Ross Mayfield's Weblog

A Real Healthy Choice

I had an opportunity to meet WSJ editor and Pulitzer Prize winner Daniel Henninger. We briefly talked about blogging, social editing and filtering; event participants may have as much to say or specific domain expertise that matters as much as the people on the podium. In today's editorial he makes the case for consumer-driven choice and supportive technology.

...Much of the talk was about explosions. Typically, "health-care costs are exploding." Employers fear they'll be buried in the rubble of health costs, now rising at some 15% annually. But other, brighter explosions are also in health's firmament--in genomics (perhaps allowing predictions about individual illness and therapies tailored to individuals); or in information technology (remote medical sensors, implanted monitors, Web-based health-care "wizards"). News arrives weekly of miracles springing from the minds of the U.S.'s remarkable medical scientists.

But here's the biggest explosion, yet to go off: Patient rage. Some analysts argue that corporations producing single-digit profits can't possibly cover double-digit health-cost inflation. So they are taking employee premiums higher for more or less flat coverage. Upwardly mobile premiums for dead-end coverage is a recipe for labor strife, and corporations everywhere are hitting this tripwire. The WSJ/World Congress meeting was about alternatives to turning over the entire bombed-out health-care cost landscape to the government (aka, rising premiums for static coverage)...

He highlights the technology available at my hospital:

All of the new plans provided tools that let employees access health information of a sort they'd never seen before. That included both Web-based programs and human "coaches" who give guidance on dealing with chronic aliments or complex medical problems. Dr. Paul Tang of the Palo Alto (Calif.) Medical Foundation gave an extensive tour of its Web-based program, PAMFOnline, to interact with doctors, renew prescriptions and track one's health care. Take my word; if you saw it, you'd want it.

As a consumer and a small business owner, its easy to see the virtue of choice for employees. Milton Friedman pointed out that third-party payment was an accident of WWII cost control that granted tax exemption for corporations. Employee health care needs are diverse and the lowest common denominator isn't a great thing to offer, so I prefer services like Administaff and Trinet that pool the risk of your company with others to get a volume discount on plans employees can choose. Others have written about how the cost of health care is a killer for startups in California, you have to strive to offer these kinds of benefits. Personally, I like making this investment and its one of the only progressive forms of compensation (you pay more for people who have a greater underlying need), offering choices for additional coverage is a premium, and a healthy workforce is a productive one.

There are a myriad of possible solutions to the health care crisis, and in its present form consumer choice is one of the virtues of the system, especially because the base level cost and of care is so low. It will be interesting to see the tradeoffs of choice and cost as the system evolves.

Health IT

The Health Care Industry is in dire condition. Health care premiums, where all costs converge, grew more than 6 times as fast as general inflation in 2003, and almost 8 times general inflation in 2002. Hillary Clinton pointed out we pay two to four times as much as other countries for health care, but the outcomes are not two to four times as good. HR executives see no way out of the current condition (even supposed economic recovery). Basically, we are due for a systemic catastrophe within 10 years.

How to cure it is stuck in the traditional arguements of market stimulus that would wastefully support the power-law: 1% of the population consumes or uses 30% of health care resources, 5% consumes or uses the majority, while 70% uses less than 10% of dollars and 20% of population consumes or uses no health care at all.

The one common theme I picked upon at the World Health Care Congress was that deploying new technologies is the single common ground for costs and care. Seventy-nine percent of polled leaders who attended the conference said IT was can improve the quality of care and contain costs, with IT as the number one priority. Health and Human Secretary Thompson said IT could save the industry $100 billion a year.

"Information technology has been tremendously underutilized by the health care industry in comparison to other sectors," observed Lewis Redd, Health Practice Leader of CGE&Y... "From improving clinical care, to enhancing the revenue cycle, to streamlining the supply chain, to increasing connectivity between providers and payers, information technology solutions are poised to help in the transformation of the U.S. health industry."

When the industry said IT, it mostly meant connecting eletronic medical records, where a standards effort is underway. If the privacy and policy issues can be navigated, web services could indeed help one of the most information intensive industries catch up.

IT does matter, not just to the health care industry, but the economy as a whole. Virginia Postrel points to the work of Catherine Mann, which suggests that offshoring software component production with local assembly and implementation could drive a wave of productivity growth:

By building the components for new integrated software systems inexpensively, offshore programmers could make information technology affordable to business sectors that haven't yet joined the productivity boom: small and medium-size businesses, health care and construction.

"Bringing those sectors up to at least the average will raise U.S. G.D.P. growth again," Dr. Mann notes. "And that's the second wave of productivity growth."

In addition to the economic benefits, she argues that improved information management could significantly improve health care, reducing paperwork and guarding against treatment mistakes like dangerous drug interactions.

That doesn't mean your health records will be in India, however. To the contrary, the health care system is probably too convoluted for someone far away to understand.

