Health Wonk Review: A Masterful Edition

Last week at this time, Augusta National Golf Club was abuzz with activity as the Masters–the most beloved of all professional golf tournaments (except for that not allowing women thing)–got underway. Last Sunday evening, after an exhilirating finish in regulation, Bubba Watson defeated Louis Oosthuizen on the second playoff hole to claim his first “green jacket.” You can watch a moving clip here. It was a lifetime achievement for the self-taught golfer and fellow graduate of my alma mater, the University of Georgia, who stood out among a gathering of greats. I love the Masters, because it heralds the start of spring, the beginning of longer days, and the renewal of life. It is in that spirit that I present to you a “masterful” edition of the Health Wonk Review, full of fresh ideas, wonderful writing, and some of the best recent writing from some of health policy’s greats. The metaphor really breaks down after that, though, so just read on for the good stuff. (I was going to include pictures from last week’s tournament, but I don’t want any copyright issues–so I’m afraid you’ll have to use your imagination.)

On the 1st tee, we have continued talk of the Supreme Court. Joe Paduda asks what the opponents of health reform will do if the Supreme Court overturns the mandate: “If the Supremes overturn health reform and/or the individual mandate, employers, taxpayers, and individuals are going to see higher health insurance premiums. The entire market will be in a death spiral. As more opt out of coverage, the cost for the shrinking number of insureds will increase. Members of the Chamber of Commerce, the NFIB, and the Club for Growth will find their profits eaten up by health insurance premiums, or they’ll be forced to drop coverage entirely.

Hopefully they’ll be okay with that, secure in the knowledge that they’ve sacrificed good health and medical treatment, for themselves and their families, on the altar of liberty. Individuals outraged by the mandate will be free to find coverage on their own, coverage which will be unaffordable for all but the richest Americans without any pre-existing medical conditions…And no, the free market will not come up with a solution. If it could have, it would have by now.” I agree with this sobering, but accurate assessment, starting the round with a par.

Headed to number 2, a long par 3 over the water and into the wind, requires careful club selection. Fortunately, Jaan Sidorov of the Disease Management Care Blog is here to scrutinize the “Choosing Wisely” web site that lists common medical tests and procedures that are often unnecessary.  Being an evidence-based and a skeptic, Sidorov has little problem with the tests, but he does criticize the use of a relatively primitive web page in an attempt to change physician and patient behavior.  He comes away unimpressed and wonders if a Web 2.0 approach or adoption by the population health management vendors would result in better outcomes. Read Jaan’s full post, here. Armed with this information, you make par.

The 3rd hole is a great place to take a break and make sure that you understand how the game is played. Enter Roy Poses, who writes often about ethics and conflicts of interest in health care at Health Care Renewal. This week, in a post entitled Conflict of Interest or Bribes? Biomet, Smith & Nephew Settle, Roy writes about a legal case that illustrates that some apparent conflicts of interest may in fact be health care corruption and suggests that true health care reform would better regulate and more strongly restrict conflicts of interest because of their potential for causing, or being health care corruption. A move in the right direction with a birdie.

Similarly, at the 4th, Julie Ferguson of Workers Comp Insider tells us that in a 50-sate roundup, there were no “A” students in the State Integrity Investigation, a $1.5 million public collaborative project designed to expose practices that undermine trust in state capitols. See her post: How does your state score for insurance, ethics, accountability, corruption? Tough break, bogey.

The 5th hole serves up an update on accountable care organizations, with Louise of the Colorado Health Insurance Insider. In “Cigna and CSHP Collaborating on an Accountable Care Program,” Louise writes “Cigna has already established their collaborative accountable care programs with provider groups in other states and the success of those programs is what’s driving the expansion into ten more states, including the collaboration with CSHP. Hopefully the program will continue to be successful in the new locations, resulting in better patient outcomes, more accessible and affordable healthcare, and better patient satisfaction. I would also expect to see more of this sort of collaboration between health insurance carriers and healthcare provider groups as time goes on.” In other words, par for this hole.

Another conspiracy appears to be in the works at the 6th, according to Neil Versel of the Meaningful Health IT News blog. In his recent post, Neil reveals that he wanted to attend the recent TEDMED conference, but found out that “TEDMED’s new owners say it won’t credential healthcare trade press unless they agree to be paid “media partners.” Double-bogey at the 6th.

