A "HealthTweep" Pulse Check

Exploring transformational potential of social media

w00t! Inaugural HealthCamp San Diego Scheduled For 9/7/10

with one comment

I must say, after my first meeting with Mark Scrimshire, HealthCamp evangelista extraordinaire, at the ‘cocktail party’ for the World Health Congress held in Carlsbad, California, in February of 2009, I became an inspired ‘healthcamper’. My participation and experience with HealthCamp for the next several months was ‘virtually’ via Twitter, and the periodic live streaming of HealthCamps’ on uStream. I got to experience my first HealthCamp ‘in the flesh’ at HealthCamp SFBay in October on my way to the Health 2.0 in San Francisco. Since then, I have adopted the charge to seed a HealthCamp in the city of San Diego.

Only recently did the generosity of Kaiser Permanente permit this vision to be fully realized. At a ‘pre-Barcamp’ San Diego social hour of life sciences and bio-tech tweeps including Mary Canady, aka @marycanady, I met Dr. Jeff Benabio, aka @dermdoc on Twitter. We discussed the granular and un-conference nature of HealthCamp, which he immediately ‘got’, and embraced as a practitioner of the social media arts, and bang! HealthCamp San Diego was borne! Thank you Dr. Benabio! Thank You Kaiser, especially, Danielle Cass aka @daniellecass.

So San Diego Tweeps, the inaugural meeting of HealthCamp San Diego will be held at the Town and Country Resort and Convention Center, in Mission Valley, on September 7th, prior to the 2nd Annual mHealth Inititative Conference on September 8th & 9th, 2010.

HealthCamp is a collaborative experience that typically tethers to how interactive digital or social media, open source and the best of the Internet, mobile (mHealth) web, and process innovation can enable better health(care) outcomes via more effective patient or consumer engagement, and incidentally further evolve developers in health technology applications and/or platforms.

HealthCamp is a user-organized ‘un–conference’ that brings together consumers (aka e-patients), health providers, payors, health industry experts and technology professionals for a one (1) day session to exchange ideas informally, locally, openly. Participants themselves provide the content, with break-out sessions they develop themselves and plug into a schedule grid on the day of the event. Anyone can present and host a session in nearly any format.

Past HealthCamp’s have been held in Boston, Philadelphia, Washington, DC, Nashville, Oakland (the SF Bay area), Maryland, and the UK. For a brief overview of HealthCamp, click here.

HealthCamp San Diego is coordinating with the 2nd mHealth Networking Conference to be held at the same location following HealthCamp San Diego on September 8th and 9th, 2010.

Please consider joining us for this inaugural ‘un-conference’ experience. Among the many topics likely to be presented in the tech-enabled consumer empowerment conversation is emerging health information technology (HIT) capabilities, with an emphasis on new communication patterns enabled by mobile technologies for:

– patient communication by text and email
– clinician collaboration systems
– use of apps on mobile devices; and
– aspects of user-generated care

Fee: $25.00, $5.00 for full time students.

For more information, or to register, click here:

About HealthCamp

HealthCamp is a collaborative experience designed to create open space for peer-to-peer learning, group process collaboration and creative expression. As an ‘un-conference’ all session content is participant-generated, many of which tether either direct or indirectly to the promise of emerging interactive digital or social media, to improve health(care) outcomes via more effective patient and/or consumer engagement with their health. Particular focus is paid to the dynamic mHealth (mobile) market due to the exploding use of iPhone, Droid and other mobile devices.

7th Annual Healthcare Unbound Conference in San Diego – July 19th & 20th

leave a comment »

A quick note to call your attention to the 7th Annual Healthcare Unbound conference which begins tomorrow, Monday, July 19th through Tuesday July 20th, in San Diego at the US Grant Hotel.

This is an impressive event that brings together many stakeholders in the consumer empowerment and evolving participatory medicine space from telehealth to the explosive mobile health aka mhealth markets.

Conference Keynotes by:

A hat tip to both Vince Kuraitis at the e-care management blog and Kristi Durazo aka @krash63, futurist at the American Heart Association.

I will be tweeting from the conference and will be using the hashtag #hcu10 for my posts.

The ‘Medical Aggregators’: Are We Entering Round Deux?

with 8 comments

First a little historical context:

For those with a healthcare ‘event horizon’ slightly more seasoned than the current health reform and related social media data frames, you might remember the initial round of aggregation in medicine lead by disruptive nameplates such as MedPartners (now operating the PBM CareMark), PhyCor, FPA Medical Management, and their second or third tier physician practice management ‘me too’ copycats.

