Kudos to AFL-CIO, its Members and Affiliates…

…for their effort to address “mangled health care" head-on!

In Thursday, March 22, 2007 edition of Pittsburgh Post-Gazette, Anya Sostek, staff writer, writes (excerpted with commentaries by Dr. Dorodny):

“…The "Health Care Hustle" Web site invites readers to submit their stories of being broken down and bruised by the health-care system.

The site www.workingamerica.org/healthcarehustle which opened to the public yesterday and to members last week, already has attracted more than 500 responses, which is only a drop-in-the bucket, considering the daily obstacles workers and their families need to overcome to access appropriate health carING.

Working America, a community affiliate of the AFL-CIO which represents about 1.5 million Americans who are not part of labor unions encourages users to send automated messages to "greedy corporations," the Pharmaceutical Research and Manufacturers of America, the insurance industry and the Bush administration.

According to Ms. Karen Nussbaum of Working America, the organization plans to launch a major campaign against the "evildoers" who receives the most votes against them.

The “evildoers” only care about their executive compensation, stock options, share prices, private jets, etc.

Currently, workers and their Unions have only themselves to blame for proliferation of and the abuse by the “evildoers” that are “just doing their jobs”.

Strive for universal access to appropriate and affordable health carING is an achievable, but a long-tem undertaking. Universal payer/single payer proposals are abundant, problematic and deceiving.

"The trade union movement today is both more embattled and smaller, and that means that it has to use the weapons of the week," said Prof. Lichtenstein (UCSB). "It's the same thing that any agitational group who is out of power would do."

But creative media campaigns will not properly address what’s on the mind of every worker: health carING. Address these issues and watch your membership and your power soar.

Organize your members and move from an "agitational group" to an enabling one.
Unfortunately, sending automated messages to “greedy corporations” will not work either.

It will not work because Pharma Manufacturers only care about their profit margins. Please read the “NEW Prescription for Pharma Marketing” and related postings on this site.

Similarly, insurance companies have core values divergent from those of workers and their families.

In addition to the conflicting core values, “business disconnects” exist due to logistical, financial, physical and ethical aspects of mangled health care:

*The workers and their families usually does not request, do not order or directly pay for the services.

*The insurance companies, HMOs, never request, do not receive, nor order the services.

*The doctors who order the services do not pay for them, nor receive the services.

Insurance companies, HMOs and other "mangled" health care companies entire purpose is to grab as many pennies from workers health care dollar as they are allowed to by the workers.

They do grab a sizable chunk: 15 cents out of every healthcare dollar without actually working, being sick or providing services.

Sign me up!

The lame-duck President Bush did not care about the worker even before he became a lame duck.

Dear Unions,

Please return to your basic focus on collective bargaining and controlling the purse strings, with a clear understanding of the fact that employees are the buyers (direct and/or indirect) of health carING services.

Employees are the buyers of health care and should drive, if not control, all health caRING decisions.

Workers and their families can request and receive health carING from doctors, nurses, pharmacists, hospitals, labs, pharmaceutical companies, etc, without mangled care companies.

Doctors, nurses, pharmacist, hospitals, labs, pharmaceutical companies, etc, can provide health carING without mangled care companies.

Workers and their families can pay for health carING without mangled care companies.

Employees and their Unions do not need the middle men (employer, insurance company, managed “mangled” care company and its stockholders) to take a 15 cent bite out of every health carING dollar!

I, for one, am willing to make a difference and show the way!

We gripe, you decide.

Shame on John Edwards...

...for shamelessly exploiting the unfortunate progression of his wife's cancer. Her previous bouts of cancer did not stop Mr. Edwards from campaigning in 2004 when his wife was receiving chemotherapy. Her psychological scars of abandonment are probably still healing.

Shame on Mr. Edwards for using his wife's now fatal condition to "breed new life" into his losing candidacy for President

Fortunately, during my 32 years of carING for patients with cancer and other terminal diseases (with and without social stigma attached) I only came across one patient, and one next of kin that were actively publicizing and benefiting from their terminal diseases.

