Category Archives: e-health

Highmark’s Care Cost Estimator looks promising

Highmark Health Services, a big Blue Cross Blue Shield plan is rolling out its Care Cost Estimator, a transparency tool designed to get members to make cost-saving choices. The video embedded below does a good job of explaining the tool. In watching it, I’m impressed at just how far these tools have come over the past couple of years.

The site is similar in concept to a travel website like Orbitz. It allows users to select the type of care they need, and then see an array of provider choices and associated costs. The costs include total costs and out-of-pocket costs that are specific to the member. It claims to incorporate all aspects of the benefit design and benefit use to calculate the actual out-of-pocket costs. The site also displays patient reviews of the providers.

The real potential of the site is described at around the 2:20 mark, where the video refers to “reference based benefits,” which set an allowable price for a specific procedure and then make the patient pay anything above that amount. Reference pricing has the potential to produce major cost savings at least for certain procedures. I wasn’t aware that Highmark was utilizing this approach. In any case, in order to make reference-based pricing effective, transparency tools like this are an absolute must.

I don’t know whether the site is as easy to use and as useful as the video makes it seem. But if so, this is a big step forward for Highmark, its customers and members.

By David E. Williams of the Health Business Group.

Patient reviews: Don’t throw the baby out with the bathwater

Patient advocate Trisha Torrey (Tragic Reminders of the Uselessness of Doctor Ratingswarns us not to trust online doctor reviews; health care journalism scold Gary Schwitzer picks up the story and runs it uncritically. There’s some worthwhile information in the blog post, but the case against reviews is seriously overstated and the alternative paths proposed are not as useful as they sound.

Torrey provides two examples of negligent physicians who received good ratings on various sites such as Healthgrades, Vitals, and RateMDs. One orthopedist later admitted performing fake surgeries and a family doctor turned out to be a drug abuser and dangerous prescriber.

Here’s Torrey’s advice:

So what do we empowered patients learn from all this?

First – that trusting reviews on a doctor ratings website is folly.  Clearly – you cannot trust them.  They are people’s opinions based on things like how polite the receptionist is – NOT helpful when it comes to the need for real care.

Second – that there are ways to find a doctor and his or her credentials online that are safe and useful, including information about malpractice.

And finally – that just because a doctor is nice, does not mean he or she is competent – and vice versa.  If you ask a friend for a referral to a doctor, and that friend uses the word “nice” – dig deeper!

As we move into 2014, and the Affordable Care Act kicks in, finding the right doctor is bound to become more difficult.  But that does not mean we can or should take shortcuts.  Read the USA Today expose cited above… it will make your toenails curl and will compel you to be very careful.

Doctors ratings are shortcuts – dangerous shortcuts.  Just don’t go there.

I beg to differ.

On the first point, reviews vary widely in quality. But they are definitely not all “based on things like how polite the receptionist is.” For example, the Yelp reviews on my physician’s practice go into considerable detail about the workings of the practice and how the clinical skills of its various doctors. Yelp also has an algorithm to put the most useful reviews toward the top, and sure enough the first one for my practice is from a woman with chronic illnesses who’s been going to the practice for 10 years. She has 3 verified “check-ins” with Yelp from the practice. Her first name, town and profile are provided, and it’s possible to see the distribution of ratings she gave to other businesses and to read her reviews. Anyone who wants to spend the time could get a very good sense of the types of people reviewing the practice and could calibrate those comments and reviews with others written by the same people.

There is plenty of room for improvement in the Yelp system, but it’s a heck of a lot better than Torrey –and many other critics of online reviews– gives it credit for. Spend 15 minutes looking at Yelp reviews of doctors and form your own opinion.

On the second point, Torrey would have us believe that it’s easy to find “useful” information, including information about malpractice. But the same USA Today article she cites to expose the family practitioner is mostly about how abusive doctors can run amok for years –or forever– without having their medical licenses suspended or any information about the bad behavior coming to light. As the article notes, “The doctors’ names are a mystery: identifying information is stripped from the Data Bank’s public file. Full access is limited to medical boards, hospitals and other institutions that are supposed to weed out bad doctors.” And malpractice cases that are settled (the majority) are not made public.

Overall I’m surprised that a patient advocate would be so quick to trash reviews by fellow patients and accept as adequate what little information comes out of the medical profession and other official sources not completely committed to transparency.


By David E. Williams of the Health Business Group.

