Wellpoint, the largest health insurer in the country, has established a Member Health Index (MHI). A Wellpoint press release explains that

WellPoint’s MHI is comprised of 20 clinical areas that reflect the quality of care an individual has received – some developed using national standards and others developed by WellPoint’s clinical experts. These measures focus on prevention and screening, care management, clinical outcomes and patient safety. Together, the measures will be combined in a proprietary statistical model to determine the quality of health care the company’s members receive year after year. For example, for members who have diabetes, the index will help to measure if they are getting necessary eye exams, maintaining their blood sugar level to reduce complications and having their blood pressure level controlled. For children, the index will measure if they received their immunizations. WellPoint will be able to analyze the data in many different sub-populations, including Medicare beneficiaries, Medicaid members and large national employer groups, in order to target improvement efforts.

Wellpoint has announced plans to tie a portion of its employee incentive compensation to improvements in the MHI. According to Wellpoint, “linking progress to incentives represents an effort to ensure that all associates are fully engaged and focused on improving the lives of the people WellPoint serves and the health of its communities.” Yes, indeed.

CMS has announced that HIPAA covered entities, such as FEHB plans, may create HIPAA National Provider Identifier (NPI) contingency plans as long as they are reasonably and diligently working toward NPI compliance and in the case of health plans are facilitating the compliance of their trading partners. The guidance, however, does explain whether Medicare on May 23, 2007, the NPI compliance date, will be implementing a contingency plan or rejecting non-compliant claims, e.g,, claims that are missing the NPI.

Here is an excerpt from the CMS press release:

CMS CLARIFIES GUIDELINES FOR NATIONAL PROVIDER IDENTIFIER (NPI) DEADLINE IMPLEMENTATION — April 2, 2007

Today, the Centers for Medicare & Medicaid Services (CMS) announced that it is implementing a contingency plan for covered entities (other than small health plans) who will not meet the May 23, 2007, deadline for compliance with the National Provider Identifier (NPI) regulations under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The final rule establishing the NPI as the standard unique health provider identifier for health care providers was published in 2004 and requires all covered entities to be in compliance with its provisions by May 23, 2007, except for small health plans, which must be in compliance by May 23, 2008.

The enforcement guidance released today clarifies that covered entities that have been making a good faith effort to comply with the NPI provisions may, for up to 12 months, implement contingency plans that could include accepting legacy provider numbers on HIPAA transactions in order to maintain operations and cash flows.” said CMS Acting Administrator Leslie V. Norwalk, Esq. Emphasis added.

America’s Health Insurance Plans yesterday issued a census report finding that “4.5 million Americans are covered by lower-premium, high-deductible health insurance plans that are offered in conjunction with health savings accounts (HSAs), a 43 percent increase since last year. * * * Previous censuses found 3.2 million enrolled in January 2006 and 1.0 million enrolled in March 2005.”

Modern Healthcare.com reports that one of the two consumer representatives on the 23 member HITSP board of directors has resigned. HITSP is the ANSI panel responsible for establishing health information technology standards under an HHS contract. “The resignation, though not in protest, comes with Rein adding her voice to those of several others recently who criticized federal efforts to promote healthcare information technology without first firmly establishing a foundation of a national healthcare privacy policy.” However, the report also notes that the resigning HITSP director Alison Rein remains a member of the AHIC privacy workgroup and of the State Alliance for e-Health.

I was an early user of Steve Case’s America Online (although I since have dropped the service) and I have read and written a lot about personal health records. (Former President Bill Clinton and former Speaker Newt Gingrich both expressed support for electronic health records yesterday). So when I discovered that Steve Case’s Revolution Health is offering free membership through the end of the year, I decided to give it a try.

I enrolled by providing my demographic information, e.g., date of birth gender, but no credit card information. I then was brought to my Revolution Health home page. It was very pink and it had quotes from “my circle” members. The quotes were all from women in their childbearing years talking about pregancy, breastfeeding, and fertility issues. It turns out that I was not assigned to a circle and these were sample quotes, but having given my age and gender, I did expected Revolution Health to place me a sample old white guys circle. I know that Amazon.com knows my preferences so it could have been done. It was a turn off, but I pressed on.

I started to build my own PHR. I learned couple things. It’s a time consuming process, and I would not be surprised if people quit in the middle and don’t go back to it. Updating it is another issue entirely. I will have to update mine because if I don’t actively use my account, Revolution Health will terminate my free membership.

I expect that health plan sponsored PHRs pre-populate the record with data that I had to fill in on the Revolution Health PHR. But I still expect that the process would take some time.

I also learned that building a PHR is a thought provoking, particularly if you don’t think often about such matters (denial being one of my personal strong suits). I was not surprised when after inputting my height and weight, my PHR told me that I am “obese”, but I don’t appreciate it either as I am an American. (Aside – I read an article today about how Gary Player, the 71 year old golfer, who has a rock hard gut does 100 crunches per day. Wow.) I also noticed that the Revolution Health PHR does not collect particularly detailed information. For example, while it asks you to identify the medications that you take, it does not ask for the pill size.

An added feature of membership is a downloadable program called SimoHealth that helps you track your medical expenses. I gave that a whirl and I can see its advantages if your family has a lot of medical bills. Intuit, the maker of Quicken, offers a similar program, Medical Expense Manager. Insurers can offer customized versions of these programs to their members.

Here are some other features of Revolution Health that I may check out later:

• Rate your doctor and see what others have to say about theirs.
• Start a 6-week healthy living program to help you achieve your health objectives, from managing your weight to lowering your cholesterol.
• Sign up for the Vital Juice newsletter and be in-the-know about the most cutting-edge health trends, advice and news.

