Saturday, January 2, 2010

United Health Care and Telehealth (2)

Well, I'm having trouble posting a comment to my own blog. Pretty amazing.

So, here's my response to Donna Cusano, who posted a comment:

Thanks for the comment, Donna. Interesting to see the other side of innovation. We know that innovations come from invention of the technology first, and use second. The inventors of telephones, phonographs, and radios had no idea of the wide usages that would come.

Seems to me that telehealth will be the same. Invent, and then see who can come up with the perfect usages. I’d say that the most obvious use would be in the Third World, and the rural parts of first world. The problem would be money – the same reason there are no doctors in the Third World is why the prospect of profit would be difficult. But there are donors, there is some money somewhere, and maybe that would work.

I think the problem of adult acute but probably not serious care is a problem of organization. Pediatrics isn’t so much of a problem, usually, although more could be done. I think most pediatric practices are like ours – acute illness will be seen on the same day, even on weekends. The main problem is with adults – why adult practices are not set up to see same day sick patients escapes me! Also, why hospitals can’t set up urgent care better is not clear. Hospitals are generally just poorly run, as we all know. Also, they can charge so much for an ER visit and get it – so why settle for an urgent care visit? So, I guess the Retail Based Clinics really do rely on just low cost.

But if that’s the case, would telehealth be low cost and thus competitive? I can’t see how that would be the case.

I agree 100% that the UHC demos of telehealth were based on PR for impressionable Reps and Senators. I agree it was part of their strategy as they won the Health Reform fight. So, I wonder why you think that UHC will be toast with health non-reform? Seems to me the insurance companies are going to get lots and lots of new subscribers with no significant limits on profit. Their problem will be what to do with all the money.

If I owned the UHC zoo, I think I would identify areas that could potentially be like Intermountain, and the Grand Junction Colorado system. I would partner with some, buy some, and then try to spread like ink spots. If I got a great team together, pretty soon I would be predominant in health care in a large part of the country. It would not be easy, it would take real investment and team building, it would take creativity – all of this would be alien to UHC as presently constituted. But that’s what I would do.

Budd Shenkin


  1. Budd--I largely agree with you about technology finding its application, although I'd characterize it as 'ready, fire, aim' in that technology has some approximate rationale or reason for being at the start, which usually is not be the way it winds up being used. (As in the telephone was the voice version of the telegraph, TV was radio with pictures, etc.)

    I also agree about virtual visits being most applicable in rural or less populated (northern MN and western PA come to mind) areas--yet it seems to be taking off in places like NYC where it's viewed as timesaving and fitting into the lifestyle.

    Why I believe insurers will be toast with non-reform;(disclaimer, from here on in, this is strictly my POV and not related to Telecare Aware, which is a news and information website with opinions expressed mainly by our readers).

    One, insurers are not constituted for change (your last paragraph.) It's not just UHC, it's Aetna (one of the worst), the Blues etc. They don't get innovation or technology; they've tried to buy it (in the form of health management companies), and driven *them* right into the ground. They are financially driven organizations that are now in phase one of organizational decline--preserve executive salaries, increase rates, slow pay providers, cut staff.

    Two, their clever politicking and lobbyists are not going to escape the current and highly unpredictable political waves, be it from the left or the 'tea party' populist side kicking everyone's tail. Insurers are nice fat targets, and deservedly so for the most part. It's hard to find anyone to say a good word about them, including physicians.

    So right now my crystal ball is saying: Congress will play ball with them to get non-reform legislation through and nice fat contributions for the 2010 elections, but then the panels, regulations and executive orders will kick in, all driving to public option/single payer. The insurers, who are losing corporate subscribers daily, will increasingly be seen as 'losers' in the game; the investment markets will reflect this. If non-reform happens, short term they will become increasingly low-pay administrators of increasingly mandated policies. By the end of the game there will be consolidation and increasing unprofitability. My model is what happened in the end stage of airline deregulation--consolidation, unprofitability of the survivors and increasing regulation.

    Throw cuts in funding and restrictions on Medicare and Medicaid. The squeeze in payments is already affecting companies like CardioNet with proven technologies. It will just work upward from there.

    On the other hand,if this is stemmed with this year's elections, the insurers may well find themselves (like Big Pharma) on the wrong side because of what they are and their gaming the system. What then happens is anyone's guess. We will see!

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