Healthcare X Prize Foundation Competition

We are entering an unprecedented season of change for the United States healthcare system. Americans seem to be united by their desire to fundamentally reform our current system into one that delivers on the promise of freedom, equity and best outcomes for best value. In this season of reform, we will see all kinds of ideas presented from all across the political spectrum. Many of these ideas will be prescriptive and don't harness the power of innovation to create the dramatic breakthroughs required to create a next generation health system.

I believe there is a better way.

This belief is founded in the idea that aligned incentives can be a powerful way to spur innovation and seek breakthrough ideas from the most unlikely sources. Many of the reform ideas being put forward may not include some of the best thinking, the collective experience, and the most meaningful ways to truly implement change. To address this issue, the X PRIZE Foundation, along with WellPoint Inc and WellPoint Foundation as sponsors, has introduced a $10M prize for health care innovators to implement a new model of health. The focus of the prize is to increase health care value by 50 percent in a 10,000 person community over a three-year period.

The Healthcare X PRIZE team has released an Initial Prize Design and is actively seeking public comment. They are hoping, and encouraging everyone at every opportunity, to engage in this effort to help design a system of care that can produce dramatic breakthroughs at both an individual vitality and community health level.

Here is your opportunity to contribute:

1. Download the Initial Prize Design
2. Share your comments regarding the prize concept, the measurement framework, and the likelihood of this prize to impact health and healthcare reform.
3. Share the Initial Prize Design document with as many of your health, innovation, design, technology, academic, business, political, and patient friends as you can to provide an opportunity for their participation.

Let's ensure that all of us--and the people we love--can have a health system that aligns health finance, care delivery, and individual incentives in a way that optimizes individual vitality and community health. Together, we can ensure the best ideas are able to come forward in a transparent competition designed to accelerate health innovation. We look forward to your participation.

This purpose of this post is to assist Scott Shreeve, MD, Senior Health Advisor at The X Prize Foundation, in raising awareness of the Healthcare X Prize Foundation competition.

The Impact of Potential Health Care Reform on Health Plans

This week, we're getting an introduction to the direction that the Democrats want to take the health care reform discussion. Consistent with the mandate viewpoint, the House and Senate sponsors seem to be taking an aggressive stance. While the plans are very complex (and assuredly difficult to administer, especially via the tax code), they contain some interesting details.

The primary proposal under consideration contains a universal coverage mandate. Senate Democrats have developed a proposal similar to that of their counterparts in the House, which would require everyone in the U.S. to carry health insurance starting in 2013. Interestingly, the plan provides for an explicit exception for illegal immigrants and people with religious objections. Families making up to four times the poverty level ($88,200 for a family of four) would be eligible for tax credits to help them afford coverage. A penalty for not carrying insurance would be imposed via the tax code. The penalty could be up to 75 percent of the premium for the lowest-cost health plan in the area where the person lives.

The federal government would set minimum benefit standards, including physician services, hospital care and prescription medications. All health plans would have to offer four levels of coverage, ranging from basic coverage to the most comprehensive set of benefits and coverage.

Most companies would be required to offer insurance to full-time employees, or else pay a special tax. The plan proposes tax credits to small businesses with up to 25 employees to lessen the financial burden on employers. However, the plan also calls for an employee "out" privilege, which will allow employees to withdraw from the employer-sponsored plan and seek individual coverage, with the employer still paying a share of the premium.

To learn more about Democratic healthcare reform proposals, read this article from The New York Times.

What does this mean for health plans?

• Probable expansion of the State Children's Health Insurance Program (SCHIP) for coverage of low income families with children.
• Increased administration costs and complexity with new mandated benefit designs, the creation of a national insurance exchange and new regulation of commercial plan marketing.
• Possible "trickle-down" mandates for hospital and physician reimbursement rates putting negative pressure on margins in managed Medicaid.
• Actuarial challenges with higher member turnover, the potential for adverse selection in employer risk pools and the creation of the insurance exchange.
  

In the opinion of G2 Management Group, health plans should seek even more efficiencies in their business processes. With administrative costs, benefit costs and reimbursement rates all likely to rise, the plans that can remove cost from the system will be best prepared to thrive. Contact us today to discuss how to mitigate the effect of health care reform on your health plan's bottom line.

Open Source BI: Is it ready for prime time? (Intro)

Business Intelligence (BI) is the use of an organization's disparate data to provide meaningful information and analysis to employees, customers, regulators, and partners for more effective decision making. Business intelligence solutions gather information together, organize it, measure it, give people access to it, and share information changes.

The use and importance of business intelligence software tools is demonstrated by the size of the BI software market. The US Business Intelligence market is currently about $6 billion with an annual growth rate of approximately 12.5%.

Several commercial software vendors occupy the BI marketplace. The market leaders, in terms of market share, include IBM Cognos, SAP Business Objects, Oracle Hyperion, MicroStrategy and SAS among several smaller firms.

Each of these firms offers a proprietary software solution to the business intelligence needs of organizations. While the software implementations are unique to each vendor, the concepts and functions accomplished by each are common to all. These common functions are also addressed by an open, community-based approach called Open Source Projects. Open Source Projects rely on the free, technical contributions and development of participating individuals and companies around the world. Pentaho, JasperSoft and Talend, to a more limited degree, are examples of commercialized Open Source Projects. The resulting products developed are freely distributed to any entity. As the capabilities of Open Source BI projects continue to increase, the value of commercial, proprietary solutions is challenged. The commercial BI software vendors, therefore, protect their products by questioning the viability and readiness of Open Source BI software for use in commercial applications.

Because of the relatively recent advent of commercial, Open Source software and the competing interests of proprietary software companies, much uncertainty and misinformation exists in the software marketplace regarding the viability and usefulness of commercial open source software applications.

In subsequent posts, I plan to examine the issues and considerations regarding Open Source BI and to ultimately answer the questions: Is Open Source BI software ready for business?