They all emerged from a robust round of venture capital backed industry determination tagged as ‘PPMC’s’, i.e., physician practice management companies. These ‘aggregators’ were the darlings of Wall Street for a while, though with some exceptions, i.e., US Oncology (formerly Physician Reliance Network), most witnessed relatively short life spans, from IPO to unwinding in perhaps a 10 year run (see: MedPartners collapse and Aftermath).

Yet, despite the promise outlined in the offering prospectus’, why did these entities fail so miserably as the ‘white knight’ consolidators or aggregators of a multi-trillion dollar ‘cottage medical industry’? Their business model proferred essentially three core benefits:

  1. Centralized, standardized and more efficient back office medical administrative management
  2. Scale of market asset concentration and therefore increased sophistication and leverage (improved pricing) with third party payor negotiation, and downstream contract management; and
  3. Serve as an ‘anchor play’ with respect to the broader design and implementation of rational though market based local delivery organization and financing, i.e., PPMC’s would harness and more effectively articulate a business culture among physicians that valued clinical integration, medical risk management, and ultimately the allocation of limited health care resources

At least this was the longer term expectation from a ‘win/win’, i.e., payor and provider perspective, of the more established players. Most however, in an effort to demonstrate value (i.e., earn their management fee) to their physician boards, focused on short term margin improvement (better rates, focus on more profitable services via improved payor mix, maximizing the contract revenue/recovery cycle, and reduced overhead, etc.), vs. the strategic focus of managing the risk (both quality and cost) of their local population (i.e., enrolled members).

So rather quickly the strategic basis of the PPMC appeal was subordinated to a short term focus (i.e., increasing net revenues) due to a rising chorus of claims that at its core the business model was merely a third party ponzi scheme which introduced another mouth to feed from an increasingly constrained health care supply chain.

Net/net, the PPMC industry flamed out big time and did not fulfill its ‘roll-up’ promise of the practice of medicine. Now many years later, we are at another tipping point. Witness the current round of promising vehicles with a similar vision of organizing physicians. These candidates include: hospital systems, health plans, integrated delivery systems, emerging ACOs, medical homes,  and even niche play organizers in the concierge, or direct practice space including SignatureMD, MDVIP, HealthAccess Rhode Island, CarePractice, Qliance, and HelloHealth, as well as the rapidly emerging series of retail pharmacy sponsored primary care clinics, e.g., CVS/CareMark Minute Clinic, etc.

Too many docs are unwilling to risk the capital of private practice, and instead are looking to hook-up with one or more of these institutional or VC backed entrepreneurial sponsors. Will they succeed where their predecessors failed? If so, why?

From my perspective, it will clearly depend on the business model chosen to enable competition of the right variety, and the degree to which the venture embraces, nurtures and expresses physician culture that values collaborative group practice. Top down, corporate strategies dependent upon an over worked and out gunned medical director or VP of medical affairs will miss the mark. The more likely way for these ventures to succeed is by ‘baking’ the culture from the ground up. In other words, ‘seed it and they will come’. One of my mentors (Ernest Holmes) once wrote long ago: ‘the soil can’t argue with the seed’. Lets nourish the soil first, then make sure we plant the seeds with the right constitution and vision.

‘Health Geek Radio’ is on the web!

with 3 comments

Ok, this is definitely a report from the ‘lean and agile’ department, and a granular sign of the ‘interactive digital’ times we’re in.

This idea is about ten (10) days old. The genesis came from Susannah Fox, e-patient and Associate Director of Digital Strategy, of the Pew Internet and American Life Project. Susannah apparently caught my broadcast of Adam Bosworth who was keynoting at the Alliance for Healthcare Foundation’s Innovation Initiative in San Diego. While acknowledging the visuals weren’t best in class, she noted the content Adam offered was worth a listen and bucketed the event in the ‘health geek radio‘ domain.

When I first heard the name ‘health geek radio’ I thought, how cool is that? And certainly there’s a lot of interest in emerging technologies all dialed into the patient or consumer empowerment cause. So, I queried the domain and also checked to see if that account ID was available at BlogTalkRadio; to my surprise, both were open, so I promptly grabbed them.

