U.S. Health Care Policy

June 14, 2011

Palantir Technologies in Health

Filed under: health 2.0 — ushealthcarepolicyatgmaildotcom @ 10:59 pm

Three years ago a friend introduced me to Palantir Technologies, which heavily recruited software engineers and system administrators for their bread and butter finance product. They have since expanded into the nonprofit and health industries. Today at the 10th Girl Geek Dinner, Palantir Technologies showcased a product that links missing children, registered sex offenders, reported runaways, witness sightings, demographics, and geospatial databases for the National Center for Missing & Exploited Children (NCMEC).

Chitra Ragavan, advisor to Palantir Technologies, brought to the attention of CEO Alex Carp an opportunity to expand into non-profit space. Based on Chitra’s investigative report on missing children, “Lost and Found” in the U.S. News and World Report, she advocated for starting with NCMEC. In a DC conference, Linda M. Krieg, currently the NCMEC Assistant Executive Vice President of Operations soon to be Chief of Operations by the end of the year, made a hard sell to Palantir. Without hesitation, Palantir very much wanted to contribute to NCMEC. The sell was mutual.

NCMEC measures itself by the number of cases it solves. With mounting missing children cases, they needed all databases to talk to each other and narrow down leads. Analysts spend much of their time manipulating data by merging and querying databases through MySQL, Access, Excel, SAS, and other database manipulation programs. And for several government entities, a matter of piecing together faxes. Palantir leaps forward with an intuitive UI that can take in voluminous data and crunch it within milliseconds. When AMBER Alerts go out, witness reports and sightings are taken as text reports. A smart highlight of keywords are used to query relevant databases. For example, partial license plate descriptions can be used to filter automobiles registered to known delinquent sex offender parolees. The list can be further narrowed down by the height, hair color, and other appearances or notable blemishes that characterize the suspect. Analysts spend less time constructing a query and more time analyzing the output provided by Palantir.

Later that evening I had the pleasure to speak with Melody Hildebrandt, who leads Palantir’s 3-person health group. Without much success responding to government request for proposals, Palantir directly approaches government clients that champion technology, such as Todd Park, HHS CTO. Todd’s campaign for Open Government has lead to the Health Data Initiative Forum, which Palantir presented with their CDC data visualization UI.

They also teamed up with the Center for Medicare & Medicaid Services to link Medicare expenditures with hospital quality and provider location. This is helpful in analyzing geographical variation in provider practice patterns driven by the risk mix of the patient population and their level of access to necessary and appropriate health care services.

Palantir is also going after electronic health records to help analysts interpret interesting historical patient and medical relationships that usually get brushed aside due to time constraints. Palantir puts in the muscle work in performing real-time data manipulation and output. Data manipulations is no longer an analyst’s arch nemesis for time. They can now mark off their wish list of issues to explore.

On a side note for business pricing strategy, Palantir bills by CPU core, as a function of data volume and query complexity. It is not clear how much development costs (fixed FTE developer salaries) and capital overhead affect their bottom line. Palantir has the incentive to have a well-defined product that prevents scope creep. The more tailored the product is up front, the easier it is to prove product effectiveness. Palantir has incredible confidence in the quality of their products, and it shows based on receptive clients and partnerships. This sells itself to the client to further trigger additional features driven by crunching more data. This financial model keeps giving and feeding itself. Brilliant business pricing to compete with large consulting firms that rely on hourly or fixed budget fees.


June 13, 2011

Vicious Cycle

Filed under: health care pop culture, health care rant — ushealthcarepolicyatgmaildotcom @ 4:27 pm

The Dalai Lama, when asked what surprised him most about humanity, said:

“Man. Because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.”

Cannot verify if Dalai Lama was quoted on this from a speech or book. For its truth that hits close to our hearts, this quote spread like wildfire on the internet.

August 17, 2010

Health Innovation Week in San Francisco, Fall 2010

Filed under: events, health 2.0, professional development — Tags: , , , , , — ushealthcarepolicyatgmaildotcom @ 1:57 pm

Health Innovation Week Banner

A dizzying array of events are occurring in the first annual Health Innovation Week in San Francisco from October 3-10, 2010. I have my eye on the Health 2.0 First Developer Code-A-Thon on September 11th followed by a showcase of the winners and select challengers at the 4th Annual Health 2.0 Conference on October 7th through the 8th. The other events slant towards electronic health records (EHR), health information exchange (HIE) and other health information technology (HIT) topics. In addition, participants can take exams to become a Certified Professional in Electronic Health Records (CPEHR), Certified Professional in Health Information Technology (CPHIT), and Certified Professional in Health Information Exchange (CPHIE).

