Growing Tensions in Emerging Health 2.0 Markets
[The Challenging Insurance, Political, IT and Business Ecosystem]
By David Edward Marcinko
By Hope Rachel Hetico
Heights by great men reached and kept were not obtained by sudden flight but, while their companions slept, they were toiling upward in the night – Henry Wadsworth Longfellow
Introduction
Health care reform – as incremental as it has been on both the Federal Medicare and State Medicaid levels – forces medical providers to look for more efficient ways to provide services, as well as additional sources of revenue in a margin-diminishing business model. Total Federal Spending for both programs, under current Obama Administration assumptions about the health costs are growing.
Skepticism is prevalent throughout the healthcare industry about the benefits and the role of market competition in the provision of healthcare services, despite pronouncements by the Federal Trade Commission (FTC) and Department of Justice (DOJ), that competition has positively affected healthcare quality and cost-effectiveness. Recommendations that many of the barriers to competition that prevent it from fully benefiting consumers have beeen, or are being, removed.
And so, according to Cimasi, Alexander, Zigrang and others; this growing economic tension has produced the following innovative health 2.0 business models and methods of reimbursement.
More here: BOOK ORDERS [Pre-Release]: http://www.springerpub.com/shoppingcart
Dictionary of Health Insurance and Managed Care: http://www.springerpub.com/prod.aspx?prod_id=49944
Business of Medical Practice 
Appendix 1: Popular Patient Blogs
A Chronic Dose
A Shot in the Dark
All Blogged Up: A Moof’s Tale
Amazing Grace
Asthma Mom
Bad Back Blog – Herniated Disc
Brass and Ivory
BreathInStephen
But You Don’t Look Sick?
Charming BB
ChronicBabe.com
Cushing’s & Cancer
Diabetes 360
Diabetes Mine
Diabetes Technology Blog
Donnabetes
Emanon’s Journey
Every Patient’s Advocate
Grief, Loss & Transitions – Journey of Hearts Blog
It’s a Wonderful Life
It’s All About the Walls
Lemonade Life
Life of a Diabetic
Life with Leukaemia
Medicana
Scott’s Web Log
Sick Girl Speaks!
Six Until Me
Sunshine and Moonlight – A Journey with Multiple Sclerosis
Survive the Journey
The Big D — New URL!
The ICI Experience
The Preemie Experiment
The Reality of Anxiety
The Red Dot Project
Too Much Brain to Contain
Your Diabetes May Vary
Appendix 2: Popular Medical Blogs
An American Medic in Britain
Ask a Hospital President — New name and URL
Balanced Health and Nutrition
Brain Blogger
CancerGeek
Center on Media and Child Health
Constructive Medicine 2.0
Counting Sheep
Crzegrl, Flight Nurse
Dare To Dream
Denver Doc Online
Doc Gurley
Doc of Ages
Doctor & Covenants
Doctor Pundit
Dr. Deb
Dr. Val and The Voice of Reason
Dr. Wes
Educated Nobody
Embrace Your Heart
Emergiblog
Essiewb’s Weblog
Eye on DNA
Fat Doctor
Fertility File
Girl MD
Grassroots Science
GruntDoc
Health Management Rx
Health Train Express
Healthy Aging For Women
Hemodynamics
Highlight HEALTH
Hope for Pandora
How I Spent My Nursing Education
Junkfood Science
Kate’s Casebook
Living With Chronic Fatigue Syndrome
Malaysian Medical Resources
Medical Executive-Post
Medicine From The Trenches
Mexico Medical Student
Midwife with a Knife
Musings of a Distractible Mind
Mutual Aid Based Group Work.com
NHS
NICU Parent Support Blog
Nobody Important
Not My Second Opinion
Notes from the Country Doctor
Nurse Practitioners in Business
Nursing Assistant Resources on The Web
Occupational Therapy
Occupational Therapy Students (B)e(LO)n(G)
On The Wards
Other Things Amanzi
PACES MRCP UK
Pallimed
Pediatrics Now
PICU Traveller
Prep4md.com
Prin’s Links for Social Work Students
Providentia
Prudence, M.D.
