s January Health Tracking Poll finds 54% of the American public feeling that addressing health care reform remains an important part of addressing the broader needs of our economy. The message is very clear that something needs to be done to correct the trajectory we are on today. On the other hand, 39% feel we need to address other things first. Everyone is concerned with the impact anything we do will have on the deficit. Overall we’re concerned about the up-front costs that will be required to make it work and we don’t have a clue of what the real costs will be.

While the need exists, there is no strong support for any of the current proposals being considered by Congress. Getting to where we are today has been ugly. I wouldn’t imagine there is any great sense of trust in the final product that has been produced as a result of this process. Interestingly, 42% of the public supports the current proposals being considered and 41% oppose them. But, it’s the intensity of the support or opposition that makes it interesting. Those that oppose it really oppose it, and those that support only “somewhat” support it. The strength of the support is still at risk and vulnerable to individual issues.

Most (42%) still feel the country will be better-off by pursuing the current alternatives but patience is wearing thin. A growing number (37%) feels our country will be worse off if we continue down this path. If the pattern continues it won’t be long before the percentage of people feeling our country will be worse off will pass the others. That will make for some interesting political discussions.

When you consider that between the House and Senate Bills you are dealing with over 3,000 pages of legal jargon it is no wonder that the average citizen does not have a good idea of what is included in the legislation. I wonder of our Congress really knows what is included in the 3,000 pages (sorry, that’s another post). While the public wants to be educated, it is still very vulnerable to the talking points of particular points of view and the public (fortunately or unfortunately) hears and somtimes believes those who yell the loudest.

The Kaiser study found that the most widely recognized provisions (those identified as included as a component of the legislation) were those that were “touted by both supporters and by opponents”. We have a signficant education opportunity as we move the public to Health Care 202 (the next level). Let’s just hope we don’t make it as ugly as Health Care 101.

It’s an interesting study and well worth the time spent reviewing it. After the elections in Massuchsetts last week we’re all still wondering the direction health care reform will take. But at least as of today the public still knows we need it, they just don’t necessarily like the proposals that are out there today. Hopefully, we’ll now take the time to regroup and listen to them a little more closely as we move forward.

I'm Just Ticked

Ok, I’ll tell you from the start this post is going to be biased. I’m ticked.

In Massachusetts, the special election to fill Senator Ted Kennedy’s seat is on the line. We’ll know the outcome later tonight (maybe- it’s going to be close) and it will be the start of a whole new ballgame. Ironically, the outcome of health reform (Senator Kennedy’s passion) as well as the broader Democratic agenda that has been laid-out in front of us is also on the line.

Democrats are scrambling and planning for the worse, Republicans are lining-up to prepare their own strategy to put a halt to the direction the Democrats have been taking. While I am not a Massachusetts resident- I would hope our goal would be to focus on putting the right person in this leadership role- regardless of the political ramifications (and I know I’m dreaming here).

We’ve been critical of both the approach and structure of the health reform direction since the House put out its version last August. We’ve been more critical with the strategy and direction of both the Obama Administration and the Senate as they focused more on a Christmas Time-Line than doing what is right. And, we’re even more skeptical of all of the side deals that are being cut to move this thing through.

We have said all along that our health care system is in dire need of reform. The Republican approach (if there is one) is too light, and the Democratic approach is too heavy. Neither side is addressing the fundamental structural problems that need to be addressed immediately to prevent us from moving into what Jim Collins calls “Stage 5 Decline”- capitulation and death. The system we have today simply hurts too many, is too expensive, and has been built by patch-working various ideas together over the years.

Our Congressional leaders need to be leaders and not followers of the special interests and lobbyists. That’s what got us into this problem in the first place. They need to be knowledgeable of the real issues- especially when lives are on the line. And, they need to remember health care is not the only thing on the minds of the voters across this country.

Massachusetts Democratic candidate Martha Coakley commented on Monday that we should be planning an exit strategy for Afghanistan because “there are no more terrorists there”. She said they all left Afghanistan and went elsewhere. As a citizen whose son is heading to Afghanistan to battle the terrorists and reads the casualty listing on the DOD site daily, I was simply appalled.

If this is an example of the base-line knowledge of the people we want to be leading the country we are in a sorry state. It’s time we put people in place that can connect with the American people- and not put people in Washington to simply fulfill someone else’s political agenda. As Mark Twain said, “Patriotism is supporting your country all the time, and your Government when it deserves it.” The Government doesn’t deserve it right now- for either party.

Republican, Scott Brown would get my vote on this one. And, Democrats have better start trying to figure it out how to deal with the fallout either way.

EMR/PHR/EHR- We're Good At Confusng People

As part of the American Recovery and Reinvestment Act of 2009 the government included a sizeable chunk-of-change to try to get the health care industry caught up in the world of technology. We all know that with the fragmented system we have today, tests are duplicated, many still rely on paper, and many times the communication and coordination between the patient and the multiple care teams they may access is hindered. Some organizations (Kaiser Permanente, Mayo, Allina Health Systems to name a few) have already made great progress simply due to the delivery structure they use. Most still have a long ways to go.

