Cavalcade of Risk #218

Where you headed?

Where you headed?

Welcome to the 218th running of the Cavalcade. Has it really been that many since InsureBlog’s Hank Stern started it up? Wow!

In case you’re wondering what Hank is up to these days, he’s participating in the American Cancer Society’s annual walk to raise money for research. You know the odds –the risks of getting cancer are too darn high. I’ve donated to Hank’s cause and you can do the same right here.

But with all that walking Hank still finds time for blogging. InsureBlog takes a New York Times blogger to task, explaining how risk transfer in insurance really works.

Creating innovative medical treatment and technologies is risky.  How does society motivate individuals to create these innovations?  Healthcare Economist reviews one proposal on the topic.

You may want to childproof your vacation. Kids can get in to trouble anywhere and at any time. At home, if you’re smart, you’re already covered. Overseas you need more help. Chatswood Moneyblog explains with a few examples.

Do you know how Experience Modification premiums are calculated for workers comp? Workers Comp Roundup helps us sort out gross payroll, losses, job classification codes and more to make it all add up.

On the Health Business Blog, I write about how even well informed patients who thought they did all their research can still get surprised by massive medical bills.

The next host will be Russell Hutchinson from Chatswood Moneyblog.

photo credit: kyz via photopin cc

By healthcare business consultant David E. Williams of the Health Business Group


Big party candidates and Globe don’t get it on tech

Evan Falchuk (I), candidate for Governor of Massachusetts

Evan Falchuk (I), candidate for Governor of Massachusetts

Jeff McCormick (I), candidate for Governor of Massachusetts

Jeff McCormick (I), candidate for Governor of Massachusetts

The Boston Globe (No innovative sparks as Baker, Coakley address tech audience) has a harsh take on the performance of Martha Coakley and Charlie Baker at an innovation policy forum:

Baker and Coakley each often spoke in generalities, sidestepped questions about employee noncompete agreements — a major hot-button issue in the tech sector — and left attendees craving substance.

“It was terrible,” said Axel Scherer, a software architect at Cadence Design Systems in Chelmsford. “They said nothing. Just empty suits going, ‘blah, blah, blah.’ ”

Right from the start of the article, I was thinking, Why is this a surprise? And I bet the United Independent Party’s Evan Falchuk and independent candidate Jeff McCormick did a lot better. Sure enough, buried in the very final paragraph is the rest of the commentary from Scherer:

Most of the crowd left after Coakley and Baker’s remarks. But Scherer stayed to hear the two independents running for governor and came away impressed by both Jeff McCormick and Evan Falchuk’s ability to converse on the issues.

(In the comments section of the Globe story online you’ll see that Scherer was taken by Falchuk and wonders why McCormick and Falchuk had to go last.)

But the Globe reports exactly nothing of the actual substance of their remarks. Why not? They both gathered enough signatures to make it onto the ballot, and Falchuk needs just 3% of the vote in the general election to establish the new party, enabling it to place candidates up and down in the ballot in future elections.

The Globe partially redeems itself in an article about a debate later on in Springfield, which also included Baker and Coakley. It included this line:

Evan Falchuk pitched himself as a truth teller, willing to speak bluntly about everything from state finances to casino politics.

I honestly don’t understand why the Globe is focused only on the Democratic and Republican nominees.  The Globe and others blew it in the primary election by running story after story about Coakley’s huge lead in the polls. Remember that the Globe reported its final poll of Coakley 47%, Grossman 25%, Berwick 13%.

In the end, it was much closer: 42%, 36%, 21%. Or as the Globe reported, “far less than polls and party leaders had predicted.” And who knows, the Globe may have thrown the election to Coakley by making Grossman and Berwick voters think there was no chance for their candidates. As a voter in the Democratic primary, that’s how I felt.

Falchuk and McCormick are not fringe candidates. (Scott Lively is, which is why I ignore him.) The majority of Massachusetts voters are not enrolled in either major party. And as the innovation policy forum made clear, the “major” candidates, left to their own devices, will steer away from the tough issues.

At a minimum it’s good for democracy to cover all of the serious candidates so the voters can learn what they have to say. And even those voters who think that the independents don’t have a chance to win in November should consider voting for Falchuk in order to establish a permanent, moderate independent party in the Commonwealth.

By healthcare business consultant David E. Williams of the Health Business Group

Health Wonk Review is up at Healthcare Lighthouse

Check out the latest Health Wonk Review blog carnival at Healthcare Lighthouse. This is the TGIR (Thank God It’s Recess) edition when all the health wonks get to ease up a bit with Congress out of session and take a longer term view.

Nonetheless you’ll see some intense posts on health policy.

Watch your back! Surprise medical bills may await

Show me where it hurts

Show me where it hurts


Dr. Richard Amerling, president of the Association of American Physicians and Surgeons, writing from New York, had this to say in yesterday’s Wall Street Journal:

A patient recently asked, “What would happen if there was no health insurance?” I responded, “The prices for all medical goods and services would immediately plummet.”

I would direct his attention to Sunday’s New York Times (After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know), which presents a much more realistic view of what goes on in New York City and around the country. To wit:

  • A patient had a neck surgery he may or may not have needed. (There are 2x-5x as many spine surgeries in the US as elsewhere in the rich world. The multiples are particularly high in places where surgeons like to live)
  • The orthopedist charged $133,000 but was reimbursed (and willingly accepted) $6,200. That’s on top of $60,000 or so in other charges from the hospital and anesthesiologist
  • An out-of-network “assistant surgeon,” probably not needed, billed an additional $117,000, which the insurance company ended up paying in full. The orthopedist says he didn’t take a cut of the assistant’s fee. Whether it’s true in this case or not, it happens

So what does this tell us?