Raecatherine Almost on the Water
Raspberry Blase
Reflections by Dr. Bruce Campbell
Scan Man’s Notes
ScienceRoll
Secretwave
Shrink Rap
Street Anatomy
Sumer’s Radiology Site
Surgeonsblog
SurgeXperiences
Suture for a Living
The Back Pain Blog
The Dental Implant Blog
The Dragonfly Initiative
The Independent Urologist
The Intensive Art — New name
The New Prostate Cancer InfoLink
The Nurse Practitioner’s Place
The Nursing Site Blog
The Palmdoc Chronicles
The Physician Executive
The Sterile Eye
Trauma Bay: Airway, Blog
Truth In Skincare
Urban Paramedic
USMLEMD
Vagus Surgicalis
Vegan Heart Doc
Veggie Queen Adventures
Wait Time & Delayed Care
WardBunny’s Coffee Break
Why am I still here?
Yen Rocks the World
Source: MedBlogerCode.com as of January 1, 2010
Appendix 3: Popular Healthcare Blog Rankings
1 Kevin, M.D. – Medical Weblog
2 Highlight HEALTH
3 GoozNews
4 The Carlat Psychiatry Blog
5 Junkfood Science
6 Diabetes Mine
7 DB’s Medical Rants
8 The Covert Rationing Blog
9 Her Bad Mother
10 The Doctor Is In
11 Health Care Renewal
12 Six Until Me.
13 Schwitzer health news blog
14 Disease Management Care Blog
15 In the Pipeline
16 Healthcare Economist
17 Fight Aging!
18 InsureBlog
19 Musings of a Dinosaur
20 Pallimed
21 The-F-Word.org
22 ScienceRoll
23 StevePavlina.com
24 Brain Blogger
25 Doctor Anonymous
26 Retired doc’s thoughts
27 Beyond Meds
28 John Goodman’s Health Policy Blog
29 The Trouble With Spikol
30 Caustic Musings
31 The Last Psychiatrist
32 Fat fu
33 Weighty Matters
34 Digital Doorway
35 Autism Vox
36 Medicine for the Outdoors
37 Dr. Deb
38 Cranky Fitness
39 CancerDiva
40 Eye on DNA
41 Adventures in Autism
42 Postpartum Progress
43 soulful sepulcher
44 Natural Variation – Autism Blog
45 Autism News Beat
46 The Voyage
47 Capital Health WW-MD’s Notes
48 Brass and Ivory
49 The Urban Monk
50 AlexShalman.com
51 Pinwheels
52 The Independent Urologist
53 The Change Blog
54 HD BizBlog
55 Kidney Notes
56 Global Health Policy
57 Autism Street
58 Jung At Heart
59 Big Fat Deal
60 PixelRN
61 Women’s Bioethics Project
62 A Touch of Alyricism
63 All 4 My Gals
64 MSSPNexus Blog
65 Midwife with a Knife
66 Feed Me!
68 Healthy Children
69 Med Law Blog
70 John McManamy’s SharePosts
71 How To Use The Law Of Attraction
72 The Rotund
73 Creating a Better Life
74 Teen Health 411
75 Aging Fabulous
76 Stayin’ Alive
77 Facing Autism in New Brunswick
78 Escape from Obesity
79 …salted lithium.
80 lend4health [beta]
81 Get Ready For Flu
82 You Already Know This Stuff
83 hospital impact
84 ReunifyGally
85 Bump on the Road
86 Andrea’s Buzzing About:
87 Medical Marginalia
88 Tech Medicine
89 AIDS.gov blog
90 A Nurse Practitioner’s View
91 ByronKatie.com
92 Fighting Fatigue
93 One Dad’s Opinion
94 Fat Man Unleashed
95 Herbal Connection
96 Big Blueberry Eyes
97 Slow Down Fast
98 Plasmetic.com
99 TomographyBlog.com
100 Dr. Joe Vitale at Zero
101 Ob/Gyn Kenobi
Source: Wikio Health, as of January 1, 2010
New ChoiceHealth, Inc is an online comparison shopping marketplace built to provide healthcare consumers a way to save money.