2010 Health Innovation Week in San Francisco

October 2-3, 2010
Health 2.0 Developer Challenge
, Venue TBD

October 3, 2010
CSCS Professional Certification Training
, Grand Hyatt

October 3 – 6, 2010
Regional Extension Center (REC) & Health Information Exchange (HIE) Summit West
, Grand Hyatt
Electronic Health Records (EHR) Summit West
, Grand Hyatt
Fourth HIPAA Summit West
, Grand Hyatt

October 4, 2010
Bay Area Healthcare Breakfast Club
, Grand Hyatt
HIPAA Academy CHA, CHP and CHSS Professional Certification Training
, Grand Hyatt

October 5, 2010
Davis Wright Tremaine Breakfast
, Grand Hyatt

October 6, 2010
Disruptive Women in Healthcare Breakfast
, Grand Hyatt
, Sidney R. Garfield Health Care Innovation Center, Oakland, CA

October 6-8, 2010
Health IT Certification CPEHR, CPHIT and CPHIE Professional Certification Training
, Grand Hyatt

October 7 – 8, 2010
Health 2.0
, Hilton Union Square

October 8, 2010
BodyShock The Future Contest Reception
, The Institute for the Future, 124 University Ave, Palo Alto, CA

October 9-10, 2010
Personalized Life Extension 2010
, Airport Marriott, CA

July 22, 2010

EVENT: Federal or State health care policy making 101

Filed under: events — Tags: , , , — ushealthcarepolicyatgmaildotcom @ 2:18 pm

AcademyHealth is hosting their 2nd annual, three-and-a-half day “Health Policy Orientation” event from October 25th through the 28th at the Kaiser Family Foundation in Washington D.C.

The event starts by reflecting on health reform and the different executive, legislative, and judicial interactions. Panelists are expected from CMS, CRS, GAO, and MedPAC. The second day evolves around state health care program such as Medicaid, SCHIP, and health reform. The timing of the event could not have been better, with the Temporary High Risk Pool Program (THRPP) commencing this October for participating states. Hot topics that are bound to come up are the preparations and funds already spent for the appropriated $5 billion towards THRPP and the eventual insurance exchange occurring January 2014. The third day focuses on Medicare and communicating with policy leaders. The last day includes a Congressional site visit with possible Congressional member meetings.

If this orientation were around when I was a newly minted health care policy graduate, I would have jumped on this chance, with firm sponsorship of course. Registration ranges from $1,260 to $1,700.

Looking at last year’s participant list, the event appears to be geared towards consultants, policy advisors and analysts, academics and fellows, researchers and statisticians, think tanks, providers, and lawyers.

See agenda thus far. List of confirmed speakers.

July 21, 2010

Part III of III: Shopping for Individual Health Insurance — How to shop for an individual health insurance carrier

Filed under: health care reform — Tags: — ushealthcarepolicyatgmaildotcom @ 10:22 pm

Where did I leave this blog 2 years ago? Oh right, I was supposed to finish up the third part of the 3 part series on purchasing individual health insurance. Can you believe in 2 years, Massachusetts and San Francisco were able to ensure that all residents could receive a certain level of care without financial worries. *clap*cap* Oh and let us not forget the monumental health care reform under Obama’s second year of office. *standing ovation* Although not everyone agrees with the change, a huge change in health care is breath-taking. Instead of people like me getting burnt out from health care policy, there is renewed interest. So I am back. Part III is no longer relevant. Reviving U.S. Health Care Policy is back on the plate!

April 22, 2008

An Economist to Defend Medicaid and Medicare Expenditure Projections

Filed under: health care news — Tags: , , , , — ushealthcarepolicyatgmaildotcom @ 10:17 pm

During his short stint at UC Berkeley, Professor Orszag had a way to calm exam anxiety amongst frazzled economic undergraduate students. Now he is charming, front and center, the two largest public health care financiers, Medicare and Medicaid. He always enjoyed the public policy limelight, and he made that no secret by flashing photos of him at the President’s Council of Economic Advisers meetings. He never voiced his passion in health care, but I suppose budget, policy, and rationale for economics are parallel with a more tangible health care subject. Best to him!