Today, I recorded a brief introduction as to the genesis and forward value of creating such a health geek community focus. Take a listen here.

The first official broadcast is yet to be confirmed, but I will invite thought leaders and change agents into the conversation. Several who I have spoken with already have indicated an interest in participating, including: Matthew Holt, Dave DeBronkart (e-patientDave), Phil Baumann, and Dr. Danny Sands, to name a few.

Written by 2healthguru

May 14, 2010 at 3:12 PM

Accountable Care Organizations (aka ‘ACOs’): Ellwood’s SuperMed Vision Lives!

with one comment

The Patient Protection and Affordable Care Act is now law, and the ‘devil is in the details’ scramble is on both inside and outside the beltway. The great divide seems to (disproportionately) line-up between the let’s roll up our sleeves and get ‘er done crowd, and the perhaps politically motivated ‘denial-ists’ hoping to successfully challenge the constitutionality of the law.

Via a separate post, I will address the ‘managed care 2.0’ nature of what we’ll likely witness as one who’s been on the ground, and frontline of change since the early 80s when the Health Care Financing Administration (HCFA) sported a placard for a little known office titled the office of ‘alternative delivery systems’, the then tiny shop in Baltimore that monitored the growth of HMOs and it’s California derivative, and soon to be dubbed ‘preferred provider organizations (PPOs). What followed is quite a storied path….

Meanwhile, let me call your attention to a timely piece of work offered by Paul Keckley and the health policy braintrust at Deloitte, titled: ‘Accountable Care Organizations: A new model for sustainable innovation‘. The title abstract is reprinted below, or you may download the full report via the site link above.

To understand how accountable care organizations (ACOs) might drive payment reform in the public and private health care sectors, this paper reviews the basic origins, definition and drivers of ACOs, and describes key features of proposed ACO initiatives, including the federal government’s proposed pilot program. In addition, using an assessment of ACO literature and Deloitte analysis, the paper profiles four structural approaches that are eligible for ACO status and puts forth seven key capabilities that are important considerations for ACO performance. Finally, this paper offers Deloitte’s perspective on the path forward and describes potential innovations that could increase ACO adoption.

So will it be ‘deja vu’ all over again, or will it be different this time? Put another way, those who wish to deny the past, may somehow find a way to re-create it. Oh, the tangled web we sometimes weave…..more will be revealed!

Written by 2healthguru

April 21, 2010 at 1:58 PM

A Physician Call to Action: ‘Stop Whining & Lead’

leave a comment »

These are complex and troubled times in medicine, and the health care industry at large, whether you consume, provide, pay, supply, sell or consult into or for the ‘whack-a-mole health care borg’. Given it’s insatiable and even rapacious share of GDP appetite, as well as its many implementation complexities, everyone, even the PPACA advocates and supporters, are mildly to significantly ‘nervous’ about what comes next: see Atul Gawande’sNow What?’, or MoneyWatch.com Special Report: ‘What’s Next for Taxes?’ or even the proactive Patient Centered Medical Home (PCMH) and Healthcare Reform: Avoiding Drowning in an Ocean of Opportunity.

Most of us (with the exception of the rhetorical ‘repeal and replace…. ahem, I mean revise’…. or worse, the ‘frivolous‘ perhaps politically motivated State AG ‘sue em’ crowd) are into action focusing on the many pilot and demonstration opportunities now written into law. Note:  for a deep dive and excellent summary of some of those opportunities, see Vince Kuraitus’ superb work (and I mean, with proper ‘fluff’ a consultant might charge $5,000 – $15,000 for these timely and laser focused insights), in ‘Pilots, Demonstrations & Innovation in the PPACA Healthcare Reform Legislation‘. Kuraitus pulls some of those ‘opportunities’ upfront, at least those impacting ‘e-care management’:

I count at least 5 pilot projects and 30 demos in the PPACA legislation.

Here are some of the pilots and demos that I believe will be of most interest to e-CareManagement readers. (A full listing of pilots & demos is shown at the bottom of the post).

