Monday, October 15, 2007

Health 2.0 and the Promise of Market-Based Health Care Reform

"The ONLY policy-based reform approach that makes real sense is for the leaders of non-health care business to come together around a change agenda. They could use their collective strength to overwhelm the health industry’s objections, and drive disciplines and tools – standards, information technologyinfrastructure, evidence-based best practices, transparency and decision-support, and performance-based payment – through policy."

Those are the words of the always welcome Brian Klepper who joins us again today this time focused on the effort the market is going to have to make if it is to reach its potential in getting America's health care costs under control.

Brian, and another one of the smartest people in this business, Jane Sarasohn-Kahn, have been challenging the rest of us all around the blogosphere on what it will really take to get the cost and quality job done.

Health 2.0 and the Promise of Market-Based Health Care Reform

by Brian Klepper

I’ve been skeptical on this site and elsewhere about the potential for meaningful policy-based health care reform. The health care industry fields the largest, best-funded and most powerful lobby that, as Bob Laszewski knows as well as anyone, has held huge sway over health policy for decades. If the reforms necessary to re-establish stability and sustainability in health care also threaten to reduce the excesses that now constitute as much as half of cost and have become the bread and butter of the industry, they’ll face a steep uphill policy battle.

Given this reality, the ONLY policy-based reform approach that makes real sense is for the leaders of non-health care business to come together around a change agenda. They could use their collective strength to overwhelm the health industry’s objections, and drive disciplines and tools – standards, information technology infrastructure, evidence-based best practices, transparency and decision-support, and performance-based payment – through policy.

But while it makes sense to try to bring together the nation’s business leaders, it also makes sense for the policy community to pay attention to market-based activities that hold real transformational promise. Perhaps the most compelling of these efforts is Health 2.0.

A few weeks ago I attended a fascinating conference in San Francisco on Health 2.0, an emerging industry that promises to change the ways patients manage their own health, and the ways that clinicians and purchasers of all types make clinical and management decisions. The term Health 2.0 refers to Web 2.0, the idea that, in social networking, people will use Web-based platforms to reformulate data for their own purposes.

Jane Sarasohn-Kahn is a respected health economist and commentator working at the intersection points of health care and technology. Jane and I worked together to describe the elements and functions we believe will be integrated to constitute Health 2.0's real value. We've posted this narrative and an accompanying image - its an animated PowerPoint slide that lets you watch the elements build - on several sites, including Jane's site, Matthew Holt's The Health Care Blog and the Health 2.0 wiki.

We have invited readers to download the image and read through the narrative, and provide then feedback on this model. Please join us. Understanding how information can be leveraged to promote better, less costly care is a critical step toward getting us there.

Aggregate, Analyze and Advise

Scott Shreve MD, an Emergency Physician who has been a prominent theorist in this exciting new area, summarizes Health 2.0's primary data management functions as Aggregate, Analyze and Advise. It's a good way to think about it, and is very consistent with the description that Jane and I came up with. A short version of our explanation is described below.

Keep in mind that the companies chasing the big, comprehensive vision that is at the end of the Health 2.0 rainbow – Microsoft, Google, Yahoo, WebMD, Revolution Health and many smaller firms – hope to make money. They'll directly get fees for the services they provide or capture the traffic and profit from the ad revenues, as Google does. (It's worth mentioning that Health 2.0 represents an incredibly powerful development in health care technology, which has a very accessible (relatively low cost to each end-user) value proposition in terms of its ability to impact the health of large populations. This stands in stark contrast to some of other health care technologies, like bio-technology, that often have very inaccessible (i.e., expensive) value propositions.)

Aggregate

To get the ball rolling and deliver on the promise of Health 2.0, though, the companies in this game first have to develop ways to aggregate patient data of all types: claims, clinic, drug, lab and image, and then map these data elements - they're from different sources and often in different formats - to a common format, like the increasingly well-recognized and accepted Continuity of Care Record.

Once aggregated and stored in centralized data repositories, they'll route that individualized information into Patient Health Records (PHRs), which help patients monitor and manage their health, to Electronic Health Records (EHRs), which help clinicians monitor and manage patients' health, and Health Management tools, which help health care professionals in non-clinical settings (like wellness specialists, case managers and disease managers) monitor and manage patients' health.

Analyze

In addition to routing the identified patient data to its proper destinations, the stored information in the CDR will be analyzed to identify patients with health risks (like people with chronic health conditions, or people who are likely to have an acute event in the future), and to identify best practice guidelines (i.e., the treatment approaches that consistently produce the best outcomes at the lowest cost). The evaluations will also allow comparison of the relative pricing/performance of providers (e.g., doctors by specialty and hospitals by service) health plans, products (drug, device, equipment and supplies by class), and interventions/treatments.

Advise

The results of these analyses can be used to create public transparency reports on health care products and services - like a Consumer Reports for health care - and can also be used to create decision support tools that advise patients, clinicians, and purchasers of all types about how they might better manage health care quality and cost.

The patient advice tools will also include expert information like medical encyclopedias, and user-generated information like patient or caregiver advice to other patients.

This flow and reformulation of information in Health 2.0 efforts will give every health care decision-maker far better information. The transparency and decision-support should facilitate vast improvements in health care quality and efficiencies. (I should also note that, operating at a higher level, they could also make the mostly-floundering local Health Information Exchange efforts (i.e., the RHIOs, or Regional Health Information Organizations) obsolete in their infancy.)

Please go over to one of the sites listed above, and give our graphic and the narrative a look. Then let us know how we can make it better.

Brian Klepper is a health care analyst based in Atlantic Beach, FL.
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