Happy 6th birthday to the Health Business Blog

The Health Business Blog turns six years old today. Continuing a tradition I established with birthdays one, two, three, four and five I have picked out a favorite post from each month. Thanks for continuing to read the blog!March 2010: Clinical decision support and meaningful use: Perspective from Zynx Health CEO Dr. Scott WeingartenPhysicians and hospitals that implement electronic health records (EHR) are sometimes disappointed with the results. In many cases, EHRs are used largely to convert paper information into electronic form, which is a costly and cumbersome process. But when advanced clinical decision support is added, significant improvements are attainable.Zynx Health CEO, Scott Weingarten explains in this podcast.April 2010: Cost control is coming to townA major criticism leveled at the health reform law is that it doesn’t do enough to control costs. Yet experience with a similar breed of health reform in Massachusetts indicates that the cost control issue will come to the fore sooner rather than later. Four news stories reinforced my conviction about this.May 2010: In praise of low medical loss ratiosThe new health insurance reform law requires health plans to pay out at least 80 or 85 percent of premiums in medical expenses, depending on whether they are selling to individuals/small groups or to large groups. Intuitively it makes sense that purchasers would want the medical loss ratio to be as close to 100 percent as possible –since the purchaser doesn’t derive utility from a plan’s administrative expenses and profits.But there is another way to look at it. From a personal perspective, I’d rather stay away from doctors, hospitals and pharmacies. If my health plan can help me do that --and have a low MLR as a result-- I'm all for it.June 2010: Opening our eyes to pro-anorexia and pro-bulimia websitesI was pleased to see that the American Journal of Public Health has published a study of eating disorder websites –the so-called “pro-Ana” and “pro-Mia” (as in anorexia and bulimia) sites that provide “thinspiration” or “thinspo” to their visitors. But the article didn't go far enough. For example, pediatricians need to know that these sites often include information on how to hide eating disorders from one's physicians.July 2010: With CRM tools, will the hospital’s marketing department diagnose you before your doctor does?Hospitals are stepping into patient-specific marketing by using data from electronic medical records to target messages to patients’ specific situations. If doctors don’t get out in front of this trend, patients may end up being diagnosed (or misdiagnosed) by the marketing department.August 2010: Value based insurance design: All reward and no punishment?Value based insurance design (VBID) is sometimes mocked as merely “free maintenance drugs for diabetics.” Although in concept it’s a lot more than that, in practice most VBID programs encourage the use of high value services but don’t discourage the use of low value services. A paper in the American Journal of Managed Care by Peter Neumann of the Center for the Evaluation of Value and Risk in Health (where I am an Executive Advisory Board Member) et al. lays out the challenges in identifying low-value services and incorporating information about them into VBID.September 2010: Malpractice defense: Internal Hernia Following Laparoscopic Right ColectomyIn addition to my consulting work and writing the Health Business Blog, I’m chairman of the board of Advanced Practice Strategies (APS), a medical risk management firm that provides litigation support for malpractice defense and an eLearning curriculum focused on enhancing patient safety. This illustrated verdict describes how APS assisted the defense in a malpractice trial.October 2010: Public is skeptical of treatment guidelines –or are they?I was puzzled by a Health Affairs article showing the public finds arguments against treatment guidelines a lot more compelling than arguments in favor. But after reading the technical appendix, which contains the full text of the survey, I think the problem is that the researchers framed the question poorly. In particular, the researchers portrayed guidelines as unrealistically rigid.Health Affairs eventually published a letter to the editor I wrote on the topic.November 2010: How hedge funds get inside information from doctors about clinical trialsThe arrest of a French doctor for leaking information about a clinical trial to a hedge fund is disturbing, but the alleged activity is neither new nor particularly rare.In this post I provide the inside scoop on how the business of connecting doctors with hedge funds works and why it’s so open to abuse.December 2010: The year ahead: Transparency, mobile health, patient safety and health reform implementationMy crystal ball was a little foggy so I decided to ask my Twitter followers (@HealthBizBlog) to help compile a list of health care predictions for 2011. I’ve integrated my thoughts with theirs and organized the predictions into four themes:

1. Transparency will change from buzzword to reality
2. Information technology progress will be uneven, with the biggest breakthroughs in mobile
3. A culture of patient safety will begin to take root
4. Health reform implementation will advance despite some ugly battles

January 2011: Let’s not forget patient safety in med mal reformMedical malpractice reform is one of the few health care policy issues where there is a real possibility of agreement between the White House and Congress. A common refrain is that the fear of lawsuits leads physicians to practice defensive medicine, ordering too many tests just to cover their behinds in case of a lawsuit.Another issue –and to my mind it’s a bigger one– is that despite the risk of malpractice lawsuits the health system does a heck of a lot to create or at least tolerate situations that are dangerous for patients.February 2011: The insanity of health care pricing, aka Alice in Medical LandOne of the interesting things I learned in business school is that not only is it typical for a business to earn 80 percent of its profits from 20 percent of its customers, but that 75 percent of its customers may represent 120 percent of its profit. But health care is even more extreme, thanks to the incredibly wide array of price levels realized for the same service. Some health care businesses make essentially all their profit from a few percent of their customers --suckers who pay full charges.---Thanks for your continued readership!