I like technology and all the information that becomes available but with the current status of the economy and mergers and acquisitions occurring today, we can stand a little less innovation in the software area, now this excludes of course the work being done to find cures with research and development. I am talking about the iPhone apps, the new EMRs that show up every week and every little business analysis program accompanied with this “over infatuated” press release that comes out.  My choice of topic here and source speaks out about the HHS and their deliverance of data for developers to work with.  Look at what HHS admits:image

“We are offering up HHS as a data platform that makes more and more data available to a growing ecosystem of innovators,” said HHS Chief Technology Officer Todd Park. “The ecosystem is already blossoming. It’s at a point where we’re not even conscious of everything that’s happening out there with our data.”

This in itself is not a bad thing but everyone who can create a simple program has a new reality that is more important than the one we just saw 10 minutes ago and it’s over whelming.  I try to weed through a lot of this and hit the important issues that are out there.  You can also see from the quote below that HHS themselves has even lost track of what’s happening with their data.

Every data addict that is out there is salivating at the mount to create the biggest and best algorithm (in their mind) that could ever exist. This is not unique to healthcare though it’s all over the place.

Warning: for addicts, when you create something that requires more time on the computer to run and work extensive analysis programs from an end user, you are being disruptive. 

Yes I read all the opinions too about disruptive technologies being good at times, and there’s some truth in that but don’t lose track of the fact that you are being “disruptive” and potentially distractive.  I have never seen a time when you could not get 2 people together to agree on one simple matter.  Everybody wants to be able to make a decision and feel good about it, but when you introduce more software analysis systems to learn and that are more complicated than what the user is familiar with and want instant participation, you have trouble and resistance.  image

“In God we trust; all others must bring data”

There’s nobody else other than doctors that live and breath this every day as they want to make a good decision when it comes to patient care and they go along with learning very well, but when data analysis comes in beyond the notion of some small and simple improvement processes it’s disruptive and this is where they struggle today.  Some organizations are better at handling this than others and coordinate with their physicians while others just leave them out there to fend for themselves, while consistently ridiculing them for not being totally up to date with the technology others believe they should be using.  Once an MD sees value, he’s sold but not until that point.  A lot of software folks are there are not accomplishing this but rather are more so out there with trying to build the monster algorithm for their own recognition purposes.

And we wonder why there’s a resistance on the part of doctors to accept electronic medical records….I wrote one and know what this is all about and the collaboration needed and we are not seeing enough of that today.image

There’s talk about the GPS asthmatic program here, well there’s also a private industry development of the Blue tooth inhaler that’s been around for a year, so are we duplicating efforts here.  Why don’t these 2 get together for goodness sakes.  Is the fact that the one using data from HHS make it better? 

Qualcomm and Cambridge Consultants Collaborate on Vena Platform – The Blue Tooth Inhaler Gets Closer with Continua Health Alliance With Launch At The Center for Connected Care A Division of Partners HealthCare

Does the average person want all of this right now, no but perhaps in time and there are some devices that have a lot more beneficial use than others by all means. 

I have seen so many rankings of doctors and hospitals published out there that today they mean nothing.  The only ones that count is the doctor you are consulting and the hospital you are in or the one taking care of you. Sure it’s good to search on the web for hospitals that provide the services you need but this ranking nonsense only confuses people and has put hospitals in a real “stupid” spot they would rather not be in. 

In the end, rankings make it harder for consumers to make a decision and you won’t see time wasted on this blog with rankings, they’re a dumb and useless idea. 

Now we have the FDA looking at the Apps site to identify any software programs that they feel need approval from their neck of the woods and they use very little if any mobile technology in house themselves.   Again rest my case here, we are making a mess and making it difficult with out better collaboration.  This stuff feeds itself and you can have innovation coming out your ears with nobody getting anywhere in a hurry.

FDA Monitoring Apps Store To Look for Devices To Potentially Flag for Regulatory Process Requirements–FDA Could Use Some Mobile Technology Themselves Too With Recalls

How much of this is creating value?  That is the big question and some common sense should come into play here somewhere along the line with someone who can see the “big picture’.  Is this doing anything for consumers where they can sell value – hell no.  The only exceptions being the group of geeks that glob onto anything, whether it’s practical or not.image

To satisfy those geeks that glob on, you need the data addicts to feed their habits too, like junkie and the drug dealer in essence, but in this case the drug dealers are also addicted and are the cause of the geek addictions so let’s get to the route and use technology wisely and do a better job of collaborating.  Put meaningful reports and data out there.  I look at very little of it and only when I need information as I am busy and don’t have time to crawl all these websites either. 