I don’t plan to fax my medical records to Steve Case so he can upload them for me in the site’s Personal Health Records Express. I’ll bet that a lot the same stuff is available at WebMD but I’ll continue to check this out while it’s free.

According to today’s Kaiser Daily Health Report , CQ Healthbeat (Carey 3/28) is reporting that while health information technology legislation has broad support, Congressional aides have said that such legislation may be pushed aside in 2007 in favor of SCHIP reauthorization and Medicare physician reimbursement levels. Of course, Congress came close to passing HIT legislation last year, but the bills principally would have enshrined in law the existing HIT bureaucracy. Although providers cite implementation and maintenance costs as a significant barrier to health information technology use, the bills would not have resolved that problem.

On Wednesday, a House small business subcommittee held a hearing on the cost issue yesterday as it impacts small and solo medical practices. The subcommittee chairman plans to introduce a bill to provide tax incentives, subsidized loans and grants to small provider. Meanwhile, the American Health Information Community’s quality workgroup considered an AHRQ report suggesting the electronic medical records may produce cost savings by dramatically increasing the efficiency of collecting health care quality data.

As you know from the FEHBlog, the U.S. Department of Health and Human Services offers health care consumers, whether or not Medicare eligible, a helpful online Hospital Compare tool. The Washington Post reports today that

[A] national survey of 500 randomly selected Medicare patients by researchers at Dartmouth Medical School has found that nearly one-third of those who underwent major non-emergency surgery reported that their doctor had been the sole decision-maker about which hospital to choose. That number was greater than the 27 percent who said that they or their families had made the decision. The remaining 42 percent said they had decided along with their doctor.The study, which appears in the March issue of the Archives of Surgery and was funded by the federal Agency for Healthcare Research and Quality, is believed to be the first to analyze the role of patients in making such a decision.

Iit’s hardly surprising that the doctor plays a key role in selecting the hospital in non-emergency cases because a patient is limited to those hospitals where his or her doctor has admitting privileges. (Or they can switch doctors.)

Many years ago, I had a sinus surgery, and my doctor had admitting privileges at two hospitals in DC. I checked with nurses about the reputation of the two hospitals which made my choice easy. Perhaps today, I would use a tool like Hospital Compare or Health Grades and ask my medical friends (since then I have gotten to know a few doctors too).

This approach to health care quality was given a boost by the President’s August 22, 2006 Executive Order. Health plans often provide this service to their members, and Steve Case’s new company Revolution Health is offering the service for a fee.

UPI reports from the American College of Cardiologists meeting that

In the blockbuster COURAGE Trial, doctors at the 56th annual scientific sessions of the American College of Cardiology said that the $38,000 angioplasty-plus-stent heart surgery — now done a million times a year in the United States with the goal of freeing patients from chest pain — did not, in the long run, even result in less pain.
“There are hundreds of thousands of Americans who are currently getting stents placed who do not need it as initial therapy,” Dr. Raymond Gibbons, professor of medicine at the Mayo Medical School in Rochester, Minn., and president of the American Heart Association, told United Press International. Thomas Ryan, senior consultant and emeritus chief of cardiology at Boston University, agreed. “This study shows that, if you treat people vigorously and coach them and they get their blood pressure under control, patients can do just as well on medical therapy,” he told UPI. But, he cautioned, “They can’t just take a pill. This is hard work. They have to get out and exercise. They have to get maximum doses of lipid lowering drugs,” he said.

It will be interesting to see how quickly the medical community reacts to this study.

HHS Secretary Mike Leavitt announced today a new Personalized Health Care Initiative designed to achieve gene based medical care combined with health information technology. The initiative has the following goals:

* Establish a secured electronic system to exchange, aggregate and analyze key data from a large number of existing secure health care databases;
* Support the science and health information technology base and enable it to expand;
* Support efficient and effective drug development partnerships between public and private sector leadership, and
* Help integrate the Personalized Health Care into the mainstream of clinical practice.

At the 2007 FEHBP carrier conference held earlier this month, Medco’s CEO David Snow spoke about the promised by gene-based medicine. He explained for example that the human genome project is facilitating the development of markers that will enable doctors to tell whether a particular drug will be effective for a patient and if so what would be the appropriate dosage. He noted that the use of these markers which is growing will improve the efficiency of the our health care system. Similarly, the Washington Post reports today that saliva based screens based on genetic codes may be used to routinely diagnose and monitor illness within five years.

The Blue Cross and Blue Shield Association recently released to the public its illuminating annual medical cost reference guide. According to the Association’s press release,

• Healthcare expenditures in the U.S. represent a greater percentage of Gross Domestic Product than in any other country. At 2.2 trillion, or 16.5 percent of Gross Domestic Product, the 2006 U.S. National Health Expenditures dwarf other major sectors of the economy – and they are projected to represent as much as 20 percent of Gross Domestic Product by 2015.
• The government – primarily through public programs such as Medicare and Medicaid – continues to be the largest payer for healthcare, bearing almost half of the total costs. Private health insurance accounts for a little more than one-third of the total.
• The majority of the U.S. population, 68.6 percent, is covered by private health insurance. Of the U.S. population, 59.5 percent are covered by employer-based private insurance and 9.1 percent are covered by direct-purchase private insurance.
• The U.S. healthcare system continues its transformation to focus more on the wants and needs of consumers and consumers are responding. For example, eight in ten Internet users go online for health information. More than half of consumers who use the Internet have utilized features from their health insurer’s online Web site.

Check it out!