healthsignals new york

The "Love Boat" for assisted living

From Lee Lindquist, M.D., instructor of medicine at Northwestern University Feinberg School of Medicine and the Journal of the American Geriatric Society, by way of Science Blog, here's an assisted living idea that might appeal to some resistant types. Comes complete with doctor and social director.

The Red Sox & Medicaid

So what happened to the Oakland Athletics this year? They didn't make the playoffs and here's why it's unusual. And how does that relate to the Boston Red Sox finally winning the World Series?

Regarding Oakland: The A's use statistical analyses to determine how to get the best value for the money they have (not much). We should use the same or similar methods for looking at all health care, but particularly at Medicaid. Does Oakland's failure to make the playoffs this year undercut the point? No. The A's know there are no certainties in any enterprise, just probabilities. And their goal has been expressed by their General Manager, Billy Beane as winning 95 games during the season 95 percent of the time. The goal is 95 games because that pretty much assures you entry to the playoffs and would have this year. (Anaheim, the division leader, won 92.) This year, Oakland won 91.

Regarding the Sox: Boston has adopted the same analytical methods as Oakland. In fact, Boston tried to hire Billy Beane away from Oakland. When Beane demurred, they hired Theo Epstein as GM and Bill James as a special advisor. They applied the same methods.

Red Sox owners John Henry and Tom Werner have hired some of the best analytical minds in the business and have spared little effort in acquiring sophisticated scouting software, computerized video analysis and business intelligence tools for mining the stacks of statistics at their disposal. The goal: Identify the best talent available, get it before their rivals do, and then figure out just how long to keep it before it stops producing. It's human capital management on steroids.

For John Henry, Boston's primary owner earned his money as a commodities trader in the world of sophisticated finance, where the use of statistics and statistical modeling is rampant, the use of similar methods in baseball must not only have been natural, but compelling.

Boston now combines the methods of the A's and the pocketbook of the Yankees. It's a formidable combination.

So science and analysis trumps superstition (curse of the Bambino) and intuition (traditional baseball management methods). But that's the regular season. Let's not forget what Billy Beane says about the playoffs and the series. Limited to seven games at the most, playoffs have a too small sample size to be useful statitistically, i.e., it's a crapshoot.

We're a long, long way to the Medicaid playoffs. Spending as much as we do and having as much data as we do in New York, we should be able to do much better during the regular Medicaid season. We can do better while spending more productively.

And trial attorneys frighten you?

Remember what Moviemaker Michael Moore did to General Motors? Remember his bit on Charlton Heston and the NRA? And what about President Bush in Fahrenheit 9/11?

We may be next. Read the report of Moore's impending work on healthcare in the Chicago Tribune (requires registration). Thanks to the Health Law Blog for spotting this.

The scruffy movie producer/director, Michael Moore may be putting together a movie on healthcare! Rumor has it that the film will focus on pharaceutical and managed care firms. By I wouldn't count on anyone being safe until it's done and they've emerged unscathed. Nevermind the sober reports. This would really get to the public in ways that reports don't. I can already imagine the gnashing of teeth.

Alternatives to evidence based medicine

Heard this a couple years ago, but it's still worth a laugh.

The Onion on Medicare drug discounts

If you never read The Onion, you should. Everyone needs an occasional shot of irreverance and satire as it keeps things in perspective. Here's their take on the Medicare drug discount card. (Warning! CMS officials, members of Congress who voted for the bill, the AARP Board of Directors, and card vendors may find this insufficiently deferential.)

Starting the week in awe

Nothing to do with healthcare, but pause and reflect as we start the week. Here are 16 photos taken from the Hubble Space Telescope. One can admire the technical accomplishment that is Hubble and the photographs it captures or be awed by the nature of the universe or both. Simply astonishing.

More on baseball and Medicaid

Last November, I wrote an op-ed for the New York Post. It's no longer online, but here's the gist of it:

For decades, New York officials distressed with the cost of its Medicaid program have compared it to California's, which serves more people for less money. A more instructive lesson can be drawn by comparing the performances of their baseball teams.

As each usually does, the Oakland Athletics and the Yankees once again won their division titles this year. But it cost the Yankees three times as much in payroll. How does Oakland do it? In "Moneyball, the Art of Winning an Unfair Game," Michael Lewis credits General Manager Billy Beane - who hires statisticians who examine reams of baseball data to figure out what really wins.

New York needs a Billy Beane for its Medicaid program, someone who treasures the data and builds a team around it. Never mind the Medicaid differences between New York and California, the differences within New York are even greater - and we can do something about them.

The second baseball lesson is this: At the end of the ball game, we know who won and who lost. Not so in Medicaid, which measures hits but not runs. We know if the patient went to the hospital, but not if she got better.

In baseball, geeks and science are replacing tobacco-chewing coaches and common wisdom. With Gov. Pataki playing General Manager like Billy Beane, we can do the same with Medicaid. Let's redefine what a Medicaid "win" really is, and use the data to figure out how to do it. Then let's train new coaches and players so that a decade from now we can watch some real major league Medicaid.

For you baseball geeks (and I know you're out there) and others of you who would like to speculate on what we could be doing with Medicaid data, take a look at Sabernomics, Economic Thinking about Baseball. All we need is to be able to access Medicaid data like we do baseball data.

Finally, the transparent solution

It's Friday, the day after tax day. I can't help it.

Before getting serious, I can't help but think this is the solution. We've been patching things together for so long. Now we can patch things together and the patches will be hidden!

ps. You know that 3M is in the healthcare IT business as well.