Both individuals were illegally abandoned by their "mangled care" insurance companies, and were doing so to collect funds for life-prolonging treatments.

Fortunately for Mrs. Edwards, she appears to be able to afford the best care available in this country without participating in a public debate and discussion of her most sacred possession: her life--a "living monument" to her husband's ambitions, despite his floundering campaign.

Shame oh her physicians for their willing participation in Mrs. Edwards' joint CNN-FOX disease management circus, and for possible HIPAA violations.

Mr. Edwards' time "invested" in press releases, news conferences, TV appearances, etc might have had a "higher return" should he engage in private carING for his wife.

I wonder if Mr. Edwards can ride the "sympathy wave" long enough to make a difference?

We gripe, you decide.

Be Well!

Health Consumers & Mr. Inlander v AMGA & Jacque Sokolov, MD

Excerpted from Michael Romano's article in the latest edition of Modern Healthcare :

"It’s hardly a secret that the doctors and managers who run the nation’s biggest multi-specialty group practices...firmly believe that their model of integrated delivery is the very best way to provide patients with quality health carING.

Despite the traditional belief, doctor does not always know best! Especially a doctor-turned-consultant-turned-executive-turned investor.

Last week, the Alexandria, Va.-based American Medical Group Association, the trade group for all those large medical groups, held its annual conference over four days at the luxurious Westin Kierland Resort & Spa in Scottsdale, Ariz.

The self-satisfied (God-like) attitude of many AMGA members took a (bit) serious and fully deserved beating from Charles Inlander, noted naysayer (read patient/health consumer advocate) and the outspoken president of the People’s Medical Society since the consumer-advocacy group was founded 24 years ago".

“... the reason you’ve (AMGA) been losing the war (health care policy) is because the focus hasn’t been on the patient. It’s been on the delivery system.”

"For some reason—token, balance, perhaps—the conference organizers invited the consumer gadfly to join a panel discussion.

Panel participants, of course, were the button-down industry veterans to Inlander’s version of a tie-dyed radical about to storm the gates and bring down the system.

After suggesting that universal healthcare is inevitable sometime in the next several years because the public will demand it, he reinforced his point about the industry’s lack of sincere concern for patients by mentioning a keynote address one day earlier by Jacque Sokolov, a physician-turned-consultant and an impressive speaker"

"But, according to Inlander, this highly regarded expert never mentioned the P-word. “Jacque never once mentioned the word ‘patient’ in a 50-minute speech..."-noted Inlander.

Dr. Jacque J. Sokolov is indeed a highly experienced and accomplished expert on most aspects of health care.

I have personally known Dr. Sokolov since early 90-s, and had the distinct privilege of associating with him on a number of projects, as well as on health care panels, forums, and on the speaker circuit.

Dr. Sokolov practically invented employer-directed managed care as Vice President and Medical Director at Southern California Edison Co—HealthFlex, and, thus became one of the co-authors of the "mangled health carING"---see this blog archive ("Mangled Healthcare" for All).

Unfortunately for then Edison employees, they were not considered to be part of the equation. Otherwise, Dr. Sokolov would have bypassed the archaic "patient-centric", and would have gone straight to the appropriate "health consumer (payors)-directed".

Fortunately for Dr. Sokolov, that position made him a national name in health care and helped launch his worldwide consulting business.

In the ensuing years, Dr. Sokolov served as top executive with Advanced Health Plans Inc. and AHP Development Corp. to "develop, finance and implement advanced, integrated health systems." He is a savvy investor in health care.

His clients included: physician organizations, hospital systems, insurance companies, managed care plans, and vendors in 100 markets in 40 states, plus three foreign countries.

Dr. Sokolov is no stranger to pharmaceutical and medical device industries either. He serves on the Board of Directors for Hospira, Inc., the global specialty pharmaceutical and medication delivery company since Hospira’s spin off from Abbott Labs in May, 2004.

He also serves as a Director of MedCath Corporation. Please see this blog archive ("NEW Presciption for Pharma Marketing).