  • That the information Dr. Amerling provided to his patient is naive at best
  • That insurance companies need to find better ways to contain costs or that regulators need to change the rules to allow them to do so
  • That patients need to be more skeptical of recommendations for surgery (especially spinal surgery)
  • That a single payer system, for all its faults, looks superior to the current state of affairs

There are benefits managers like MedSolutions that help insurance companies and employers deal with this sort of nonsense. At the very least this news should be good for their business.

photo credit: Darcie via photopin cc

By healthcare business consultant David E. Williams of the Health Business Group

Apple Health App: A first taste

Blood alcohol might be of interest to hackers

Blood alcohol might be of interest to hackers

Nothing for now, but it's coming

Nothing for now, but it’s coming

I was brave (or stupid enough) to download iOS8 on my iPhone 5 early yesterday morning at Boston’s Logan Airport. Luckily the update completed before I had to get on the plane. It was neat to see a Health icon pop up on the home screen, and I had a chance to give it a quick look. There wasn’t all that much I could do with it for now, beyond entering some basic data like height and weight, but it’s an intuitive app that fits in with the rest of Apple’s iOS offerings. We’ll have to wait for 3rd party apps to hook into Health through HealthKit, which will take awhile. And the Apple Watch isn’t out yet either.

I think Health is going to lead the market, but not dominate. Here’s my logic:

  • Like other Apple innovations –think iPod and iPad– decent products already existed in those categories and were starting to get some traction. I had mp3 players and a tablet computer years before, but Apple did a better job of packaging everything up and taking usability to the next level. For me, the iTunes store differentiated the iPod and the long battery life made iPad worth ponying up for. In this case Apple is entering a market that others have already been prospecting in. Some of those others –like Fitbit– have taken a lesson from Apple and tried to make elegant products that won’t be so easily pushed out of the way by Apple mania
  • The soon-to-be-introduced Apple Watch should work very smoothly with the iPhone or iPad. I’m planning to get one when it arrives, and I’m holding out hope for a high quality heart rate monitor as part of the package. This is the type of product that should evolve quickly, with new sensors and improved performance, but it will take some getting used to before I start trading in my watch every year or two and charging it up every night
  • Despite the recent dustup over iCloud accounts being hacked, I do trust Apple with my personal data more than I trust competitors like Google.  Apple’s business model allows it to make money by selling products and services to consumers without resorting to data mining. Apple seems to be going out of its way on the Health side to emphasize its trustworthiness. That’s a selling point competitors will have trouble matching –because data mining is the business model. More consumers are going to care about this as things move along
  • One reason use of personal health data technology has been so low is that while younger people are open to it they are generally healthy and don’t need to deal with their records nearly as much. But it’s been seven years since Microsoft’s HealthVault was introduced –and those same tech-embracing folks are getting older. Also, there’s been a remarkable change in the level of use of smartphones in the past few years. They’ve gone from non-existent to ubiquitous, so Apple doesn’t need to convince people to bring another device along. The passive collection of data through sensors also makes a huge difference in ease of use and accuracy of the information. (See Health tracking apps: Not yet ready to make a big impact)
  • Apple’s move is going to bring a lot of app developers into the market and we’ll see some pretty clever uses for Health before long. That will include general purpose apps and those for folks with specialized needs, like those who need to track specific parameters for a chronic illness

Makers of health apps and tools will all need to look to Apple Health to figure out how they fit in. The opportunities for data suppliers and vendors serving doctors and hospitals are there, too, but it will take at least a couple years to sort out the most promising approaches.

I look forward to going along for the ride.

By healthcare business consultant David E. Williams of the Health Business Group

Take a deep breath: Marijuana product placement is on the way

Coming soon

Coming soon

Paid product placements for cigarettes are back on the big screen. The tobacco industry agreed in 1998 not to pay for product placement in movies. But electronic cigarettes weren’t around then and aren’t included in the ban. Some brands are now pushing the envelope, according to the Wall Street Journal:

Throughout the movie [Cymbeline], actress Milla Jovovich puffs away on an e-cigarette called a SmokeStik. In one scene, signs for the brand hang in a convenience store next to condoms and calling cards.

The product’s cameo appearance comes courtesy of Canada-based SmokeStik International Inc.—in just the kind of paid-product placement that has been off-limits to traditional tobacco companies in Hollywood for nearly two decades.

The cynicism of the cigarette (or nicotine) business is on full display:

“I don’t see a problem with glamorizing something that saves lives,” says SmokeStik’s chief executive, Bill Marangos. Like others in his business, he considers e-cigarettes to be a less-harmful alternative to traditional smokes…

Mr. Marangos wouldn’t say how much the company paid for the placements, but he does allow: “They know we pay well.”

This got me thinking, how long until we see paid product placement for recreational marijuana brands? The weed is now legal for recreational use in Colorado and Washington, and it seems a wave is building that will lead to legalization in other states and perhaps nationally. I think it’s a really bad idea for public health, but the tide is moving against me.

Once the business goes mainstream, I expect to see the development of national brands and the pursuit of a vigorous marketing push via whatever means are not declared illegal. Product placement in movies will be a no brainer to get some buzz for the brand and the film. And as with any sort of drug dealing, it’s a lucrative business that can pony up the cash.

It’s quite possible that we’ll see marijuana “edibles” promoted in films rather than smokes. Ironically that could take us back to the early days of product placement in the movies, to the famous Reese’s Pieces placement in ET. Candies for kids once again.

I hope we don’t see dope promoted with paid product placement, but I think we will.

photo credit: Cannabis Culture via photopin cc

By healthcare business consultant David E. Williams of the Health Business Group