AskBlue does its best to explain health insurance and Obamacare

Polls show that few people understand health insurance or the Affordable Care Act. That’s especially so for those who have the most to gain from Obamacare: people who are uninsured and haven’t had health insurance for a while. It doesn’t help that so much of the political debate and news coverage is about the battle over Obamacare rather than education about how it works.

Amidst all the noise, the BlueCross BlueShield Association has posted a new website, AskBlue to try to explain insurance in lay terms, educate the public on the impact of Obamacare, and point users to Blues plans in their area to buy insurance. All of this is happening in the run-up to the scheduled October opening of the health insurance marketplaces.

I had a look at the site. It does a good job of explaining “What Do I Get? What Do I Pay? How Do I Choose?” But let’s face it, the concepts are hard enough for even a well-educated consumer to understand. For example:

  • Premiums versus out-of-pocket costs. The differences between copays, deductibles, coinsurance and how they interact with one another and with out-of-pocket maximums
  • Types of plans: PPOs v. HDHPS v. HMOs, and the hybrid models like POS plans
  • “Metal” levels: Bronze, Gold, Silver, Platinum that are independent of the types of plans
  • Two terms for the new insurance shopping sites: “marketplaces” and “exchanges”

Despite all these topics, the site barely skims the surface on topics that matter such as: choosing a doctor, navigating the delivery system, evidence based care, pharmacy benefits, FSAs, patient portals.

Bottom line: Can we really expect people to understand all of this and act on it in an intelligent manner?

The site is a solid resource for those seeking to understand more. But all the complexities of the commercial insurance world will continue to make it pretty hard for most people to optimize their use of benefits, and will keep administrative costs high.

I’m on NPR’s Marketplace today

NPR’s Marketplace has a story today on daily deal sites for health care. I’m quoted.

The story is drawn from a longer piece on NPR’s Dallas station, KERA.

My view: deal sites are an interesting phenomenon but are not likely to play a major role in health care cost containment or price transparency. The deals are and will likely remain confined to ancillary providers such as dentists, vision care, and cosmetic dermatology.

VitalHealth introduces an EHR for optometrists

The Mayo Clinic and Noaber Foundation of the Netherlands have collaborated to develop a cloud based, tablet-enabled, user friendly electronic health record (EHR) for small physician practices. The company they created, VitalHealth Software is now introducing an optometry EHR, offered exclusively by their partner VisionWeb as “Uprise.”

Optometrists are eligible for Meaningful Use incentives, but their workflows and practice patterns do not lend themselves to the use of the typical systems that are on the market.

In this podcast interview, VitalHealth executive Blair Butterfield discusses the needs of optometrists, explains VitalHealth’s relationship with eye care company Essilor and distribution partner VisionWeb, and describes the interoperability needs and how they can be addressed.

Physician Compare: Still unimpressive

My friend, Jordan Rau at Kaiser Health News reports that Medicare is upgrading its doctor ratings website, Physician Compare to get ready to provide more robust information as part of the Affordable Care Act. The site is intended to include more information about doctor quality and patient experience. It also has the capability to let patients search for doctors by part of the body, e.g., abdomen.

I like the idea of the Physician Compare website. In particular I’m hopeful that we’ll start to see some information at the individual physician level (which is what patients care about) rather than the group practice level (which is what most providers prefer). For now, though the site is not too useful.

I tried searching for my doctor, an adult internist in a good sized group practice that I’m sure takes Medicare. I also tried my former physician. No luck. Then I searched for some pediatric specialists (figuring there is some Medicaid data on the site) but couldn’t find the people I was looking for.

After that I checked out some of the individual listings. There’s very little there now. The only thing about quality is what programs they are participating in, e.g., PQRS. Nothing on the results.

If Physician Compare adds data, as the Kaiser story promises, it may become useful. But it will still have the problem of incorporating information just on participants in federal programs like Medicare rather than looking at a provider’s entire population, which typically includes plenty of commercial patients.

The comments section of the Kaiser article includes some good points: how do we feel about sharing our views of providers in a post-Snowden world, why doesn’t the site include information on whether the provider is employed or in private practice, and how old are the data?


By David E. Williams of the Health Business Group.

Q&A with Health Payment Systems CEO Jay Fulkerson

Health Payment Systems (HPS) helps consumers understand and pay their bills. In this interview, HPS CEO Jay Fulkerson answered my questions about the origins of the company and what they are trying to achieve.

What challenges are you trying to address?