Pilots

Sec. 3023. National pilot program on payment bundling

Sec. 4202. Healthy aging, living well; evaluation of community-based prevention and wellness programs for Medicare beneficiaries
Sec. 4206. Demonstration project concerning individualized wellness plan
Sec. 10326. Pilot testing pay-for-performance programs for certain Medicare providers

Demos

Sec. 2704. Demonstration project to evaluate integrated care around a hospitalization
Sec. 2705. Medicaid global payment system demonstration project
Sec. 2706. Pediatric Accountable Care Organization demonstration project
Sec. 3024. Independence at home demonstration program
Sec. 3027. Extension of gainsharing demonstration
Sec. 2601. 5-year period for demonstration projects. (for dual eligiblebeneficiaries)
Sec. 3140. Medicare hospice concurrent care demonstration program.
Sec. 3510. Patient navigator program.
Sec. 4206. Demonstration project concerning individualized wellness plan.

So what is ‘disorganized medicine’ to do?

  • Will we revisit the ‘circle the wagons’ days when Bill Hsiao proferred the landmark fair valuation system aka RBRVS, only to witness a special interest orgy demanding and even suing for re-balancing of certain procedural vs. cognitive events?
  • Will we go the direction of certain specialty societies, or more broadly represented yet so-called ‘national’ physician organizations (one with 2 State chapters), who opposed health reform?

Or will medicine step up and lead? Can medicine lead? Afterall, we do know what works, we certainly know the root problem(s), so why all the internecine fighting so endemic to political medicine, and where are patients in this conversation?

For me, Jack Cochran, MD, CEO of the Kaiser Federation says it best on a recent panel at the National Governors Association starting at 01:24:00

lets step up, and in the conversation and represent what a different future could look like

or, paraphrased by me ‘stop whining and get busy.

So where will you put your focus? Will it be to demonstrate the financing and delivery system of the future? Or, continue the ‘echolalia’ of pessimism and Armageddon so rampant in this run up to change?

Written by 2healthguru

April 9, 2010 at 2:20 PM

Interview with @DoctorAnonymous on Physicians, the Web & Social Media

leave a comment »

On Tuesday, April 6th, 2010 I chatted with social media trail blazer Mike Sevilla, MD, aka @doctoranonymous, a practicing family physician from Ohio. We toured the landscape of social media, why and how he got started, how it’s impacted his life and practice, and where he see’s all this going.

You can listen to the broadcast here. @doctoranonymous offers seasoned insights for physicians considering putting a ‘toe in the water’ of social media, and also suggests where you might consider starting.

@doctoranonymous hosts his own web based radio broadcasts here.

According to Klout @doctoranonymous, is a ‘persona’ in the social media space:

@doctoranonymous is a persona: You have built a personal brand around your identity. There is a good chance that you work in social media or marketing but you might even be famous in real life. Being a persona is not just about having a ton of followers, to make it to the top right corner you need to engage with your audience. Make no mistake about it though, when you talk people listen.

Written by 2healthguru

April 9, 2010 at 12:35 PM

From ‘Health Reform’ to ‘Delivery System Transformation’

with one comment

Well we made it! It’s over for now. Obama thrashed through the red zone and against all odds drove the football of health reform across the plane of the goal line. But no rest for the weary, since that drive was the ‘easy’ part. Congrats Mr. President, the ‘Patient Protection and Affordable Care Act‘ as amended by the ‘Health Care and Education Reconciliation Act of 2010‘ is now U.S. law. Yet, phase two, aka the ‘devil is in the details’ implementation challenge is now before an industry that has historically opted the path of least resistance, rather than risk true game changing innovation.

For an excellent recap and summary of the combined bills, see: Kaiser Family Foundation’s ‘Summary of Coverage Provisions‘. Yet, I am most interested in the quality, and payment provisions that will drive the innovators’ in the mix. Most of the applicable language can be found in ‘The Timeline for Accountable Care: The Rollout of the Payment and Delivery Reform Provisions in the Patient Protection and Affordable Care Act and the Implications for Accountable Care Organizations’.

While the law falls short of what I hoped for (I stood for a robust public option to ‘discipline’ the health plan community, and most certainly favored a ‘Medicare E’ option for the 55-64 demographic), it offers many needed incremental improvements to the U.S. health insurance industry practices, as well as the granular ‘patient’s first’ innovation imperative if the reform effort is to honor it’s coverage goals, and not bankrupt the country.

Bottom line, is we’re  entering the era of Managed Care 2.0, a do-over or ‘Mulligan’ – if you will. Since the failure of the grand HMO experiment, and subsequent risk ‘push back’ in the mid 90’s when the typical hospital sponsored integrated delivery system (a poorly equipped and improperly motivated first generation risk management vehicle) constituted mainstream efforts to manage care, we’re now hoping this time will be different. But will it? What’s changed to suggest we’ll have a different experience this go round, or are we just doing the same thing over (and over) again expecting different results?

