Random Reports from the Field at the World Health Care Congress

The Disease Management Care Blog is in Orlando tonight, getting ready for tomorrow’s presentation at the Academy of Managed Care Pharmacy annual meeting. Its message: that pharmacists have a role to play in population-based care programs, including the medical home. More on that in a later post.

In the meantime, the flight from Reagan was an opportunity to pull out various notes made at various times while sitting in the audience at the World Health Care Congress. What a great meeting.

In unrelated and random order, here they are:

While the speakers knew of which they spoke, the moderators ranged from superb to hopeless. Just because you carry a byline in some household-name news organization doesn’t mean you can spot when the speakers are hiding behind their vague nostrums. The DMCB came away with a better understanding of the divide between the complicated business of health policy and the ability of the media to understand it, let alone translate it.

Attendance? Around 1400 persons, which was not only high for the WHCC, but contrasts with other meetings in the non-health care fields, where attendance (according to a meeting planner) is down by 25% or more. During the ride to the Orlando Hotel, the driver told the DMCB that he was thankful that there was a cardiology meeting coming up, 'otherwise we'd be out of business!' Strange? Unexpected? You be the judge.

Karen Davis of the Commonwealth Fund saluted Germany’s healthcare system for providing the nurses that staff the doctors’ clinics for care management services. It seems to the DMCB that that is closer to the ‘disease management’ model (externally supported nurse coaching) than the medical home model (in which the primary care site is responsible for staffing a team). As noted before, the DMCB thinks a combined model is best and looks forward to when Dr. Davis can salute the U.S. system for being better than Europe's.

George Halvorson of Kaiser blithly dismissed malpractice costs as a driver in health care inflation. He can afford to do so because of MICRA. Is this another reason why California's integrated delivery system may be less of a role model for healthcare reform than anyone thinks, or is he just plain wrong? And is the DMCB crazy, or is the resemblance to Orson Wells more than just skin deep?

In addition to founding a social-missioned bank in Bangladesh, Nobel Prize winner Muhammad Yunus also started a Bangladeshi insurance company with a premium of $2 a year. Interestingly, the benefit involves co-insurance, otherwise ‘people would see the doctor for anything, like being dizzy in the head.’ The DMCB asked him about the all important cost ‘trend’ in his insurance company. He noted it was low, not only because of the out of pocket consumer brakes on utilization, but 1) because when people in Bangladesh get ‘sick,’ that means they are physically unable to get out of bed. ‘If they can get out of bed, they are not sick’ and do not need any health care services, 2) his insurance covers wellness services such as non-physician-based prenatal care in all the villages, and 3) use of the internet for specialist physician consultations – ‘we don’t bring the doctors to the villages, we bring the villages to the doctors.’

Peter Salgo MD, host of Second Opinion announced that ‘evidence-based medicine’ (EBM) is far less available than anyone believes. Rather, most of what passes for EBM is really high probability medicine (how the DMCB interpreted Dr. Salgo's remarks), characterized by the best guess at what works for average persons within the bounds of statistical probability. The moderator and other guests on the dais were horrified.

Dr. Jeffrey Kang, the Chief Medical Officer of CIGNA, pointed out that comparative effectiveness research (CER) could be used for one of two purposes: coverage or reimbursement. In the former, only treatments that pass CER muster will be “covered” by an insurer. In the latter, treatments that don’t pass muster will either be reimbursed with a comparatively lower fee or, alternatively, the patient- consumer will be responsible for a higher out of pocket payment. He thinks the reimbursement approach will be far more palatable to the American public.

Is the classic server-web-clinic based electronic medical-health-personal record already obsolete? The DMCB wonders if that’s the case. It ran into two vendors that rely on the cell phone as the primary platform for e-medical record management. Think of an icon on your IPhone or Blackberry that retrieves your history, sorts your medications, stores your lab results, remind you to take your pills, texts your providers and who knows, even pulls up your x-ray images. If you LOSE your phone, the vendors will signal the absconded phone with a signal that will wipe it clean. More on this in a future post.

Finally, an historical insight from Newt Gingrich. While the Poles were overthrowing their Communist government, one of their slogans was ‘2+2 = 4.’ The point was that the government had been telling them that ‘2 + 2 = 5’ and it was time to face reality, not slogans. Newt felt the last ten years in the U.S. were filled with ‘2 + 2 = 5’ economics (quote: ‘a strange detour in the American journey’), in which we failed to recognize that ‘when you can’t afford a house….. you can’t afford a house.’ He’s afraid the next ten years will be one of ‘if you can’t afford all the health care you want….. you can’t afford all the health care you want.’