He is best remembered for presiding over the decline and, final demise of the Coastal Physician Group, Inc., after a protracted proxy battle with Dr. Steven Scott, founder of Coastal Physician Group, and much-publicized law suit (Scott v Sokolov, 1996, NCBC 2, Durham, North Carolina).

In-fighting under Dr. Sokolov’ tenure as Chairman of the Board & Vice-President for Healthcare, resulted in Coastal Physician Groups' stock price sinking from a high of $42 to around $13.

Fortunately for Dr. Sokolov, he was able to walk away from Coastal (which later became PhyAmerica Physician Group, Inc) with a sizable “chunk-of-cash”.

Currently he is Chairman and Senior Partner for SSB Solutions, Inc. His bio on the company’s website states: “…. Over the past 15 years, he has led consulting engagements with top-tier physician organizations, hospital systems, and managed care organizations in virtually every major market in the country…”

Curiously, but not surprisingly, the patient/health consumer is not mentioned. Is it because patient/health consumers do not pay exorbitant consulting fees, speakers’ honorariums or luxury hotel and airline accommodations?

The long of it:

Mr. Inlander is absolutely correct;

Dr. Sokolov, a former cardiologist, works for "...top-tier physician organizations, hospital systems, and managed care organizations..."

AMGA is absolutely wrong and was caught "red-handed";

Mr. Inlander "has a heart" & works on behalf of Patients-Health Consumers;

Dr. Sokolov does NOT work for patients/health consumers;

AMGA either knew, or should have known the content of Dr. Sokolov's presentation.

Dr. Sokolov could have removed the "patient-centric" slides to stay within the allotted time.

AMGA is in "damage to its real image" control spin;

Mr. Inlander will not be invited back by the AMGA, but he is always welcome on my blog!

The short of it:I am pointing out the obvious to the obviously blind!

Be Well!

"Mangled Healthcare" for All

With great fanfare the Consumer Federation of California (CFC) announced on February 27th, 2007 that "...every Californian deserves access to high quality, affordable health coverage"--a noble concept, indeed.

I certainly agree that “Our health care system is a disaster for the uninsured and insured alike. Nearly seven million Californians are uninsured. Co-payments for workers are skyrocketing, and businesses that cover their employees are being crushed under the rapid escalation in insurance premium rates."

When originally introduced to this naive country and promoted by then, and still, misguided and ill qualified Mrs. Clinton and her Jackson Hole task Force, it was defined as: " A prepaid risk-based system of integrated health care delivery, having appropriate capabilities to improve quality of care and manage utilization and cost of a given population.” (Thomas Morrow, MD., at NMHCC/IT Fall 1998, Los Angeles, CA)

Here are my postulates of "Mangled Care" vs Managed CarING:

•If someone is already paying a lot, let him or her continue
•Even if a lot of people complain about quality of managed care, it won’t contain cost
•Never provide coverage unless the treatment is unpleasant
•Quality is being in a waiting room with people who earn more money than you do

Managed care is an oxymoron by default--this system that should have been providing health carING, while managing costs--in its present form is better described as mangled health care.

The for-profit (and very profitable) “managed care” companies have embraced, and are functioning under divergent and practically mutually exclusive core values.

These companies are obligated to provide (or rather severely ration) health care services. They are also obligated to generate consistent profits for the executives and shareholders of those companies.

When the provision of proper health care and managed care companies profits come into direct conflict, it creates a “double explosion” of the system, where the availability and quality of health services goes down, while costs of services and mangled care companies' profits go up.

This abominable situation creates significant “counter-incentives” to provision of appropriate, accessible, affordable health carING to Californians, which can be gauged by the divergence coefficient.

In addition to the conflicting core values, “business disconnects” exist due to logistical, financial, physical and ethical aspects of mangled health care:

•The recipient usually does not request, does not order or pay for the service.
•The payor never requests, does not receive nor order the service.
•The orderer does not pay nor receive the service.

Governor Schwarzenegger, a traditional foe of pro-patient health care reforms, now says he wants to address the health care crisis. Unfortunately, the governor’s proposal puts too much of the burden on the uninsured, and it fails to control cost increases. Similarly, Sen. Kuehl “Zelda’s Single Payor Legend” falls far short of the target.