Rather, like hardware, software can be divided into components, basic building blocks of integrated systems. While those components may be developed abroad, integrating them into a useful system requires more specific knowledge of the client organization or its legal environment.

As with putting together hardware, building software systems is likely to happen locally. There will be less demand for basic programming and more demand for higher-value, higher-paid systems integration.

Health care seeks to automate to the level manufacturing industries have with the notable constraint of a premium on quality. Standardized and loosely coupled medical records may speed processing and inform good decisions, but quality comes from what Jerry calls MADA: Memory, Analysis, Discourse and Action. Conversations foster quality above transactions that move records. Especially in an industry that needs more conversation to survive.

UPDATE: I'm still learning about this industry, and received a good book recommendation for George Halvorson's Epidemic of Care. The author was the source of the resource distribution statistics in his speech.

Blogs Bubble Into Business

Great in-depth article in Computerworld on how enterprise weblogs are being adopted.

World Health Care Congress

I'm in DC in a hotel with a nice view of the J. Edgar Hoover building.

Facilitating a Socialtext Eventspace for the World Health Care Congress.

The World Health Care Congress is the first focused and inclusive conference to determine and to implement solutions for an improved U.S. health care system that focuses on the needs of the nation’s largest employers. The World Health Care Congress will convene the major constituencies in health care including leading health care purchasers, payers, providers, suppliers, analysts and governmental officials in order to determine actionable goals and feasible implementation strategies for a new healthcare model based on value, quality and consumer choice.

I'll be conference blogging from the Eventspace.

Socialtext in Mercury News

Dan Gillmor's Sunday collumn is on Wikis and Wikipedia, with a Socialtext mention. Read the whole thing.

One lesson is deceptively simple. When you remove the barriers to changing things, you also remove the barriers to fixing what's broken.

Syndicate

Yesterday Socialtext announced support for RSS, a Internet syndication standard.

Today AtomEnabled.org launched as a source of information about Atom, the emerging syndication standard. Which we will support too.

During RSS Winterfest, I heard two new things about Atom. Scott Johnson pointed out that it could help resolve metrics issues required for advertising in feeds. I asked Jeff Jarvis how his publication business would change with more user generated content (via Atom API). His view was that syndication standards create a new architecture for all content, especially when users generate it, which again creates new opportunities for targeting, but more importantly creates a greater dynamic.

RELATED: Blogger supports Atom.

RSS Wintefest Day Two

Participating in the second day of RSS Wintefest, this time moderating between sessions. So I'm blogging (with about 600 others) here.

RSS Winterfest Today and Tomorrow

RSS Winterfest, a free webcast on Internet syndication augmented by an Socialtext Eventspace (wikiblog in this case) starts at 8:30 PST today.

Startup CEO and HR

Susan Mernit points to an interview on Always On with Heidi Rozen and sugggests startup CEOs pay attention to this:

Q: "...What's the hardest lesson for a startup CEO to understand?

Answer: "Time and time again, it is the lesson of the true cost of the under-hire. The CEO fills a role out of desperation, or recruits a buddy who is not quite the right fit but will do for now, and then that person in turn takes the organization down the wrong paths, hires the wrong people, et cetera.... My advice to CEOs is to hire the very best, act as if your life depended on every person you bring on your team, and put a ton of cycles into finding, referencing, recruiting, and retaining those people."

Yes yes yes. You may have heard most of this before, but there are good old adages for startup hiring. Try to hire people better than you, always search, hire slow, fire quick and work with people that can wear many hats. You can't always find the right person for the job and for existing relationships, and only a culture of diversity and tolerance can overcome this fact. There are moments for hiring people you trust, but you can't forget to forsee their role and its consequences. First hires are the top of a pyramid, the bottom slowly grows over the years, founders may leave, but always hire employees that can also manage growing teams.

These are great things to learn, but you have to experience them. Its an unforgiving job that takes a great deal out of you and your relationships. You are only a first-time CEO once. Its fun, but inevitably painful the first time. Second (and so on) time is a charm. Getting to the been there, done that, lets you spend your energy on the more rewarding work.

UPDATED: Tim adds beware hiring down
RELATED: Why CEOs Fail, an 11 step program

State of the Onion

Went to a nice State of the Union house party with recovering wonks and enlightened tech types. A chorus of good criticism sure beats screaming at the TV at home.

Now, I used to be a speechwriter, so I try to put some of the politics of aside to listen to the rhetoric. Bush has settled into a good speaking style and there were some well written moments.

However, fear, social regression and economic deception make for bad content unless you have a predisposition to nod your head in agreement. Great speech to shore up support, a little reactionary, due to outrage the left, but effective for the right. The only thing holding the center is fear and deception.

Peel back the layers and you will find a domestic axis of evil: the war economy and attacks on civil liberties and civil rights simply stink.