Have I seen anything that just knocks me over and blows my mind, no.  Do I see anything created that gives value to a consumer more importantly – no.  Do we have any role models that really use any of this stuff – no.  We have a lot of people that talk about how good it is, but they are just magpies and repeat. 

The new Health.Gov is helpful and that was a targeted project for consumers, the rest of this stuff is not but the addicts when presented with data to write algorithms to create software will jump on almost anything you throw at them.  I keep a link on this blog to the site to be helpful.   Believe me I was once at that point a number of years ago and I have recovered from having to query everything I see as I found I really didn’t need all that stuff and it does make decisions too complicated if you are looking at too much irrelevant data.  There’s no big fascination any more and I fully understand how the ones with the machine gun technology rule the care and money that goes on in healthcare.

We have so much data today in different formats that the once “miracle worker IT folks” can’t run out there and put together what you want in a short time like was has been possible in the past!  Ask any CIO and they’ll tell you, it’s a headache.image

One of my readers was kind enough to write me a few chapters on how data structure came about and if you have a few minutes, take a read.  Keep in mind we are talking data use and creation and you can see how the insurance companies created the data base information, still administer and basically are all tied at the hip with the government.  With current bidding and the deluge and glut of data, can they even keep up with their “machine gun” technology to keep moving it around, updating, etc as the commenter says the contracts only last 3-5 years so if you lose the next one, down the tubes you go.  (I gave this commenter credit too as they knew the Senate downed funding for cloud computing, so it’s not just me that sees this).

“National Government Services (NGS) is a subsidiary of WellPoint (WLP). Back in 2005/2006, WLP bought 3 private companies: Empire, Administar Federal, and United Government Services. All these companies were fiscal intermediaries for CMS, the Centers for Medicare and Medicaid, which works under the U.S Department of Health and Human Services. Before the Medicare reform, which was under President Bush (and I have no bias about him, I'm just trying to give you some basics), these private companies were paid based on cost to administer funds to health facilities that served Medicare beneficiaries. Since blue cross had the administration experience, a lot of these companies were originally specialized departments within Blue Cross and they broke off to singularly work for the Medicare Program. Workers were dedicated to the Program and spent many years developing the databases and information systems.

So, we have fiscal intermediaries and they develop these databases so that congress and the senate have information to make decisions about the program and create laws.
One of their biggest sources of information is the hospital cost report. These reports are kind of like how an individual files a 1040 with the IRS...you submit information to the IRS and there are incentives-- like if you have a mortgage, you get deductions for your interest and property taxes, etc. Well, CMS requires health facilities, the most important being hospitals, to file these...

Where was I? The cost report...Each hospital submits an annual summary of all the services they administered to Medicare beneficiaries and the overhead costs. This is all public information made available on the CMS website for every hospital every year. So on this summary, a final settlement payment amount is calculated-- similar to filing a refund for your IRS 1040. In addition to paying for servicing Medicare beneficiaries, there are incentive payments-- nursing and allied health programs, residency programs, organ acquisition programs, Medicaid payments, and bad debt payments. This is really all that's left for Prospective Payment Hospitals...All hospitals greater than 25 beds are paid on a fee schedule...Hospitals with 25 beds or less are paid on cost

So yea, we're in the middle of contract reform, which was started in 2006 and is supposed to be completed in 2011. The government could not afford to pay on cost anymore to administer the Program, so they decided to contract out the administration of the Program. On FBO.GOV, you can find the request for proposals for these contracts. On the CMS website, under contract reform, you can see the map, where each new contract was assigned an administration jurisdiction. Under the original passing of the law, 15 jurisdictions were created. These contracts are called Medicare Administration Contracts or MACs.image

In the beginning, in 2006, these fiscal intermediaries thought that they could bid and win these contracts...WellPoint bought UGS, Administar, and Empire; they merged to form NGS. They won the contract for J-13, New York. At one time, they had 24% of the MAC contracts and thought that they were the top contractor for CMS.
However, CMS didn't really have experience with awarding contracts and competition was fierce. Companies hired lawyers and protested with the GAO...The GAO had major findings that required corrective action, re-bidding, and major delays in awarding these contracts. These delays were measured in years and they're still going on as we speak.
Only the companies with lots of cash flow could withstand waiting years to win a contract and get through all the protests.