While it’s true that every other industrial democracy offers universal health coverage to its citizens, it does not translate into universal health carING, and in the case of Canada and England is actually counter-productive.

Surely, universal health care made some inroads in Hawaii, but only because it is a State with a super tight control of population---there are no immigrants (especially illegal) pouring over the boarder from the rest of the world. California, from the point of health care services, is a perpetual bottomless barrel, with fixed amounts of moneys paying into the system, while an ever-increasing numbers of residents generate a snowball demand for services.

Before declaring that health care (not just basic and/or catastrophic), but in fact “appropriate” (cosmetics?) health care “…is a right, not a privilege – and every Californian deserves access to high quality, affordable health coverage…” the CFC might want to clarify the definition of a “Californian” to prevent even faster emptying of the “bottomless barrel”.

CFC’s purposely trying to confuse general public and exert undue influence on Legislators by implying that just because they are uninsured resident of California, they are uncared for. Nothing can be further from the truth--the tax-paying and health insurance-paying Californians are actually paying for the care of the un/under insured.

I also disagree with CFC’s assertion on the issues of providing “…universal health insurance for all Californians at no added cost simply by taking the for-profit insurance industry waste out of the system and using those dollars for the delivery of health services”.

Health consumers can request and receive health carING from doctors, nurses, pharmacists, hospitals, labs, pharmaceutical companies, etc, without mangled care companies.

Doctors, nurses, pharmacist, hospitals, labs, pharmaceutical companies, etc, can provide health carING without mangled care companies.

Healthcare consumers (Payors) can pay for health carING without mangled care companies.

Only complete elimination of the middle man-managed care companies can generate enough money to provide universal health carING.

Its time to move from patient-driven to health consumer-administered health carING.

California Government can only guarantee universal health care when all of the recipients of such care, including the illegals, pay their fare share.

Be Well!

NEW™ Prescription for Pharma Marketing.

Since the beginning of my healthcarING© career in 1993, in addition to my full time clinical practice (since 1975), I have served as the Managing Editor of Managed Care Medicine, Editorial Board Member of the US Pharmacist, Advisory Board Member, Center for Consumer Healthcare Information, Board Member of The Formulary & Managed Care Information Exchange (M.C.I.X.), Editorial Board Member, The Medical Reporter, Editorial Board Member, Managed Healthcare Journal, Information Security Magazine, Editorial Board Member, ADVANCE for Health Information Executives, to name a few.

In addition, I’ve served on numerous Advisory-Industry-Executive Boards: National Managed Health Care Congress, (NMHCC/IT), American College of Managed Care Medicine, American Board of Managed Care Medicine, Pharmacy Partnership/CMA Foundation, State of California Task Force on Health Plans and Managed Care, The IPA Association of America (TIPAA), US Congress, Ministry of Health of Russian Federation, Association of Medical Directors of Information Systems (AMDIS), American Society of Consulting Pharmacists, the Institute for Alternative Futures, and the National Pharmaceutical Council among many others.

As a private Consultant first, and later as the Chief Medical Information Officer, Superior Consultant Company, I had the privilege of working with the top 50 pharmaceutical, biotechnology & medical device companies in the world.

Given my expertise and track record, that I can categorically state that the days of detail and/or clinical liaison person as well as any and all financial incentives for physicians, pharmacists, nurses, and allied health providers are over. Similarly, the days of TV ads bombardment and hiring of models for the trade shows are over and should be over (please see "The Prescription Project ).

The NEW ™-old prescription for pharma-biotech-device marketing has been around since September, 1995 when I was invited by the FDA to present my expert opinion on the subject of Pharmaceutical Marketing and Information Exchange in Managed Care Environments.

In my testimony, from October, 1995, I presented the key incentives and disincentives of implementation of then emerging information technologies by the pharmaceutical industry. (see the US FDA Archive). Here are the “nuts & bolts” of my model proposed to the FDA in 1995:

“…The pharmaceutical companies should be moving from drug providers to total health solution providers including an expanded self-definition and developing their identity as a shared vision. Customers and partners who share an expansive vision of health help pharmaceutical companies to identify and create new market opportunities. This enhanced feedback mechanism will move pharmaceutical companies along the path of development into markets that are being formed by new information systems that organize the population with ever-increasing regularity...

