Envisioning 2.0

Last week, I asked readers of Grand Rounds to submit posts about consumer-driven healthcare. One of the reasons I decided to focus on this issue was because President Bush made healthcare a major focus of his State of the Union address last week. In what some might call a policy wonk’s dream speech he made a proposal that (if it became law) would begin the long and difficult process of decoupling health insurance from employment. One potential consequence of providing tax breaks for health insurance would be that some uninsured individuals may be encouraged to purchase it.

Focusing on tax policy is just one of the tactics employed by those would like patients or “consumers” to take more responsibility for managing their care. Over the past decade or so, healthcare economists, policy analysts and others have touted “consumerism” as the solution to the United States’ health cost woes. The country currently spends a significant percentage of its gross domestic product on healthcare. Proponents of consumerism argue that one of the reasons that healthcare spending continues to rise is that patients are shielded from the “real” costs of care and often utilize more medical services than they need.

Unfortunately, the conversation about consumer-driven healthcare has been largely limited to the ivory towers of government, academia, corporations and the media. Many Americans are not aware of healthcare consumerism and need to learn more about it. This was one reason why I decided to make this topic the theme of this week’s Grand Rounds. Given that some regular contributors have said they do not like themes, I was worried that my request would result in a very bare bones edition of this well-respected blog carnival. I needn’t have worried. I received more than 35 submissions for this edition and the vast majority dealt with healthcare consumerism. Following are the 25 posts I selected. Happy reading!

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An intriguing article published today in the Wall Street Journal (subscription required) highlights an ongoing battle between the NAACP and the government over coverage of the controversial cardiovascular medication BiDil. NitroMed, which makes the drug, has run into financial trouble because sales have not taken off.

BiDil, the first and only medication approved for use by a single racial group (African Americans), combines two generic medications: isosorbide dinitrate and hydralazine. NitroMed has had trouble securing insurance coverage for the medication because the manufacturer’s fixed-dose combination therapy is more expensive than its separate components. The government has not required private insurers running Medicare Part D plans to cover BiDil. However, in November, NitroMed announced that it had “entered into final agreements to place BiDil on preferred formularies of 2 of the nation’s 5 largest Medicare Part D payors.”

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at the blog of the well-regarded health policy journal, Health Affairs.

Next week’s Grand Rounds will be hosted here at Envisioning 2.0 on Tuesday, January 30.

I’m pleased to announce that I will be hosting the venerable and well-regarded blog carnival Grand Rounds next week. I’m very honored that Nicholas Genes provided me with the opportunity to highlight some of the best writing in the healthcare blogosphere.

From reading Grand Rounds, I understand that some people love themes while others hate them. Despite this, I’ve decided to focus on a theme because I’m very interested in hearing from the blogosphere about healthcare consumerism or consumer directed healthcare. As many of you may know, President Bush will be unveiling a new healthcare proposal during his State of the Union speech this evening. Early reports indicate that he is interested in encouraging people to purchase individual insurance plans via tax breaks. Whether his proposal lives or dies, it is clear that consumerism – asking patients to take greater control of their medical spending and decision making – is alive and well.

So, fellow healthcare bloggers, I’d like to hear from you on this subject. Please submit posts that address:

-Your views on the healthcare consumerism movement
-Whether you think it will solve the economic, treatment and societal problems associated with healthcare
-Your experiences with it as a patient, provider, policy wonk, student or otherwise

Adhering to this theme, of course, is not required. I’ll find a way to include your submission. Please note: I’ll be choosing 25 posts to include in this edition. Following are directions on how to submit your post:

-Submissions are due by midnight (EST), Sunday January 28
-Please do not submit any posts promoting a product or service
-Please use Grand Rounds as the subject of your e-mail
-Include the link to your post in your e-mail and a short 2-3 line description of your submission
-Please review the Grand Rounds guidelines prior to submitting your post
-E-mail your posts to envisioning AT envisionsolutionsnow DOT com

Thank you and I look forward to hearing from you all.

A December 2006 Center for Studying Health System Change study provides some interesting information about the health of the consumer-driven healthcare movement. The Center studied consumer uptake of consumer directed health plans (CDHPs) and found the following:

-“When offered a choice of plans, relatively few employees (19%) select CDHPs”

-While employer’s costs for administering CDHPs are similar to traditional insurance plans, employee expenses are significant.  “Annual deductibles and employee out-of-pocket costs are much higher, especially for routine office visits.”

-Employee enthusiasm for CDHP is much lower than employer’s.

This study indicates that employees are fearful and skeptical of CDHPs.  When they look at the numbers, they prefer to stick with traditional plans that shield them from the financial costs associated with medical care.  In addition, they may be unsure how they will handle the additional costs burdens associated with CDHP.