To monitor and re-tweet these discussions, I’ve started a Twitter notebook and associated ‘managed care 2.0’ (#mc20) hashtag to pool tweets. I anticipate a robust discussion in both the blogosphere as well as on twitter, so get ready for a flood of activities on Patient Centered Medical Homes (PCMH), Accountable Care Organizations (ACOs), PHOs versions 2.0, and a re-invigorated IPA community including their Management Services Organizations’ (MSOs) as ‘infrastructure and strategy’ hosts.

Also add to this mix the growing membership (and buzz) into direct practice (boutique, concierge, retainer, etc.) medical models that offer access to basic medical care outside of an insurance or health plan context. This is a space that is likely to witness a clash of definitional interest as to what constitutes a ‘patient centered medical home’ and for what purpose, whether it be as defined by law as an ACO or PCMH vs. a primary care practice that opts out of Medicare or participating with health plans, to service their members as de facto equivalents of medical homes albeit of the ‘unregulated variety’.

May you live in ‘interesting times’ or so goes an ancient Chinese proverb or perhaps curse; and yes we do!

Written by 2healthguru

March 29, 2010 at 7:31 PM

Health Reform Summit: More Theater of the Absurd or Gettin’ it Done?

with 2 comments

So where’s the ‘smart money’ on the likely net take away from the health reform summit, or as the more cynical would say ‘Obama health care photo-op’?

I suppose the prevailing sentiment would say hey it’s Washington, and therefore more theater with sound byte positioning for ‘ideologue base speak’ is the best we can expect. But might there be another way to frame this event, and its potential to yield one or more tangible deliverables for the health reform imperative?

As has been chronicled elsewhere, while Americans remain divided on key provisions of Senate and House approved bills, certain provisions are quite popular among majorities of Democrats, Independents and Republicans. When coupled with a national mood that is pretty fed up with finger pointing, and the relentless blame game, seasoned with recent revelations of obscene Anthem or Blue Cross individual health insurance premium rate increase requests in Michigan (56%) and California (39%), it just may be possible to hold these politicians accountable to the American people.

Lets face it, while its been a long and painful process to observe (especially the Senate Finance committee) or engage in, clearly the subject of the American health care delivery system, and its failing financing paradigm is a top of mind issue even for Joe Six-pack and those who might otherwise not give the subject the time of day.

So the time is now, ‘the whole world is watching’, and yes, failure is NOT an option. A bill must be signed that fully embraces the initial ‘Obama-care 101: The president’s 8 principles‘ or the more recently published  ‘Presidents Proposal for Health Reform‘.

For those of you who will not consume the health reform summit live, here is Ezra Klein’s ‘A Viewer’s Guide to Health Care Summit‘ courtesy of the Washington Post.

So Tweeps, lets get ‘er done!

Written by 2healthguru

February 24, 2010 at 11:05 PM

Social Media Absent Context for Content, and Process: Is it Just More Noise?

leave a comment »

It’s been said in this ‘you the media’ culture we find ourselves, that ‘content is king’. This assertion is primarily driven from the perspective that in the digital age, coupled with the explosion of both free and premium open platforms for information delivery, that content is the essential oxygen and currency in the space.

On Tuesday, February 23rd, at 12 noon Eastern, I chat with industry observer and thought leader Phil Baumann (@PhilBaumann on Twitter) on this timely and often misunderstood topic.

As Baumann notes:

A king without a kingdom is a pawn. A kingdom without power is checkmated.

After listening and meeting companies and the agencies that want to do business with them, one theme has emerged: so many of them don’t know what to do and ultimately feel somewhat powerless against a sea of endless new media emerging. They get a few slivers of sound-bites at the myriad of conferences abounding these days, like the ePharma Summit in Philadelphia earlier this week. Overall, however, there doesn’t seem to be unifying, integrating and penetrating views propagating. Echoes mostly. That’s OK – we all need training wheels.
.

See Phil’s complete blog post  here: ‘Content is King – Context is Kingdom – Process is Power“.

Please join us for an exploration of ‘Patient Empowerment: Content versus Information and How They Work Together‘. Your participation is welcome via call in (347) 539-5527 or chat-room participation.


Written by 2healthguru

February 22, 2010 at 6:41 PM