With http://www.NewChoiceHealth.com consumers can easily locate medical facilities and compare medical procedure costs for services like MRIs, CT scans, mammograms, and more.
Patients may shop nationwide, or right in their own local market from over 20,000 medical facilities for over 400 of the most commonly performed medical procedures.
Mary
Disgruntled Doctors
Not all physician blogs are geared toward practice information, markets, marketing, competition or medical sensationalism.
In fact, just the opposite seems to be the case in some extremely candid blogs, like “Ranting Docs”, “White Coat Rants,” “Grunt Docs”, “Cancer Doc,” “The Happy Hospitalist,” “Mom MD”, “Cross-Over Health”, “Angry Docs” and “M.D.O.D.,” which bills itself as “Random Thoughts from a Few Cantankerous American Physicians.”
http://www.thehappyhospitalist.blogspot.com
According to some of these, they are more like personal journals, or public diaries, where doctors vent about reimbursement rates, difficult cases, medical mistakes, declining medical prestige and control, and/or what a “bummer” it is to have so many patients die; not pay, or who are indigent, noncompliant, etc.
http://www.CrossOverHealth.wordpress.com
We call these the “disgruntled doctor sites.” Some even talk about their own patients, coding issues, or various doctor-patient shenanigans.
Privacy Issues
But, according to psychiatrist and blogger Dr. Deborah Peel and others, the problem with blogging about patients is the danger that one will be able to identify themselves – the doctor – or that others who know them will be able to identify them.”
Her affiliation, Patient Privacy Rights, rightly worries that patients might tracked back to the individual, and adversely affect their employment, health insurance or other aspects of life.
Camille
An Innovative Primary Care Working-Lab
http://www.RenHealth.net
For several years, Rushika Fernandopulle MD, MPP and Pranav Kothari MD have been perfecting an innovative primary care practice known as Renaissance Health.
Serving as a working lab for innovation, the practice provides an unprecedented level of service and access to patients, and has been critically acclaimed both locally and nationally as a medical practice model for the future. Based on several years of research at Harvard University, this new-wave practice embodies several innovative features, including:
• Time and focus on preventive care and wellness, including comprehensive annual strategic health assessments with proactive planning to provide resources such as nutrition, exercise, stress reduction and other counseling to achieve these goals.
• Ability to directly contact doctors anytime by phone or email, without having to go through receptionists, nurses or other gatekeepers. Often, these interactions substitute for face to face [F2F] visits.
• Guaranteed same day, or next day, appointments with no waiting room patients.
• A full spectrum of resources to help patients play an active role in self-care, including 24/7 access to medical record (either online, on a secure key chain, or on paper), educational material and group visits.
• Proactive management of conditions rather than simply being reactive.
• Full performance transparency regarding satisfaction, costs and outcome variables.
• Optional patient involvement in new services and operations improvement.
MIKE
On Power to the Patients
http://www.Dossia.org
A common rallying cry of the turbulent sixties was “power to the people”. It embodied the zeitgeist of a generation that never seemed content until the democratizing electronic era emerged. In the healthcare space however, power still seems to rest in control of a select few; medical providers, employers, insurance companies, the government and other third-party intermediaries [command and control hierarchy]. Everyone, but the patient, until now [flat or matrix hierarchy]!
And so, for physicians, nurses, office mangers and medical-executive scions of that era, the founding of Dossia.org, is particularly gratifying. Why? Because Dossia is an independent and nonprofit internet based platform that is personally controlled by patients, and patients alone? It is a voluntary, private, portable, secure, lifelong and decentralized repository of electronic medical information archived from many sources.
In brief, the mission of Dossia is nothing less than the complete transformation of health information technology, to reduce costs and improve quality, by developing a lifelong personal health record [LPHR].
