Archive for July, 2013



By Any Other Name; Technology May Make Capitation in Healthcare Work

July 30th, 2013
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With apologies to William Shakespeare, in this post I ask: will capitation smell sweeter, if called by another name? A recent article by venture capitalist Abbas Gupta lays out the case for a new variant of capitation (i.e., fixed healthcare fees), called the Affordable Care Organization (ACO). This time, consumer-facing technologies that empower consumers and generate more precise profiles of consumer behavior may bring promise to the previously ill-fated payment system.
 
In the 1990s, capitation was reintroduced as a way to manage healthcare costs. Doctors able to keep costs under a certain level could keep the amount they “saved,” but they were not reimbursed for costs in excess of that level. Capitation failed partly because of the perception that doctors sacrificed quality of care (measured in procedures and tests), and partly because doctors eventually were better able to negotiate contracts by consolidating practices and leveraging their numbers for better reimbursement rates.
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Clinical Trials Could Get More Participant “Likes” from Social Media

July 19th, 2013
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A few months ago, I discussed the development of a patient-centered clinical trial, in which participants could access their own health data and even help design more personalized clinical testing protocols. Much of this activity would happen online, which begs the next question: can the online patient-centered trial model be used to drive more people to volunteer for trials?
 
Recruiting enough participants has long been a significant challenge for clinical trial coordinators. Poor site selection and slow recruitment are the biggest reasons for clinical trial delays (which in turn, are the biggest reasons for slower drug approvals). As of 2010, it took 6.8 years on average to complete the clinical trials component of a drug’s development, out of 8.3 years to finish the entire cycle from IND to NDA. On average, recruitment delays add 4.6 months to the clinical trial process—on top of all the other factors that delay trials, this is one we can control.
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Can Digital Health Technology Be Part of the Secret to a Long and Healthy Life?

July 12th, 2013
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A comprehensive study of American lifespans and health published in this week’s Journal of the American Medical Association, which has received much media coverage, shows that while Americans are living longer, those extra years are less healthy when compared to older people in other industrialized countries.
 
While the report notes that certain diseases, like strokes, colon and breast cancer, and AIDS, have seen decreases in incidence, most of the conditions leading to increased cost of healthcare (namely, obesity and its associated co-morbidities cardiovascular disease, diabetes, and asthma) are increasing, and can be prevented with behavior and lifestyle changes, earlier intervention and better management. But clearly, that prevention isn’t happening.
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New WellPoint Plan Increases Healthcare Consumer’s Level of “Skin in the Game”

July 9th, 2013
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When Warren Buffett used the phrase “skin in the game,” he referred to company managers investing in their own companies. In healthcare, we’ve discussed how equally important it is for consumers to also have some “skin in the game,” bearing at least some responsibility for their costs of care.
 
A recent Wall Street Journal article (subscription required) discusses how WellPoint, the nation’s second-largest health insurer, has developed a group plan in which consumers would be responsible for the cost of medical services in excess of that offered by their employer plans. While WellPoint’s idea doesn’t appear groundbreaking at first, this type of plan would dramatically shift the dynamics of healthcare costs.
 
Here is how the Journal’s Anna Wilde Matthews described the WellPoint plan:
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