As a technology company, we look for ways to close existing gaps or delays by streamlining the healthcare payment and billing process and connecting its various components. The current payment system is convoluted, confusing and wasteful. We need to rethink it from the ground up if we’re serious about doing the very best for healthcare consumers. We hope to bring an increased understanding of the process and simplification for the patients and providers, as well as empowerment for consumers.  Data shows patient satisfaction with their provider decreases 10 percent from the time of discharge to after receipt of the bill. We’d like to see that turn around—where the payment process is another opportunity to affirm the strength of that provider’s brand and mission

What is the Super EoB and why was it developed?

The Super EOB was developed after one of HPS’ founders, James Brindley, underwent treatment for cancer and saw the bills begin to mount.  After a full recovery, Jim gathered his stack of paperwork, met with his neighbor who was in the healthcare field and said, “There’s got to be a better way to make sense of all of this.” After two years of research and planning, they incorporated Health Payment Systems. Sometimes patients need to simply focus on getting well, and the overwhelming medical bills and EOBs do not help.

The Super EOB benefits three entities:

  • Providers receive a single electronic payment from HPS for both the benefit plan and patient portions of a bill
  • Employers save money because HPS passes along savings it secures from providers
  • Families receive one monthly statement, the Super EOB, which includes healthcare services from all HPS providers, for all family members.

It’s really a win-win-win for all involved.

What kind of feedback are you getting from patients?

We know that patients can easily understand what they owe, where to submit payment and by what due date. A process like this saves time, trees and money, plus patients understand it better and don’t have as many questions for employers.

In a recent focus group, we asked employees of a local county government what they thought about the advances in claims technology and the ability to receive something like a Super EOB. Participants liked that information for all family members was on the same page, and that they could make one payment for everything on the statement

Who are your customers? What is your business model?

Our customers range from small employers to large, self-funded companies.  We have a large portion of municipalities and school districts, as well as healthcare providers. As a healthcare technology company, our business model is aimed at taking waste out of the claims administration process, while making the healthcare payment experience easier for consumers to understand. Our provider network includes more than 6,500 healthcare practitioners in Wisconsin. We enroll more than 75,000 patient members and have 40 employees.

What impact is ACA implementation having?

The ACA was created to provide affordable healthcare to everyone. In order to do so, steps need to be taken to make healthcare more affordable.  Removing waste from the payment of health care services is our primary business, and is one factor that will help make healthcare more affordable.  There is no better time for employers to embrace the single payment technology offered by HPS.

Why did you develop the YouTube video? What do people think of it?

To tell our story better, we put together a short, animated YouTube video that demonstrates just how much paper the average family receives related to healthcare billing.

It’s a fun, easy-to-understand explanation of the current state of healthcare paperwork from the patient’s perspective. HPS actually has a stack of EOBs and bills that we counted to get to the numbers mentioned in the video. We have some pretty fascinating data that I’m not sure anyone else on the claims or provider side has researched before.

The response to the video has been positive.  It has helped HPS tell our story, as well as allowed our employees to share with their family and friends to help them understand what they do at work.

What’s next?  How else are you hoping to improve patient experience?

We have been out starting the conversation—meeting with providers and employers to see what their changing needs are and how we can help address them.  We need to shift our idea of competition in order to work together toward better value for patients and communities. That said, we would love to partner with a local provider about launching a Payment Value Stream. It would allow us to examine each step in the current process to see where we can remove waste and create value. From a lean perspective, this is an area of care not many people have looked at, and we think it’ll give us great insights. We continue to work at incorporating the voice of the customer and transparent performance data into our approach.  Finally, we are working on a consolidated billing product, will soon be rolling out a more robust patient portal and are looking at additional ways to empower consumers.


Bio: Jay Fulkerson joined Health Payment Systems (HPS) in 2011 and serves as the president and CEO of HPS. Previous to his role at HPS, Fulkerson served as chief executive officer of Touchpoint Health Plan in northeast Wisconsin. Following the acquisition of Touchpoint by United Healthcare, he served as chief executive officer for Wisconsin and then as regional chief executive officer for United Healthcare’s Midwest Region.

Interview conducted by David E. Williams of the Health Business Group.


Medical device connectivity: Interview with Capsule’s Stuart Long

Hospitals have many devices collecting data on patients, but until recently information from those devices has not been routinely integrated nor stored in electronic medical records. In this interview, Stuart Long, Chief Marketing and Sales Officer of Capsule explains the benefits of medical device integration and how it works in a hospital.

Why is medical device connectivity important, and what benefits does it bring to the patient?