So, the Department of Health and Human Services produced another monstrosity of a document outlining the “meaningful use” criteria that will be considered to qualify for the billions of dollars eligible for payment if providers (hospitals/physicians/etc.) initiate information technology (IT) in their delivery. These criteria are open for comment with final rules due sometime early in 2010. Doctors and hospitals are already concerned with the “burden” these rules would place on their organizations. Technology companies are encouraged with finally having a roadmap they can follow (See our Blog of April 26, 2009). You can read the document by clicking here.

The goals outlined in the document are admirable; “to improve the quality of health care, such as by promoting the coordination of health care and improving continuity of health care amonth health care providers, by reducing medical errors, by improving population health, by reducing health disparities, by reducing chronic disease, and by advancing research and education.”

But, once again health care is confusing people with its definitions. We’ve also posted a 2006 white paper by HiMSS Analytics providing a pretty decent description of the difference between an Electronic Medical Record and an Electronic/Personal Health Record:
Electronic Medical Record- Clinical data depository, clinical decision support, controlled medical vocabulary, order entry, pharmacy and clinical documentation applications.

Electronic Health Record/Personal Health Record- A subset of the EMR. Owned by the patient- includes patient input and access that spans episodes of care across multiple delivery organizations.

While the DHHS meaningful use criteria reflects an EMR (by the definition above)- they are calling it an EHR. While consumers may have access to the EMR as it is described, they don’t control it. While we certainly need to improve the interface and technology in health care today- the consumer needs to be a part of it- not a victim of it.

Many consumers are already exploring other options to organize and track their health care information. Google Health, Microsoft HealthVault, Mayo, Revolution Health, and others are already providing consumers with software and technology to begin to interact more effectively with the system we have today.

As the delivery system moves forward in improving its communication and coordination by improving its technology- let’s not (once again) leave the consumer to be on the receiving-end of the experience. Let’s also get our definitions straight and make certain we all stay on the same page.

As we know, health care is good at confusing people- even amongst ourselves.

CMS just announced that the spending growth rate in health care slowed to its lowest level in 50 years. Health care spending in 2008 increased 4.4% to $2.3 trillion and now represents 16.2% of our GDP- up from 15.9% in 2007. Health care spending continued to outpace the spending in the rest of our economy.

About 10 years ago the government set some goals for our country to achieve to improve the overall health of our population. Healthy People 2010 goals were built off of the Healthy People platform established over 20 years ago to set some benchmarks and measure the health and wellness of our country. How’d we do?

We’re fatter, we eat more salt and fat (not less), more have high blood pressure, and we have more children with unhealthy tooth decay.

To be fair, we did improve in lowering cancer rates, increasing smoking regulations, reducing work-injuries, and improving childhood vaccinations.

We hit 24% of the goals established in 2000, and are expecting slightly less for 2010.

At the same time, the University of Michigan recently completed a study showing that the growth in the obesity rate in this country is snuffing out the “wellness benefits” gained from the decine in the use of tobacco. We smoke less, but we’re fatter.

Bancprutcies soared in 2009 increasing over 32%. While many were related to the housing market, a substantial number can be expected to be in some way related to medical expenses.

I’m now looking over the 700 pages of “Meaningful Use” rules that will direct the implementation of Electronic Medical Records for physicians, the Genetic Information Non-Discrimination Act (GINA) that will impact the development of wellness plans for employers and their employees, and anticipating the barrage of rules that will come out of health reform, and I wonder where all of this is leading? Is innovation that can improve the health care experience for the individual (and ultimately result in lower costs) dead?

We can do better than what we’re doing today.

The individual consumer is the key and our health care system just isn’t connecting. The rules of the game that are being established aren’t making it any easier.

Health care organizations are going to need to go out of their way to connect, really connect, with the individual. They will need to understand that most will trust their doctor, but not much else. The processes we have in place are confusing and sometimes frightening. We really need to work hard to keep the individual in mind- and not just focus on meeting regulations and completing transactions. We need to create relationships.

Consumers need to step-up-to-the-plate big time. They need to be informed of the workings of this system, and not become victims of it. They need to take responsibility for their health and take care of themselves. Our lifestyles create over 50% of our problems in the first place.

So, as we look over the landscape of health care reform, we’re going to focus on doing what is right for the individual. We’ll continue in our efforts to “educate the consumer” and help organizations create the “trust” that is going to be needed to connect with the individual.

Health is personal- Eat right, exercise, get plenty of rest, and keep the stress down; It’s not difficult. Creating the social context around these ideas to engage the individual is the challenge. And, health plans and the government aren’t the right messengers right now.