Of course, as with any new technology, on may wonder if patients and stakeholders are ready for it? Unfortunately, most are not; but increasingly more are. And, supporters of consumer directed healthcare, concierge medicine, marketplace competition, medical price transparency, direct reimbursement, retail clinics and the like, often respond in the affirmative. Therefore, consider if your private medical practice, clinic or healthcare entity is aware and ready for Dossia.org?
Ready or not, the promise of Dossia [or similar] is complete information about your patient’s medical history — information that they alone control — that will become available whenever needed: for routine office visits, away from home, in an emergency, for hospital admission or after a disaster that could destroy paper records or stand-alone computers. Dossia enables patients to become an active and collaborative partner in their healthcare management. In short, it will allow them to participate in their own care, and:
* Share information with doctors, clinics, outpatient centers, hospitals and healthcare systems.
* Avoid delays, mistakes and miscommunication when more than one doctor is involved.
* Reduce medical communication errors and eliminate waste, costs and redundancy.
* Track, manage and treat chronic illnesses and enhance evidence-based best practices.
* More effectively utilize physician and patient-provider face-time.
* Help family members manage their health care; and more!
The key feature of Dossia is its personal and private nature. Only the patient is allowed to include or exclude information in a health record, and determine what parts will be shared with others. The patient will choose how much data is collected and how the record is shared – with whom – and in what form. And, while it is recommended patients share a complete medical history with their providers, the decision will always rest with them. Others can not access information without permission, including employers and insurance companies.
Of course, the Dossia Founders Group is highly suited for this Herculean task. Thus far it includes: AT&T, Applied Materials, BP America, Inc., Cardinal Health, Intel Corporation, Pitney Bowes, sanofi-aventis and Wal-Mart. It is growing and has been endorsed by the American Academy of Pediatrics, the American Academy of Family Physicians, the Centers for Disease Control and Prevention [CDC] and the National Association of Manufacturers. Initially, Founders will work with Children’s Hospital in Boston, and other qualified experienced vendors to develop and implement the Dossia Network infrastructure.
Check it out.
Joseph
Computerworld Speaks to the Healthcare Industry
Did you ever wish that you could talk to a doctor without schlepping all the way to a crowded medical office where you’ll probably pick up even more germs? Well, if you live in Hawaii, you may be in luck.
According to Computerworld, January 15, 2009, the Hawaii Medical Service Association (HMSA) just launched a new program where patients can connect with doctors over a standard Internet connection or telephone. The service is available 24 hours a day to anyone in the state.
Several Medical Specialties Available
Customers of the insurer pay $10 and non-HMSA members pay $45 per session. About 140 local doctors, including family physicians, cardiologists, ophthalmologists, pediatricians, psychiatrists and surgeons, have signed up to be available for questions.
Is Hawaii the Vanguard?
“HMSA’s Online Care is making Hawaii’s health care system more accessible to patients by overcoming the constraints of time, distance, mobility or lack of insurance,” so says Michael Gold, HMSA’s executive vice president and chief operating officer.
Assessment
HMSA, an independent licensee of the Blue Cross and Blue Shield Association, also notes that this is the first health plan in the US to provide state residents with online service. Now, we ask, is it coincidental that Hawaii is President-elect Barack Obama’s home state?
Dr. David Edward Marcinko; MBA
Managed Care Matters
Joseph Paduda’s weblog on managed care for group health, workers compensation & auto insurance, covering health care cost containment, health policy, health research, and medical news for insurers, employers, and healthcare providers.
http://www.JoePaduda.com
Randy
Making the Grade
How Doctor-grading Websites Can Impact Your Practice and what you Can Do to Lessen the Blow
Owen Dahl, MBA, FACHE, CHBC, and Altamash Rahman
http://hcplive.com/primary-care/articles/online_physician_grading_websites
Sheldon
Doctors, Hospitals and Recessionary Best Practices
[An Interview with Dr. Marcinko]
http://www.arkansasmedicalnews.com/best-practices-stimulus-can-help-hospitals-in-recession-cms-738
Hope Hetico; RN, MHA
[Managing-Editor]
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Ultimate Competition for Patient Dollars
For the uninsured, HSA and HRA policy holders, or those with underinsured health plans or wanting an elective surgery, or a procedure not covered by their insurance; visit http://www.MediBid.com
Link: http://healthcarefinancials.wordpress.com/?p=20852&preview=true
Samantha
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Like it or not, DR.Oogle empowers
A few weeks ago, Stewart Gandolf posted “Social media empowers consumers – including your patients” on his blog, Gandolf’s Marketing Magic.