The 7th hole offers an opportunity to regroup after struggling at the 6th. With Kat Haselkorn’s post “The Power of Employee Engagement” at the Corporate Wellness Insights blog, we learn of the subtle but crucial difference between employee participation and employee engagement in worksite wellness programs. In order to fully engage employees and improve population health, intrinsic motivation must be a factor. External motivators (like the ever-popular incentive program) can lead to high levels of participation but little personal investment in adopting healthy behaviors. Back on track with a birdie.

Headed to the 8th, we have “The Big Shift” written by Bob Vineyard of the InsureBlog. Does less health care really equate to lower health care costs? InsureBlog’s Bob Vineyard explores this conundrum and his answer may surprise you. The magnitude of wasteful spending amounts to a hazard, and after the penalty stroke, you’re lucky to escape with double bogey.

Finishing the front nine is David Williams of the Health Business Blog who has good things to say about health reform in Massachusetts. In his post “Massachusetts health reform has not driven up costs,” we learn that despite what GOP Presidential candidates would have you believe, Massachusetts has achieved its coverage goals without the undesirable side effect of increased per capita spending. We also learn that with near universal coverage in place, Massachusetts is ready to tackle costs. No need to lay up here, go for the green and make birdie.

As we kick off the back nine on number 10, it’s worth asking how other countries pay for health care. Jason Shafrin, who blogs at the Healthcare Economist, considers this topic in a post entitled Healthcare Spending in Indonesia. How do Indonesians pay for healthcare? What is the government’s role in the provision of healthcare services in Indonesia. The Healthcare Economist provides the answers. Eagle at the 10th is a great way to start off the back nine.

The 11th is a chance to hear from the relatively new voice of Brad Flansbaum, blogging at The Hospitalist Leader about the limited availability of healthy fruit and vegetable options in many neighborhoods in a post entitled “This is About Brussel Sprouts, Not Broccoli (And It’s Not What You Think).” After catching a bunker, it’s a solid par.

Hole number 12 comes courtesy of the Health Affairs Blog. In a piece from their “Contributing Voices” section by David Lansky, the President and CEO of the Pacific Business Group on Health, titled “Public Reporting Of Health Care Quality: Principles For Moving Forward,” David notes challenges for public reporting, discussed in articles in the March issue of Health Affairs and elsewhere, including the shortcomings of hospital reporting, the importance of framing quality information in ways consumers can understand and apply to real-world decisions, and the need for more consumer-relevant measures. He suggests that we have not done a good job designing public reporting programs to deal with these challenges, but he says the answer is not to abandon reporting but to do it right. Accordingly, he offers several principles for moving forward, such as meeting consumers where they are — rather than trying to lure them to stand-alone websites or publications — and implementing measures that consumers say they want, regardless of the inherited limited data infrastructure. Things continue moving in the right direction with a birdie at the 12th.

Lucky number 13 is a piece from John Goodman’s Health Policy Blog at the National Center for Policy Analysis that explains the economic sense of choosing a high deductible health plan. In an attempt to avoid moral hazard, you lay up short of the green, and two putt for bogey.

A string of pars on 14, 15, and 16, leads to Anthony Wright’s Health Access blog on the 17th, exploring “What California Has at Stake at the Supreme Court.” According to Wright, California is well on its way to implementing health reform—and so hundreds of thousands, if not millions,would lose coverage and financial help if the ACA were to be struck down. California was desperately trying health reform before “Obamacare,” and the status quo is unsustainable, so it will try again with or without the federal law (including improving upon it, especially if a part is struck down)—but it would be very, very hard without the tools and resources from the Affordable Care Act. On the green under regulation, with another two putt, this time for birdie.

Finishing the round at the 18th, we have an excellent post from Joanne Conroy, MD, writing at Wing of Zock, who explains how health reform could really benefit from having some continuity of leadership at CMS. According to Dr. Conroy, “The “who’s right” of partisan politics gets in the way of what’s right. Our health care system is too important to be a political football. Stable leadership does not remove the input of elected officials. It just makes recruitment of health care leaders to government service and the implementation of sound policy more efficient if you are not playing musical chairs every 18 months.” The long birdie putt drops in.

Well, that’s it. If you’re playing along at home, we’re 2 under for today’s round. Not bad after a series of dramatic ups and downs. Stay tuned for the next edition of Health Wonk Review being hosted by everyone’s favorite “To Be Determined.”