U.S. News: CBO Chief Is Health-Care Referee — Peter Orszag Takes A High Profile On Crucial Issue

By Anna Wilde Mathews
1039 words
21 April 2008
The Wall Street Journal
(Copyright (c) 2008, Dow Jones & Company, Inc.)

As the presidential candidates and Congress rev up the debate over the future of health care, Peter Orszag is already playing one of the toughest positions: referee.

Mr. Orszag, a 39-year-old economist, is the director of the Congressional Budget Office, the influential agency charged with toting up congressional bills’ impact on the federal budget. Such scoring can sink bills that can’t offset their costs with savings — a serious risk for proposals that aim to expand federal health programs to cover more citizens.

Mr. Orszag increasingly is focusing on health issues, taking an unusually high profile for his nonpartisan office. He has become a prominent speaker at health conferences and co-wrote two pieces in the New England Journal of Medicine. He has launched a blog, cboblog.cbo.gov/, boosted the number of staffers who work on health to 47 from 31 and is seeking to add more. The agency has 235 employees.

“This actually is our fiscal future, and policymakers do not have as much analysis and options as they would need to make sound long-term decisions,” says Mr. Orszag.

Mr. Orszag wants to drive home concerns about what he says are the “unsustainable” current growth rates of Medicare and Medicaid. Over his desk hangs a chart showing projected growth in federal spending on the two programs, which together are projected to represent 9% of gross domestic product in 2035 and 19% by 2082. Currently, they constitute 4% of GDP, or nearly $600 billion in federal spending for 2008. The Medicare trustees have said the elderly-insurance program’s hospital trust fund is on track to run out in 2019.

Though Mr. Orszag, who worked in the Clinton administration, steers clear of presidential politics, his office could play a key role in the fate of the next president’s efforts to re-organize the health-care system. Because of the sharply different approaches of Republican candidate Sen. John McCain and the two Democrats, Sens. Hillary Clinton and Barack Obama, health plans will likely be a significant policy clash in the general election this fall. And the work the CBO is doing now may provide ammunition to one side or the other, as it examines different potential approaches.

The CBO director, who started his four-year term in January 2007, is going beyond the traditional budget-Cassandra role, and analyzing causes and solutions. He has emphasized that the biggest driver of rising medical costs is the increasing use of new technology, not simply an aging population. Mr. Orszag likes to present a slide show that highlights geographic variations in Medicare spending — which, he points out, don’t clearly correlate with healthier people.

“Peter has helped change the focus in health-care-policy debates to the delivery system,” says Mark McClellan, who headed the federal agency that oversees Medicare and Medicaid during the Bush administration and is now based at the Brookings Institution.

Mr. Orszag, who didn’t focus on health care in his own research at Brookings and elsewhere, says he found “astounding” the gaps in spending between particular hospitals that emerged in Dartmouth Medical School research. “We’re paying twice as much at one place as the other and we have absolutely no idea what we’re getting in exchange for it,” he says.

The CBO has released an analysis on the hot-button topic of “comparative-effectiveness research,” which weighs different medical treatments. The analysis generally took a favorable view toward such research as a means of reducing costs. The office is scheduled soon to release an analysis on information technology, likely exploring the evidence for its usefulness and its possible budget effects.

The CBO’s health-care work “will be very instructive to members when we attempt to take steps to right the ship,” says Sen. Kent Conrad, the North Dakota Democrat who chairs the Senate Budget Committee.

Like all CBO directors, Mr. Orszag gets constant prodding from lawmakers eager to play up their bills’ budget savings, and the stakes will be far higher for any major reorganizational legislation. In 1994, then-CBO director Robert Reischauer famously testified that the Clinton health plan would cost the federal government far more than the White House projected, resisting pressure to score it more favorably. The testimony was a serious blow to the plan.

“Because the CBO plays such a critical role…of course what he says will have a big impact,” Mr. Reischauer, now president of the Urban Institute, says of Mr. Orszag.

Because many of today’s proposals haven’t been tried before, it is particularly challenging to model — and easy to argue — their likely effects, economists say.

“Effective policies to increase access to health care, and to improve the quality of that care, have far-reaching effects on our economy,” says Sen. Edward Kennedy, the Massachusetts Democrat who chairs the Senate health committee. “It’s essential for the Congressional Budget Office to take this complexity into account in analyzing health legislation.”

