Next Things First

A Glimpse at Where We Could Be Heading… by Rob Coppedge

The Center for American Progress, Obama transition team chairman John Podesta’s think tank, has just released a blue print for health care reform (The Health Care Delivery System: A Blueprint for Reform).

The book’s goal is clear – even stated right up front:

This book offers recommendations and path¬ways to systematically promote quality, efficiency, patient-centeredness, and other salient characteristics of a high-performing health system. The blueprint it lays out is a vision of how different parts of the system should be structured and how they should function. Even more specifically, it proposes policies that the next administration and Congress could enact over the next five years to improve our health system.

Since the people involved in creating this report are almost certain to end up in (or in close orbit around) the new Administration – and since every sign suggests that health care “reform” is going to be top of Obama’s list of priorities – this is an essential read for people in the industry.

We would love to hear your thoughts:  from the perspective of health care’s importance to economic recovery to its role in the decline of American manufacturing; from the fiscal impossibility of continuing growth in spending to the moral imperative of taking care of our older and sicker populations.  The ways that the public and private sector work together to “reform”  and “change” the system will create a range of opportunities for innovators and have the potential to impact America’s social and economic well-being for generations to come.

Posted by RobC


The Wall Street Journal on Obama’s “Emerging Health Care Plan” by charlottegee
November 20, 2008, 12:59 pm
Filed under: health policy, medicaid/medicare | Tags: ,

The opinion piece in today’s Wall Street Journal—The Obama Health Plan Emerges—is certainly worth a read. The closing sentences can give you a quick idea of the article’s overall tone:

Either Senator Baucus and President-elect Obama are making promises that can’t possibly be kept. Or they’re not being honest about their plans for U.S. health care.

The usual statistics are cited, along with a brief rundown of the mess we’re in … the “slow-motion catastrophe,” and a review of the Baucus and the Obama plans. The author(s) eventually conclude that the “public option” (an insurance program managed by the government and modeled after Medicare that will compete with private plans) will not work, and then “Congress will deal with the problem by capping overall spending and rationing care through politics (instead of prices) — like Canada does today.” And it’s funny, because those words can scare a lot of people to death.

Full opinion piece: The Obama Health Plan Emerges

Corresponding WSJ Health Blog post: Insurers Will Sell Plans to All Comers — If Everyone Must Buy In

Posted by CharlotteGee


What “Joe the Plumber” Means for Health Care by Rob Coppedge
October 15, 2008, 9:11 pm
Filed under: health policy, medicaid/medicare | Tags: ,

Hard to believe that was the last debate. We are actually going to get to vote and close out the never ending campaign. And after nearly two years of talking, what do we actually know about what would, could or might happen to our health care system under a new Administration?

Listening to the debate tonight, it became clear to me that we don’t know much – primarily because the candidates themselves aren’t sure what they’ll have the money to do. As Dick Morris said before the debate last week in Nashville, the next President will be like a trustee in bankruptcy court. As the waves of financial crises (subprime to credit cards to the fall out from buy out deals) wash over the system, the next President will have the political will but no financial wherewithal to do what they (and their supporters) would like.

But, as McCain invokes plumbers and Obama follows suit, one thing is clear – this is Walmart rhetoric: Who can help the little guy more? And in that world, despite strong rational arguments of why it shouldn’t be so, I believe Medicare Advantage plans are in big trouble.

Obama picked on them tonight. They were one of the only things he could bring himself to single out as “cuttable”. McCain didn’t discuss them, but even with his strong support a heavily Democratic House and Senate will surely go after them aggressively.

So, with government sponsored business being one of the only recent growth areas for health plans – and many insurers like Humana having gone deep into that business – it will be interesting to see the how a show down between Washington and the private sector changes the landscape of the health plan business.

Posted by RobC

More Perspective on Cutting Medicare Health Support (yes, this came out last month…) by Rob Coppedge
September 18, 2008, 7:48 pm
Filed under: chronic care, medicaid/medicare | Tags: ,
Before we launched the blog, Jonathan Burkland, an investment banker at Stanford Group who has followed the Medicare Health Support issue closely and knows a bit about the disease management industry, had an opinion piece in Modern Healthcare on the subject.

Chronic-disease patients unquestionably are a heavy drain on the healthcare system. The Centers for Disease Control and Prevention estimates that chronic-disease patients account for 75% of America’s healthcare bill.

The CMS seems to have ignored those facts, and earlier this year said it intends to terminate the project with the last of the pilots shutting down in December…

…how can the CMS presumably believe that the interim results of phase one did not justify continued exploration into phase two? Are there other elements that could have contributed? Did patient enrollment, for example, take longer than planned? Did the program run long enough for the initial investment in areas such as patient recruitment and compliance to be offset by the long-term reduction in expensive care, such as emergency room visits?

We agree that Congress and CMS has “cut the cord” on this program too quickly. Plagued by bad data feeds and should-have-been-expected difficulties in identifying, reaching out to and managing the health of Medicare members in ways that hadn’t been attempted before, these efforts deserve a second-life. As Burklund points out:
There is some good news on this front. The recently passed Medicare bill, which survived a presidential veto, calls for a study on the feasibility of establishing a Medicare Chronic Care Practice Research Network of providers who would test new models of care coordination and other care approaches for chronically ill beneficiaries, and expand those models to the larger Medicare patient population, if appropriate. Also, the bill calls for a thorough study of the methods of analysis and the program design of Medicare Health Support. Maybe this can get things back on track.

Medicare for “Dummies” by Rob Coppedge
September 18, 2008, 6:25 pm
Filed under: caregivers, health it, medicaid/medicare | Tags: , ,

Modern Healthcare reports today that CMS is taking very positive steps to reach out to the large community of caregivers (link here).

“A lot of people who are on Medicare need to know how to use the Medicare program better, but they’re being taken care of by somebody,” Weems said. “We need to talk to the 51-year-old soccer mom who has a 15-year-old kid and a 70-year-old mother and she’s trying to figure out Medicare.”

If executed well, this is an important step. More importantly, it highlights the significant and under appreciated needs of the caregiver community.

As the the implementation of information technologies across the system fail to keep up with the need to coordinate complex care, the roles of these caregivers – many with very little formal health care experience (but loads of experience with the system’s administrative inefficiencies and lack of centralized clinical records) – become even more important.

Companies targeting this community – with tools to save time, better manage information, better navigate the health care system and to gain more understanding about their loved ones’ conditions – will find a largely untapped market opportunity.

For once, CMS is getting out ahead of the market.