Cigna is a good case study right now. Cigna won the J-15 MAC and subcontracted the Medicare Part A workload to a fiscal intermediary called Riverbend. This was just awarded this year and the RFP came out in 2006-- so they've been waiting 4 years. Riverbend is no longer in business and Cigna is up for sale. The other contractors that bid on the award have protested this award with the GAO because CMS awarded a contract to a company that no longer has a Part A subcontractor and probably doesn't have the cash flow to transfer the information systems to its facilities.
So, as you will see under the Spotlight section on the CMS contracting reform page, there are only a handful of contractors left in business.
Because CMS went through so many growing pains by contracting administration, they are actually in the middle of combining those 15 jurisdictions into fewer jurisdictions.
When Medicare contracting started, companies were bidding at $1.25 per claim. Now, they are bidding as low as $.60 per claim.

So now, its a double edged sword for smaller companies...they have to spend the money on IT to update their systems and at the same time, cut overhead high enough to where they can bid at $.60 per claim.
The major problem is that they have people who dedicated years to the Program and making these databases. So if they lose those employees, which is what is happening, no one knows how to access the data and new employees take years to learn the systems...image
Companies like WellPoint have the cash to change the systems, make them more efficient, and make them automated. This reduces labor and also it reduces the type of labor. Before, someone would require high IT skills, high analytical skills, and an accounting background. WellPoint had to change the systems to reduce labor costs, so that the systems can be operated by not so skilled workers. That's the only way they could reduce costs in the long run to compete at $.60 per claim.
The problem with that is even now, its so complex, its very hard to cut this skilled labor and still meet the requirements in the MAC contract.
Another major problem is that these contracts only last 5 years. So its really like doing a project for the government. By the time the company sets up the infrastructure to complete the contract, its time to pack up...Meaning, they don't want to be stuck in a building lease...WellPoint is currently experimenting with having labor work from home so that no matter where the contract is in America, their workers can do the job from their computer in their pj's

This is a good thing, but the government did not approve cloud computing as part of the contract because they couldn't grasp the concept...With cloud computing, the software would have been designed so that a contractor would update the software and all the hospitals would have the software...the data would be in a cloud-- a server housed wherever, and all the hospitals could access that server with the electronic health records. It is unfortunate that the government could not grasp this concept because it could not only save lives by giving hospitals access to records, but it is also more efficient and less costly going forward...”

Now once you have read all of this is makes one wonder, what was the illusion of a public insurance plan;  after reading all of this was it just that, an illusion with no data resources?   There’s no infrastructure to run it unless it went over to Social Security who is in their own world of having to update so their data can scale and they can get out of COBOL, yes you heard that correctly. and they are working on it.


Innovation needs balance and I’m not seeing that at all, and even the VC investments are down, again due to over indulgence in too many non focused directions and everyone complains on Wall Street about that too. When the pressure gets to be too much we focus on a mosque, something we know how to make a decision about, and if it isn’t that it’s something like it that is simple.  Be nice to your friends and don’t let some of the silly statistical stuff get in the way as it will always be there but you have choices with a lot of this.  A little less focus on who can write the most productive algorithm would help, the work can go on but for goodness sakes let’s take the big focus off the production of the software as it will continue to evolve on it’s own.  One other item too is that once the software is created, there’ support and learning that is chapter 2. 

Nobody has done squat to help engage the consumer so far as they are so wrapped up in analytics, the patient is still left out in the cold and heck we don’t even see any leaders using any technology themselves.  We used to see President Obama using technology but that seems to have died along the way too and he was the shining star that did engage consumers. 

In jest, why doesn’t HHS work on a a new program to help those with this chronic condition of data addiction? 

Mark my words it’s evolving and I just happened to write about what I see and could be ahead of my time here <grin>.  BD 

In December, the Department of Health & Human Services (HHS) will launch a Web-based bonanza of healthcare data – leading health indicators on the national, state, regional and county level that can be sliced, diced and mapped in a variety of ways.

HHS’s Community Health Data Initiative (CHDI) will release all of this data in a standard format that can be exported automatically to Web-based applications. In doing so, HHS hopes to spark the next generation of healthcare applications that will lead consumers, doctors, policymakers and others to make better decisions and improve the quality and reduce the cost of healthcare services.

Innovative healthcare applications that exploit government data are already emerging:  from inhalers equipped with GPS systems that track when and where asthma patients need their medication, to iPhone apps that locate the nearest emergency rooms and dashboards that rank counties by the quality of their healthcare systems.

HHS has already offered what it calls “a glimpse of the beginning” of the next generation of Web-based healthcare applications. On June 2, the agency showcased more than a dozen cutting-edge healthcare applications at a Washington D.C. event when it unveiled the Community Health Data Initiative.



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