From a communications perspective, proponents of CDHPs have to do a better job of:

-Comparing and contrasting the cost-sharing options associated with CDHP to traditional plans.

-Explaining the benefits and drawbacks of CDHPs to older, sicker employees to encourage them to enroll and avoid adverse selection

While employers currently provide consumers with a lot of information to aid CDHP-related decision making, some have recommended that one-on-one, intensive education is necessary.  For example, Kevin Condon wrote an article last July in Employee Benefit News where he said that making an “impartial external advisor” available to provide financial advice to employees can be a cost-effective means of boosting participation in CDHPs.

Whatever the communications solution, employers and plan operators will have to closely examine the behavioral, psychological and informational barriers to CDHP uptake and devise methods of overcoming them.

With the House passing legislation giving the government the ability to negotiate drug prices for people on Medicare, rhetoric is heating up and data is flying from people on both sides of the debate.

Pro Price Negotiations: Joe Paduda has this analysis of statistics used by opponents of the House plan. He says that some are “using faulty methodology and selective data to promote a perspective.”

Against Price Negotiations: Pfizer produced this video that highlights its arguments against price negotiations and says that they would lead to less innovation in critical areas, including Alzheimer’s.

Earlier this week I published an article on this blog focusing on the disconnect between consumers and pharmaceutical executives about drug firms’ activities. Dr. Roy Poses, who writes the blog Health Care Renewal, was kind enough to include my post in the latest edition of the Health Wonk Review. He also took issue with a phrase I used to describe industry insiders: well meaning. Here is what Poses said:

“[Johnmar] saw pharmaceutical executives as mainly well meaning, but having to cope with an onslaught of negative publicity about the industry. Readers should peruse some of the stories about some of the leadership of the biotechnology and pharmaceutical industry on Health Care Renewal, and think about just how well-meaning they have been, and whether some of the bad publicity was not deserved.”

It seems that I struck a nerve with Poses because he referenced my post a few other times. For example, in a post highlighting pharmaceutical industry support of the president of the Massachusetts Biotechnology Council who admitted to obstruction of justice, he said:

“Doesn’t advocating a confessed felon, and an obstructor of justice at that, to continue as a top industry spokesperson, as the Globe alleged, suggest a management approach that is badly ethically challenged? Maybe pharmaceutical industry executives could convince people they are “well-meaning” if they at least were to restrict their spokespeople to those who have not been convicted of felonies” [emphasis mine].

In a comment I left on Poses blog, I talked about why I used the phrase “well meaning.” I said: “The study I cited showed that people in the industry believe they are much more ethical than the public believes. By saying that many people are well-meaning, I mean that many in the industry believe they operate ethically. However, as I have pointed out on my blog and in other places, there are abuses that take place, which should and, in some cases, have been curbed. In addition, I have said that ethics and transparency will be watchwords for the healthcare industry as a whole in 2007 and that communications can help in this regard.”
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A new study released today by PricewaterhouseCoopers (PWC) reveals that there are “significant differences between the public’s view of pharmaceutical companies and the industry’s self perception.” PWC concludes that this disconnect is “causing the industry’s messages about its value to society to fail in the court of public opinion.”

Following are some of the most startling results of this survey (from PWC’s press release):

-Consumers are split between believing that pharmaceutical companies consider important unmet medical needs when deciding to develop a new drug (55 percent) instead of choosing to develop “me-too” and “lifestyle” drugs with the greatest sales potential (45 percent). This compares to 71 percent of industry stakeholders and 91 percent of pharmaceutical executives, respectively, who say health needs are a top priority for pharmaceutical companies.

-94 percent of consumers and 81 percent of industry stakeholders said that drug companies are too aggressive in promoting unapproved uses of their product. Fewer than half (47 percent) of pharmaceutical company executives agreed.

-62 percent of stakeholders agreed that drug companies often manipulate or suppress negative clinical trial results to maximize sales. Four out of five pharmaceutical executives disagreed.
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Last year the headlines were filled with unflattering stories about pharmaceutical companies, hospitals, managed care organizations and other healthcare industry players.  For example:

- Reporters and others focused on the relationships between non-profit organizations and their corporate backers

- Kaiser Permanente came under assault for its implementation of an electronic medical records initiative and for providing sub-optimal care to some patients

- Biotech firms developing life saving medications for cancer and other major illnesses were attacked because of their pricing strategies

- Researchers were criticized for not disclosing their relationships with drug firms, medical device manufacturers and other companies in articles they submitted to major medical publications

- Critics of the Food and Drug Administration charge that the agency is beholden to the pharmaceutical industry.
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