Providers not aligned with market forces

Of the three major categories of players in the health care system - patients, payors and providers, the first two are aligned in their driving interests - better health, lower intensity of interaction with the providers - make up for better quality of life for patients, better profits for payors. The competition among the 160 insurers (plus Medicare) leads to systems which offer better outcomes for employers (and thus patients) - whether this is the Patient Centered Medical Home, or Patient Portals, or Personal Health Records, or EHRs that interoperate and give access to CCRs that are kept in globally accessable PHRs.

These forces also make feasible care managers who would work with patient and provider to ensure that accepted care guidelines for acute or chronic disease are on course, in line with what evidence says would be the best management strategy.

However, these forces do not align with the interests of providers, who after all, are essentially paid for each service rendered, whether in the office, hospital or surgery. These people are not paid for patients or the public to be healthy or disease free.

This is why an integrated system like Kaiser (or the countries with universal care and state-owned facilities) run the risk of conflicting goals in their business model. On the one hand, the payor arm wants to keep patients on a long-term low intensity in demand for provider services; on the other hand, they need to keep the clinics and hospitals open, and to keep doctors, nurses fed. Unless the provider staff share in the retained earnings of the payor, the integration has a strategic challenge to meet.

Physicians who adopt EMRs or EHRs, or who are asked to implement Medical Homes, need to be given ways in which their interests are aligned with those of patients and payors, and not simply at an altruistic or ethical level. Even if the providers are employed by payors.

EC

Health2.0 Spreadsheet of 170 entities

From the speed-dating of one day at Health2.0, I looked at all the websites of companies, people and organizations in the Proceedings, read through all of them, followed some other leads that were of immediacy, and ended up with a spread-sheet that has:

1. Some ontological characterization of the Health 2.0 space
2. Live clicks to web-sites of each one, plus a few secondary sites
3. Commentary (mine) on each one
4. An ontology related to my interest in Personal Health Records, Patient Centered
Medical Home, Patient as Partner, Clinical Portals, Knowledge Portals

Of course, all ontologies are biased constructs, and deserve deconstructing.

These data will the basis of a report on the application of these concepts and technologies to single payor integrated health care systems across other domains, where insurance is not competitive and drivers are different from ours.

A copy of this spreadsheet is available on request to ec.health2.0@gmail.com

I am in the process of sending this to Matthew Holt at Health2.0accelerator / advisors, and it may be that it is available there as well.

EC

Left-handed electrons

Why is it that electrons have a left-handed spin ALL THE TIME? There are some constants about this universe we inhabit that are just plain unbelievable! Makes no particular sense...shouldn't they be random? Like coin flips? What IF they were?

It occurs to me that if memes are truly cosmic, then it may be more than "if I have an idea new to me, someone else will have thought of it already" but instead that by the very act of thinking of a new idea, it creates the meme (as in paired photons) in some time past, so that at the instant of thinking of it, there will have been created, and in existence, an uncertain number of copies of it in other space-time coordinates....

Of course, this thought itself must also be a meme...so don't tell me "Richard Dawkins said that" - that assertion, if true now, did not exist until this thought was created....perhaps by some other actor thinking of it, creating the instance in my mind....are there prime thinkers? how could one ever tell?

Distributed and decentralized creation of memes...take that notion into a venture capital meeting.

EC

First post

Oct 15, 2009. Victoria BC

I know nothing about how a blog gets followed, but it seems to me that at least some of my thoughts will be preserved for me, and anyone else who stumbles across it.

Right now, I want to connect twitter and blog, so this is a place holder. More to come....already, I feel the pressure of unrestricted size of a blog is more intimidating than the 140-character limit of a tweet.

EC