Conversely, the office can face second-guessing when it does chalk up some savings. Joseph Antos, a former CBO official who is now at the American Enterprise Institute questioned the CBO’s decision to attribute at least some potential offsetting savings to comparative effectiveness.

The upshot was that at the end of a 10-year span, the project would effectively break even. “The great tradition of CBO has been that if there wasn’t clear evidence on some proposal, the response was, ‘We won’t give you a score,'” Mr. Antos says. “The evidence is simply not there, by my reading.”

Mr. Orszag says he is seeking to battle perceptions that the CBO doesn’t adequately take potential savings into account. He has heard more objections about the CBO being too stingy in its analysis of the comparative-effectiveness provisions, he says.

In general, he says, “we should give our best estimate on either side.” His background in an academic family — son of a Yale math professor; brother of two other Ph.D economists — prepared him to weather such arguments, he says.

March 30, 2008

Medi-Cal lawsuit on the horizon, a financial policy one

This past week, SFGate announced that San Francisco’s Mayor Gavin Newsom’s administration and coalition are outraged by the 10% Medi-Cal physician reimbursement implemented by Governor Schwarzenegger‘s Medi-Cal wonks (article 1 and article 2). This desperate $600 million savings attempt by the State government is plan B after Governor Schwarzeneggar’s Medi-Cal reform failed to come to fruition.

Being in the Medicaid field, I have no idea how Mayor Newsom’s lawsuit can stand legal grounds. Burden of health care access? By cutting reimbursement, physicians who can forgo the slim Medi-Cal reimbursement margins will bar medical services to existing or new Medi-Cal patients. If this financial barrier to health care access can be shown, then the new decreased reimbursement is not actuarially sound. If this cut had to be approved by the Center for Medicare and Medicaid Services (CMS), then an actuary’s signature must have certified the rates to be sustainable for the current level of access or greater. Obstruction to access is difficult to prove because of the intangible definition for the highly fluid Medi-Cal population. In addition this is only arguable for managed care but not for the fee-for-service system. The testy lawsuit stands weak legal grounds.

Can anyone with more policy and legal field experience enlighten me on the legal argument of this lawsuit?

In my mind, if Mayor Newsom wants to become Governor Newsom, this lawsuit is more of a political platform building opportunity for the 2010 election. I really hate seeing charismatic politicians that have the power to do wonders but then become a disservice to the American public, and I think Mayor Newsom thinks so too. So I nailed my opportunity yesterday to put in a plug. I really did not want to seem like every other San Francisco business person in line to shamelessly plug their business and that is it. I wanted to tell him how I could be part of his A-team of civil servants to make his health care policy progressive, hospitable, and vastly improved. So what did I do?

I am very gracious that my firm participated in the city planning team for San Francisco Earth Hour. In exchange for volunteering for the event by handing out energy conservation incandescent light, I earned an invite to the kick-off event at MarketBar where I knew that the Mayor had a public appearance.

San Francisco Earth Hour

I sealed the deal by thinking of two main points to capture his coveted attention. Point one was to get him engaged: Do you recall a few months ago when you rode the N-Judah Muni Metro to work?

My witness to his N-Judah presence provoked his outrage on the city’s MUNI issues. His knowledge of the issues and detailed ridership numbers impressed my friend whose husband has a MUNI love and hate relationship. As he pointed out the electric MUNI car parked outside of MarketBar, I took a jab that Austin long had these buses, and the vehicles are cleaner, wider, and more comfortable. That comment sparked Mayor Newsom’s competitive sportsmanship. San Francisco can do much better than Austin!

Point two was to hit his health care policy interest dead-on. I had a little trouble plugging myself because I am very shy, too polite, and passive. So my friend helped me out by shouting that I had health care policy interests. That grabbed his attention and he asked, “Did you know that we are suing the governor for their Medi-Cal cuts?” I thought, “Duh!?” Which health care policy wonk did not. So I put in my plug for what my team did for the current Governor’s administration on Medi-Cal redesign. He asked for my business card, and I sincerely hope his administration follows up.

If Mayor Newsom is going to be the next Governor, I want my hand at health care reform done right the first time his administration proposes it. I am sick and tired of living through stale iterations of reform, issue attrition, and waning political momentum. I am also sick of complaining. While young and capable, I have the time, patience, and aptitude, and I hope I get in on the action.

