It’s Not About The Box Improving Care at Group Health with People, Process and Technology

March 26, 2010

EBM triumphs

Filed under: Policy — Matt Handley @ 10:27 am

Thanks to Kathy Brown, Director of GHC Pharmacy for sending along this information:

Today Kaiser Permanente won a lawsuit they brought against the maker of Neurontin (gabapentin).  This is the result of a long standing case that Kaiser had against Pfizer for their pattern of off label marketing of Neurontin…approved in 1994 for add-on tx of partial seizures….it bloomed into $10Billion drug mostly for the off-label use for migraines, bipolar and pain management.
The pattern of off-label marketing was company strategy including ghost written articles, suppression of negative studies and millions spent in getting physicians to prescribe neurontin for migraine, pain and bipolar disease.      Of note, of the many company documents and emails introduced as evidence, there was an email about Group Health and a residency project to reduce the use of neurontin based on the lack of evidence of efficacy–the email stated that “all we need is for Group Health to present data at AMCP to induce a snow ball effect”  Indeed, GH was amongst the first to look at limiting use of this drug for lack of evidence (something to be proud of!).

…and part of the closing arguments:  “The premise of evidence-based medicine is that there is a complete, accurate, and truthful scientific base to it.  Dr. Dickersin wrote in the New England Journal of Medicine, she said that “Selective outcome reporting,” cherry-picking the results, “threatens the validity of the evidence.” The heart of evidence-based medicine is the evidence, but the soul of evidence-based medicine, the soul is the validity of that evidence. And when the validity of the evidence is corrupted by lies and misrepresentations, as was done in this case, then physicians can no longer trust and rely on the validity of the evidence. If your verdict is a verdict you return for the defendants in this case, it will embolden them to continue market-based medicine. And if market-based medicine continues, physicians won’t be able to trust and rely on the validity of the evidence, and evidence-based medicine, as we’ve come to know it today, will die. But if you return a verdict for Kaiser, your verdict will be for evidence based medicine.”

Jury verdict under federal RICO and California’s Unfair Competition Law:  $47 million, which will be automatically trebled — $141 million.

March 23, 2010

A personal note from Atul Gwande

Filed under: Policy — Matt Handley @ 10:32 am

Just had to share Atul Gwande’s post on the New Yorker blog about the reform bill.  Love that he brought his kid.  I admit that a favorite moment for me was touring the capitol with my daughter Kate last year.  Especially nice to remember that Congress can do right (although we all wish for more consistent execution)

Gwande’s post

March 4, 2010

How important is cost?

Filed under: Uncategorized — Matt Handley @ 7:57 am

Right now Paul Grundy MD, who works for IBM, is relating a discussion that he recently had with the CEO of one of the top hospitals in America.  that hospital is focused on bringing on more procedures for the population they serve.  And that led to the frank discussion that IBM will not relocate employees to that are.  think about that.  For employers, the largest growth in expenses is their employee health benefits.  Big enough that they the efficiency/value of care in a community is a major issue considered in where to locate a business.  The hospital CEO wasn’t able to hear the message yet.  And each of us as patinets needs to think this one through.

Great cartoon to illustrate:

fire cartoon

Alliance of Community Health Plans – the Good Guys

Filed under: Uncategorized — Matt Handley @ 5:38 am

I am sitting in the ACHP medical directors meeting in Philly.  ACHP are the “good guys, and it is great toaddress issues with like minded leaders.  I really like how ACHP frames the work.  The Triple Aim (health of populations, great patient experience and affordability) is not enough – they have added an important one.

Quadruple Aim:  Focused on health of populations, optimal patient experience (outcomes, quality, satisfaction), affordability, and community benefit.

Each of the member organizations are community based, cultivate strong provider relationships with aligned incentives and are not for profit.  And they include many of the top performing groups in the country.  We are all facing the same challenges, and it is great to share ideas about how to increase our ability to innovate and adopt innovations.  Brenda Bruns and I will be sharing some of the great work from GHC over the next two days.

As I participate with this group for the next two days – with reform a part of every conversation – I will be thinking of the quote attributed to Bobby Kennedy  “If not us, who?  If not now, when?”.

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