Rapidly becoming a priority for many hospitals, biomedical device connectivity to the hospital network—or medical device integration (MDI)– enables medical devices to transfer patient data from the point-of-care over the network into an electronic medical record (EMR) system or other charting systems. Device integration delivers patient data to clinicians in near real time so that information supporting patient care decisions is delivered timely and accurately.  Without MDI, patient data, particularly vital signs, is transcribed on paper charts and the recording is duplicated by manually having to key the data into the patient’s electronic record. MDI helps assure data accuracy by eliminating manual transcription errors while relieving caregivers from burdensome manual tasks, enabling more quality time with patients.  The bottom line is increased patient safety and care.


Why is it important to automate the collection of patient data (i.e. vital signs) and how does this improve the quality of data entering the EMR?

End-to-end automation of patient data collection ensures accuracy and precision.  Full automation removes potential error points along the way as device information is sent to the EMR or other systems.  For example, as I mentioned before that many caregivers read data from a device, manually record it and then input it into the electronic system.  From an administrative standpoint, the need for absolute accuracy of data is greater than ever before.  In addition, having data in electronic format is essential to ensure the full realization of a complete electronic record, which enables data exchange with other hospital IT systems and access to this information hospital-wide. Again, from a regulatory and reimbursement standpoint, the importance of this electronic format is increasing as Meaningful Use (MU) guidelines become more defined.


What happens to patient data as it moves throughout the hospital? How is that data being used?

As patient data is collected through electronic means, it is aggregated from software or hardware, analyzed by the connectivity software, and translated into a format appropriate for the hospital IT system receiving the information.  Various hospital departments—whether the ED, OR, ICU or med-surg–may output device data in disparate formats, often completely proprietary formats.  That data then must be translated into a standard format for the EMR and perhaps reinterpreted once again for compatibility with specialized departmental IT systems.  As each new department inputs information, the data is normalized as required and translated for the needs of specific hospital IT systems.  In that way, device information can follow the patient through the hospital, wherever it is needed.


What are some of the differences across care units in the hospital? How does that impact the technology being used?

Workflow varies greatly among various care units—the ED, OR, med-surg and step-down, for example, and also varies by hospital.  Med-surg units often have many beds with a limited number of devices shared among them on mobile carts.  Intensive Care, by contrast, may rely on a greater number of devices, which are fixed in location and associated with a particular bed. A quality MDI system seeks to reduce the complexity of its technology by supporting the existing workflow already in place in a particular setting.  Capsule has different hardware and software solutions to support various settings and workflow requirements. Some are wall-mounted units that accept fixed-position devices and are already associated with a specific bed for continuous data collection. Another solution would be a mobile device interface for equipment with no fixed location, which must be associated with the individual patient for periodic data collection.  Data must be validated, and in some settings, a nurse requires flexibility about the timeframe care patients may require immediate attention before caregivers have time to accept data.


Interview conducted by David E. Williams of the Health Business Group.

Solving the patient payment problem: Interview with Simplee

Patients are often confused by the medical bills they receive from providers and have difficulty matching them up with the so-called Explanation of Benefits (EOB) forms they get from health plans. The result: frustration, wasted time and bills that don’t get paid. This problem befuddles not just to the ignorant or feeble-minded; I freely confess that it afflicts me as well.

In this podcast interview, Simplee co-founder and CEO Tomer Shoval explains how his company’s medical wallet and self-service payment platform help patients understand and pay their bills and help providers collect payments faster and at a lower cost.  Shoval has a background in e-commerce (he’s ex-eBay) and that experience shows through in Simplee’s approach.

By David E. Williams of the Health Business Group.

The still-early state of online doctor reviews

A front-page Boston Globe article on a neurosurgeon suing a caregiver for a harsh blog post  is exciting but unrepresentative of the overall state of online doctor reviews. However it caused me to take another look at online physician ratings from the perspective of someone trying to find a doctor. Conclusion: we are still in the early days and there is plenty of opportunity for better, more useful information. It’s still difficult to use the sites for real decision making.

First I tried searching HealthGrades, Yelp, Angie’s List and Massachusetts Health Quality Partners (MHQP) for information on something I really care about. I typed in the name of a medical specialist at a local academic medical center who is caring for a family member with a serious illness. This doctor has been in practice for 20 years but only one site I looked at (HealthGrades) had any reviews, and those two were not detailed. I then looked for other specialists and found that there are typically very few reviews available. It’s unusual to find more than five reviews for a given specialist on any one site, although I’m sure there are some exceptions. MHQP doesn’t include specialists.