On a separate note, the Governor learned from former First Lady’s Hillary Rodham Clinton’s political debacle at health care reform. Since 2004, the Governor had various task forces to gather genuine buy-in, extensive input, and productive discussions. PR wise, “redesign” appears to be a more salient policy term than “reform.” This was one of my first health care policy field work assignments. I will save this story for another day but feel free to browse through one sliver of the redesign planning at the California Health Care Foundation. I am just sad that with all the effort, blood, sweat, and tears, plan A failed, hence this slapped together Plan B to help salvage the State’s budget. Not surprising, a lawsuit abounds.

March 4, 2008

Five A’s of Health Care Access

Filed under: health care literature, health care pop culture, health care stream of conscious — Tags: — ushealthcarepolicyatgmaildotcom @ 9:10 pm

There are many catch-22’s in the health care system. A managed care company reimburses providers and hospitals for services rendered to beneficiaries at a certain payment level. The payment is just enough for hospitals and providers to maintain a contractual relationship with the managed care company and just enough for the insurance company to expense the least possible reimbursement to maximize profits. This reimbursement amount is a major factor in maintaining a large and stable network of providers that beneficiaries can choose from and can easily obtain care. The catch? Only if the payment is enough!

Access to health care is important. If you were taught under the same school of thought, the Five A’s of ACCESS are affordability, availability, accessibility, accommodation, and acceptability.


March 2, 2008

Health Policy Institute for Continuing Education Units

Filed under: events — Tags: , , , — ushealthcarepolicyatgmaildotcom @ 11:31 pm

Sponsored by George Mason University, the College of Health and Human Services Center for Health Policy Research and Ethics, the Washington Health Policy Institute hosts its 16th annual meeting from June 3rd through 6th of 2008.At the meeting, “academics and health professionals interested in health policy research can learn firsthand about current policy issues and how policy is made through lectures and discussion with some of the nation’s leading policy makers. Students can also earn graduate credit through the Institute by attending morning didactic sessions and completing an analytic policy paper. An additional Institute option is the Policy Leadership Training Program for post-baccalaureate students and health professionals with a desire to enhance leadership capacity and skills in policymaking, research, and advocacy.”

Here’s a list of invited speakers —

Vice President, Health Policy
Capitol Associates Inc.PATRICK FINNERTY
Director, Virginia Department
of Medical Assistance Services

Associate Director, Health Workforce
Maryland Department of Health and
Mental Hygiene, and Former Senator,
Maryland General Assembly

Editor in Chief, American Journal of Nursing

Associate Director, Government Affairs
American Nurses Association

Executive Director
National Rural Health Association

Director, Federal Government Affairs
American Association of Nurse Anesthetists

Chief Nursing Offi cer
Veterans Health Administration

Arent Fox Kintner Plotkin & Kahn, PLLC

Senior Vice President, Legislative Policy
Maryland Hospital Association

Since this meeting is slanted towards eligible graduate credit or CEU’s, I encourage students and policy practitioners with a few days in Washington D.C. to spare to attend.

After this affair, you may piggy back off the 25th annual AcademyHealth Annual Research Meeting, which follows soon after George Mason University’s affair.

February 22, 2008

Register for Raising Women’s Voices National Conference in Boston

Filed under: events — Tags: , — ushealthcarepolicyatgmaildotcom @ 3:03 pm


Thursday & Friday, April 17 and 18, 2008
Hosted by: Simmons College
Boston, Massachusetts

Featured Keynote Speakers
Dr. Joycelyn Elders, Former Surgeon General
Miriam Yeung, National Asian Pacific American Women’s Forum
Byllye Avery, Avery Institute for Social Change, Black Women’s Health Imperative

Join us and more than 300 other activists, mothers, daughters, sisters, caretakers, consumers and community leaders for this national conference to learn and strategize about how we can get quality, affordable health care for all. Together we will discuss and plan for health care reform that will meet the needs of women and families.

This conference will launch a network of trained and outspoken women who are mobilized to work for a health care system that:

  • Includes comprehensive reproductive health services
  • Meets the needs of diverse women and our families
  • Bridges the inexcusable gaps in services and care that we face in the current system
  • Provides quality health care that is affordable and accessible for women and our families across the life-span.

To get the health care debate to reflect women’s issues and concerns, we must join the conversation!

Questions? 866-210-3114

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