Gandolf defines modern branding in dentistry when he concedes, “Consumers are now empowered, and some are getting aggressive.”
http://www.gandolfsmarketingmagic.com/2010/02/04/social-media-empowers-consumers-including-your-patients/
I told Gandolf if one plays to win, losing becomes increasingly less likely.
I’ve mentioned that I depend on DR.Oogle (doctoroogle.com) for a steady supply of new patients. It’s the most cost-effective marketing I’ve ever purchased. When I became active in September 2005, there was hardly any competition. I’m glad I got an early start.
If a dentist has the confidence to ask patients to refer friends and family, it’s only another small step to ask them to put in a good word on the Internet. I suggest that following a pleasant appointment, ask the satisfied customer to put in a good word on the Website of your choice while handwriting the address on a business card. Let the customer know that their opinion is precious enough to go out of your way – to ask them to go out of their way.
Health 2.0 and Web 2.0 marketing platforms like DR.Oogle become increasingly effective as patient satisfaction data accumulate and more consumers (and competitors) discover the power of numbers. Here’s something that should appeal to any dentist: New patients are sold on my abilities before they walk in the door. Now that’s beautiful. In addition, my staff and I try extra hard to please all our patients. It became habit.
Empowered consumers on computers are more critical for healthcare reform than empowered preferred provider lists. Besides, empowered consumers are here to stay. Sources like Delta Dental only acts like it.
One more thing: It’s sort of a favor. If you know a Fort Worth dentist, please don’t mention what I said about DR.Oogle …. and you can tell Delta Dental to bite me.
D. Kellus Pruitt; DDS
Doctor, Doctor, Give Me Reviews
[Don’t even bother with Web-based doc-rating systems]
Essay by Kent Sepkowitz
http://www.kevinmd.com/blog/2009/05/how-doctors-should-deal-with-physician-rating-sites.html
Shane
More Primary Care Doctors are going “Cash Only”
http://www.kevinmd.com/blog/2010/03/primary-care-doctors-cash.html
Bradley
Why health insurance matters?
http://theincidentaleconomist.com/why-insurance-matters/
Edna
Economist says episode payments will bend healthcare cost
Episode payments – case rates for major acute interventions and chronic conditions – are the best approach for payment reform, according to a University of California economist.
http://www.healthcarefinancenews.com/news/economist-says-episode-payments-will-bend-healthcare-cost
The episode-of-care-model is the best thus far. A fixed price meal; not an ala carte menu that is selected by the waiter.
Travis
To all our Readers
The New England Journal of Medicine [NEJM] recently said that 50% of physicians will leave medicine because of ObamaCare. But, we feel it’s more likely the number of practicing physicians [as reflected by our client cohort] will shrink by less than 25% due to fiscal insecurity and a general lack of transferable business skills.
Nevertheless, this passive strategy may force Congress to boost payments to physicians to keep them in Medicine and to get them to accept more Medicaid and Medicare beneficiaries [in the short term].
We trust this book, and our active professional consulting services, will help all our colleagues for the long-term.
What do you think?
Dr. David Ewdard Marcinko; MBA
[Editor-in-Chief]
Dr. Marcinko,
Unfortunately, many believe that the impact of newer more theoretical competitive models of medical practice, like consumer-directed health care, medical homes, micro-practices and the deployment of health information technology, may actually add to healthcare costs over the next five to 10 years (Congressional Budget Office).
So do I, as these are all just another layer of costly middle management.