...The pharmaceutical companies will use this information technology for mass markets, where one size fits all, moving towards customized health solutions when one size fits one. In this growth, the competencies are naturally growing around disease management. The ever-evolving definition of disease management by customers, including patients and their families, as well as professional providers, both physicians, pharmacies and the allied health professionals, will expand the competencies of pharmaceutical companies...

...This evolution leads to an expanded marketplace that reaches beyond the products into services, including many that are non medical, but nevertheless effect health. The health care consumers ( patients with specific diseases) who interactively help shape the new services, will lead pharmaceutical companies to pay far greater attention to post-market information. For this information to develop, pharmaceutical companies will form new partnerships with information companies...

...The pharmaceutical companies that succeed in such partnerships will be those that are open to participatory information sharing and development. Increasingly, the customers and partners of the pharmaceutical company that succeed in redefining themselves will look to these health solution providers for leadership. Also, creating such a partnership will help deal with the concept of the “fantasy of certainty”©...

...One strategy is to use feedback to help consumers play a more important role. The successful application of this strategy also supports shifting consumers from possible recipients of care to empowered proactive self-care participants…”

In summary, I challenged the FDA to “…regulate less and guide more and become a source of information for all”. During my service on the FDA General Scientific Advisory Board (Consumer Representative), from 1998 to 2002 I continued to advocate and promote the use of the Health Care Value (HCV©) which I originally introduced 1995, based on evidence- supported, repeatable, verifiable outcomes. I also continued to champion the cause of informed health consumer-concerned provider partnerships (PPP) enabled by the ethical and socially-responsible manufacturers.

HCV© is a near-quantitative time-tested measure, accepted by the FDA and a number of forward-thinking, proactive pharmaceutical, biotechnology and medical device companies trying to operate with quality and ethics in the industry's "quality vacuum" created by the ever-mounting requirements for quality performance reporting in the absence of government standards or industry consensus.

Let's now forward to 2007: The US FDA has "dropped the ball" and the overwhelming majority of the pharmaceutical and biotechnology companies are still engaged in the “traditional” marketing methodology of directly and/or indirectly "incentivising" physicians, pharmacists and allied health professionals to increase their respective market share of newer, as well as “me 2” drugs and drug delivery systems.

Instead of educating the providers, empowering the health consumers and empower health consumer-provider partnerships based on HCV© the majority of manufacturers are engaged in a barrage of “no-indications” TV ads devised to create demand “from below” by creating paranoia among the health consumers and overwhelming the providers.

With its corporate values of being science-based, competing intensely and winning, working in teams, creating value for patients, trust & respect for each other, ensuring quality, collaboration, communication and being ethical and accountable, Amgen seems to be "ahead of the pack". Sounds great, but is it factual?

Hence, I am introducing the Pharmaceutical Ethical Marketing & Manufacturing (PEMM©) Index, which is a ratio of the R&D budget to the Marketing & Administration budget by the company across all product lines (% of, or actual expenditures). Currently, the industry-wide PEMM© index is around 0.39. This index will serve as rough, but sorely needed, guide for health consumers and providers.

Since Americans are already subsidizing every manufacturers world-wide sales (as evident by significantly lower prices for the same drugs in Canada, Mexico, Bahamas, Europe, etc.), it is totally reasonable on the part of consumers and providers of health care to expect a PEMM© index of every ethical and carING© manufacturer to be at least a 1.0, and preferably higher. I hereby invite and challenge Amgen and all other manufacturers to make their PEMM© index information public--I am confident Amgen's index will be much higher than industry average.

In the meantime, here is an unsolicited NEW™ prescription for pharmaceutical, biotechnology and medical device manufacturers: deliver verifiable, evidence-based health care value (HCV©), partner with & educate your customers (consumers & providers of health care, not the PBM managers or HMO executives), and foster patient-provider partnerships---keep your PEMM© index high, and your sales will follow!

Be Well!