Thursday, August 2, 2007

Following Intel's CEO

What follows is a compendium of postings from my other sites concerning Intel's visionary CEO. This observer heard his September 2006 address and thought his remarks put our health care delivery crisis in the right context. Enclosed as well are subsequent postings and links.

Barrett, September, 2006

On September 26 at 8:30 am, Intel CEO Craig Barrett spoke at the eHealth Initiative Health Information Technology Summit. He preceded Secretary of HHS Michael Leavitt.

He prefaced his remarks by emphasizing both his support for the political process but also his frustration with the pace of change and leadership "around the margins." He mentioned in a positive sense his participation in the American Health Information Community.

But Barrett's words were strong and, in the view of this observer, dead on.

Among his comments:

  • U.S. jobs will continue to move offshore at a rapid pace unless corporate America exerts its power to force the health care industry to adopt systems that will cut costs and improve efficiency. "Every job that can be moved out of the United States will be moved out ... Because of health care costs," which on the average were in excess of $6,300 per person in 2004.
  • "The system is out of control, it's unstable, it's basically bankrupt, it gets worse each year and all we do is tinker around the edges when what we need are major fixes"
  • Asking "who should pay for it" is the wrong question. No one can pay for it.
    Even if one makes a massive, one-time change in the chronic care disease management, unless the trend is toward continual improvement, the costs will inexorably climb.
  • "Every other industry has adopted this technology and (the health care) industry continues to sit here and debate"
  • Why does the health care industry expect subsidies to pay for health care technology? Every other industry makes these investments as a matter of survivability?
  • Employers should demand that hospitals select standardized record systems to lower costs or take their company's business elsewhere
  • Companies should only do business with health care providers who meet certain standards, including fully electronic patient records and published "best practices" for patient treatment
  • Price transparency is critical to employer and consumer engagement. How many other industries can't tell you what a service will cost or explain their charges in a simple way?
  • Hospital networks could and should be transformed into "competitive centers for excellence" that are paid to keep employees healthy.

Wal-Mart Stores Inc. Executive VP Linda Dillman joined Barrett on the stage and spoke of Wal-Mart's costs as an employer and their innovative approach to providing health care in pilot settings.

  • Barrett said the health care industry could learn from the efficiency of Wal-Mart.
  • He claimed Wal-Mart was an information technology company that sells what it tracks and excels by its ability to employ IT in conjunction with effective business models and great customer service

Barrett (November, 2006)

In a September 29 posting to this site, this writer quoted from a presentation given by the CEO of Intel to the eHealth Initiative meeting. Warning of the crisis in health care delivery, he assured the public that large employers will take action.

In a November 29 article in the Wall Street Journal by Gary McWilliams, Barret's "jolt to the health care system" is describe in greater detail. mcWilliams states that in the coming week, Intel, Wal-Mart, British Petroleum, and others will disclose a plan to provide digital health records to their employees "and store them in a multimillion-dollar-data warehouse" linking hospitals, doctors, and pharmacies. (This writer believes the actual technology will be an exchange with strong privacy protections and not a giant data warehouse; a clarification will assuage public concern).

Craig R. Barrett, Intel's chairman, calls this effort part of a "building-block to modify the U.S. health industry" and he doubts that "the industry is capable of modifying itself."

The costs projected for the project seem low; the article claims a contribution of 1.5 million each from 10 employers. The model appears to let "consumers and insurers...evaluate price and performance data from millions of employees." Eliminating duplicate tests and erroneous or lost information would also slash administrative overhead, accounting, according to the article, for up to 40% of medical costs. An appeal to reduction of adverse drug events is also made.

Functionality includes an ability for doctors to "measure which treatments worked best for chronically ill groups of patients" and the ability to prescribe electronically.

The article raises some points that will draw concern. Quoting:

"Coalition members believe that giving consumers control over their own records would help get around the technical and cost issues. But the idea of portable medical records and a massive repository still faces hurdles. Privacy advocates worry that digital records will be misused by employers and insurers to deny jobs or health-care coverage. The watchdog group Patient Privacy Rights Foundation urges employees to shun the approach until there are adequate protections. 'The system is leaking information,' says Chairwoman Deborah C. Peel, a practicing psychiatrist. 'Once out there, it's like a Paris Hilton sex video. It's [there] for the millennium.' "

Other features:

  • The employers will insist that health-care providers adopt electronic records and prescribing as a condition of future business.
  • Wal-Mart will apply its purchasing power to get bar codes on products intended for hospitals and clinics.
  • Employers will expect employees to pick doctors willing to use and update their records, though employee compliance is voluntary.
  • The "records will be the property of the employees, and the data will be mined by insurers and others only after the patients' identity is stripped off."

Linda Dillman, who was on the stage with Barrett at the eHealth Initiative meeting in September, states that they are "trying to bring all the right people to the table and show them what can be done."

The article also elaborates on some sobering costs, claiming that "Intel figures its health-care spending will be as much as a fifth of its research and development costs by 2009. Wal-Mart says the costs for its 1.3 million U.S. employees, if unchecked, will climb $1 billion annually for the next five years."

The final feature - patient "ownership" will be an interesting driver. Quoting from the article:

The Intel-Wal-Mart plan to offer employees medical records and automatically update those records with hospital, doctor and pharmacy detail "is very ambitious," says Dr. Greenfield, an adviser to Care Focused Procurement LLC., a nonprofit putting together an HMO claims database. "We love the patient as the agent."
"It has always seemed unusual to me that the medical record is seen as the property of the medical system," adds Donald Berwick, chief executive of the Institute for Health Care Improvement, Cambridge, Mass. Tests are duplicated and information lost in the handoff between physicians or clinics. "The best integrator in the end is the patient," Dr. Berwick says.

One expects reaction to be rather diffuse until more clarification is obtained. The "disruptive" element of this plan is note employer drive for digital health as much as, this writer suggests, it will lead to alternative care delivery models. Something that our Nation dearly needs.

Follow-up stories and links

Barrett (July 2007)


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