Next I turned to primary care. The information is better –MHQP in particular stands out on data quality– but there is still a lot to be desired. I searched for my physician, Dr. Johanna Klein of the Beth Israel Deaconess Medical Center’s Washington Square Group. Here’s what I found:

Healthgrades — a listing with a lot of publicly available information (address, phone, insurance, date of graduation) plus seven patient experience surveys showing that people generally like her

Angie’s List — which I paid $11 to join– has a confusing search function. I found Dr. Klein but no reviews for her. There were 16 reviews for the broader medical group, though, enough to get a general idea of the practice and some specific doctors within it. One of the reviews is harsh “I seriously question if she has actual medical training…” but most are pretty sober, boring and don’t sway me one way or the other. This site was the most disappointing overall and I don’t recommend subscribing.

Yelp –is the liveliest of the sites, at least in its reviews of this practice, and also incorporates some of the most innovative social media features. There are 7 reviews, 3 of which give 5 stars, 3 with 1 star and 1 with 2 stars. In addition to the rating most have a significant amount of text –quite a bit more than Angie’s List. Reviews are sorted by “Yelp Sort” as a default and can also be sorted by date, rating, Elites (a Yelp designation for evangelists) and Facebook friends. The Yelp sort takes into account various factors –like user votes and recency– to list the most helpful reviews first. Each reviewer has her or her first name, last initial, town and photo displayed, along with the number of Yelp friends, number of reviews posted and how many times they have “checked in” at the location. Clicking on the reviewer’s name provides a profile of the person, ratings of the usefulness of the person’s reviews, and a distribution of the person’s ratings. The distribution of ratings is interesting because it gets to a key concern physicians have about ratings: are they just posted by people with negative experiences?

The Yelp sort did an excellent job of ranking the ratings. The first review is by a person with multiple chronic illnesses who’s seen a specific doctor at the practice for 10 years and gave 5 stars. She had many specific things to report about her doctor and clearly had plenty of basis for her comments. Four people had rated the review helpful, and it showed that she had checked in twice on Yelp while at the practice (compared to none for the others).

The next two reviewers gave low ratings: 2 stars and 1 star. These reviewers have written more than 150 reviews each –awarding 4 or 5 stars in the vast majority of cases– so this is a helpful credibility builder for me.

The last 2 reviews –1 star each– are written by people with no Yelp friends and only a few reviews. The negative ratings are based on specific anecdotes and even though one has six “useful” votes it is still at the bottom, where I think it deserves to be.

Overall the reviews rung true to me based on my own experience.

MHQP is much more scientifically rigorous than the rest of the sites, and its data forms the basis for Consumer Reports’ recent report on physician quality in Massachusetts. Data on clinical quality comes from health plan data and patient experience is derived from a statewide survey. In patient experience there are 90 responses for the Washington Square Group. Results are also displayed as one to four stars, but here the stars have a statistical basis: e.g., 4 stars means an office did better than 85 percent of others in the survey, 1 star means it did worse than 85 percent of the offices. MHQP also enables a side-by-side comparison of different offices, which is a nifty feature.

Despite the harshness of some of the Yelp reviews of my practice the picture painted by the MHQP results are –if anything– worse. There are quite a few categories with 1 star (e.g., How well doctors give preventive care and advice) and few with 4. And yet 71 percent of the Washington Square Group’s respondents say they would “definitely” recommend their doctor and 19 percent say “probably.” Because of its statistical rigor the MHQP site is bereft of qualitative comments that could shed light on the findings, and results are reported at the level of the group rather than for individual physicians. And of course MHQP is only available in Massachusetts, although certain other states and regions have similar resources.

I looked at these websites when I picked my primary care physician. They didn’t have much influence on me then and wouldn’t today. In the end the number one issue was finding a specific physician I liked –and as mentioned there is essentially nothing documented on my doctor. Instead I relied on my previous doctor’s recommendation after eliminating a few other potential choices. Location was also important and I wanted someone within the Beth Israel system because I like the hospital and my records are on the PatientSite portal. I do have some concerns about the overall customer service of the practice and some of the low MHQP ratings, but figure if I watch out for myself that these things won’t affect me.

In an ideal world the rigor of MHQP ratings would be extended to the individual physician level –at least for certain measures– and to medical and surgical specialists. Physicians or practice manager would also have a way to reply to the ratings and reviews at least in a general way. If some of the Yelp approach could be applied to add texture to the data through user commentary then we’d really have something.

By David E. Williams of the Health Business Group.