Chris
Medical Industry Sources of Competitive Information
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g. “Health Care Policy Report.” (weekly) Bureau of National Affairs, Inc. 1231 25th St. N.W., Washington, DC 20037; (800) 452-7773. http://www.bna.com.
h. “Health Law Reporter.” (weekly) Bureau of National Affairs, Inc. 1231 25th St. N.W., Washington, DC 20037; (800) 452-7773. http://www.bna.com.
i. “Jenks Healthcare Report Top 100” (annual) Jenks Healthcare Newsletters, P.O. Box 7664, Atlanta, GA, 30357; (404) 972-9546.
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l. “Practice Management STATS: Quick Reference.” (annual) Practice Support Resources, Inc. Independence, MO 64055; (800) 967-7790. http://www.practicesupport.com.
m. “RMA Annual Statement Studies.” (annual) Risk Management Association. One Liberty Place, Philadelphia, PA 19103. (800) 677-7621. http://www.rmahq.com.
n. “Socioeconomic Characteristics of Medical Practice.” American Medical Association Center for Health Policy Research. 535 North Dearborn Street, Chicago, Illinois 60610; (800) 621-8335. http://www.ama-assn.org.
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p. “United States Health Care Laws & Rules.” (annual) National Health Lawyers Association. 1120 Connecticut Avenue, N.W., Suite 950, Washington, DC 20036; (202) 833-1105.
The End
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The End
Are independent medical practices an endangered species?
Will a new generation of physicians and business pressures spurred by politics, technology, an aging population, the participatory patient movement and healthcare insurance reform finally converge to wipe out mom-and-pop doctor’s offices as we know them?
http://www.fiercepracticemanagement.com/story/are-independent-medical-practices-endangered-species/2010-06-01?utm_medium=nl&utm_source=internal
Your thoughts?
Graham
On CDHPs
Advocates of consumer directed health plans (CDHPs) argue that it’s principally the degree third-party payment that should be adjusted. But, if patients directly pay more for their care they’ll make better decisions about what care to buy and how much it is worth.
Now, there is something to this notion. It’s not obviously wrong. But, it’s not obviously right either. What do you think?
Jane
Emerging Healthcare Organizations: [Accountable Care Organizations]
According to Robert James Cimasi of http://www.HealthCapital.com, the new healthcare reform legislation has proposed the implementations of Accountable Care Organizations (ACOs) as a way to increase efficiency and value, and decreasing the cost of delivering healthcare services.
While the success of implementing an ACO model is yet uncertain, and procedural and legal issues must be resolved, early pilot operations appear to have given some insight into the potential benefit that ACOs could have on the healthcare system.
Click to access ACO.pdf
Ann Miller RN, MHA
Insurers open retail stores to sell individual policies
WellPoint’s Anthem Blue Cross and Blue Shield of Colorado is the latest of a handful that have opened a retail store. The store is at Southwest Plaza mall in Littleton, Colo., a Denver suburb, American Medical News reports.
http://www.e-healthcaresolutions.com/AMA/aciphex-amednews-0310-inter.php?url=http://www.ama-assn.org/amednews/2010/09/06/bisc0906.htm
Samantha
Managed Competition
Princeton PhD economist Alain Enthoven’s 1993 paper in Health Affairs on “managed competition” is almost two decades old (health care markets have changed greatly since then) but not in his prescription for change.
Of course, some ideas are outdated, but many expressed ideas are still very relevant today and embodied in several provisions espoused by advocates for additional contemporary healthcare reform.
In fact, we have mentioned the “Father of Managed Care” in all three versions of our textbook; including this newest third edition for 2011: The Business of Medical Practice [Transformational Health 2.0 Skills for Doctors] http://www.BusinessofMedicalPractice.com
We therefore recommend that every healthcare stakeholder read the paper entirely; and then decide for your-self.
Link: http://content.healthaffairs.org/cgi/reprint/12/suppl_1/24
Hope R. Hetico RN, MHA
[Managing Editor]