We appear to have “bent the curve” in health care spending last year; national health spending grew at a historically unprecedented low of  3.9%. That’s including all national health expenditures — private insurance, Medicare and Medicaid, and out-of-pocket expenses.

You would think this was a good thing, right?

But according to Deloitte’s new survey, not necessarily:

• In the United States, three in four (75 percent) consumers say the recent economic slowdown has impacted their health care spending.
• Forty-one percent are more cautious about spending, 20 percent have cut back on spending, and 13 percent say they have reduced their spending considerably.
• Sixty-three percent say their monthly health care spending limits their household’s ability to purchase other essentials, such as housing, groceries, fuel, and education.
• In an effort to save money, 36 percent of prescription medication users say they asked their doctor to prescribe a generic drug instead of a brand name drug.
• One in four (25 percent) U.S. consumers skipped seeing a doctor when sick or injured.

• Consumers believe that hospital costs (68%), lifestyle

choices (62%), and fraud (62%) are major drivers of

overall health care costs. Administrative costs (57%),

prescription drugs (54%), and defensive medicine

(51%) are also commonly cited.

• Over half (51%) of all consumers believe that 50% or

more of health care spending is wasted

• Of those believing that the system is wasteful,

49% feel that money is wasted because

individuals are not taking enough responsibility

for maintaining their own health.

• Consumers also blame redundant paperwork

(55%), defensive medicine (46%), lack of

adherence to evidence-based approaches (40%),

and extreme measures taken at the end of life to

extend life for a short period of time (35%)

What are the odds that I would find myself in a room with two other women who  also worked at Intel and were passionate about health care?  I thought maybe a million-to-one until I met Halle Tecco and Leslie Zeigler at Rock Health. They are truly star power.

It gets better from there. Rock Health is a new nonprofit incubator in the touristy Chinatown part of San Francisco.  But take the elevator past the imported knickknacks and large animal sculptures in the doorway and you will find an open, industrial workspace dedicated to software development to change health care. These women have the dream of disrupting the worst-run consumer industry in America with new mobile technologies that put power back in the hands of patients and providers.

In case you are wondering where the power lies now, it’s in the hands of the payers.

In most industries, the growth of information technology has shifted power to the customer. Or at least put it in the hands of the vendor who can target based on known customer preferences.

But healthcare has very little CRM, and no VRM. These software driven terms translated to health care would mean that the provider had adequate information about you to offer you intelligent treatment choices, and that you as the patient had the power to choose who and what gets treated and what you will pay. In healthcare, the patient has almost no choice of either treatment or cost.

Rock Health has eleven resident grantees (who have received nominal sums of $20,000) in its the first program, and twenty “member companies” who have not received money but can come to workshops and receive advice. They are focused everywhere from preventing hospital readmissions, to drawing conclusions from large data sets, to helping people find doctors who will give discounts.

But Rock Health isn’t trying to boil the ocean of our broken health care system. Instead, it is trying to work around the intransigence of the existing old guard to empower patients. It doesn’t touch the areas of data integration or flirt with privacy laws no one understands. Realizing that mobile devices can be used for prevention, monitoring, and better communication, it is trying to encourage startups that can succeed in selling into this difficult market because they are not selling to hospitals, but rather selling WITH hospitals.

What I loved most about Rock Health, and why I plan to stay involved with it, is the energy of the founders, one of whom was recently diagnosed with ulcerative colitis and got a crash course in health care systems mismanagement herself while still in her mid-20s. She has blogged a bit about her colonoscopy prep here.

There’s nothing like being a patient in our health care system to fire you up for change.

A few years ago, my partners in AHITA.org ( a non-profit organized to help providers implement EHRs)  and I implemented an electronic health record in a physician practice. Along the way, we evaluated every major product and discussed with the physicians in the practice what they needed and how to examine their workflows to automate.  It was very effortful, took almost a year, and cost the physician practice about $50,000 in consulting fees.  At the end of the engagement, the AHITA partners decided in all good conscience that all the products sucked and wouldn’t help a small practice; we kind of drifted away from the idea of electronic health records. Our physician partner, who had written his own EHR, gave up in disgust because he couldn’t get anyone to buy it.

Now, Obama’s administration has given incentives that mandate EHRs. 2010 looks like it is going to be the year. And hopefully, many of the products have improved in their ease-of-use and financing programs during the past couple of years. There’s a lot of behavior change around implementing new technologies, and even practices that already own EHR technology need to learn to use it properly to qualify for the meaningful use incentives the government is offering. For most practices, this will mean an increased focus on workflows around ordering, e-prescribing, and clinical decision support and some attention to improving them, not just automating disfunction.

As far as I can discern from listening to the Allscripts webinar I just heard, many of the incentives revolve around seeing more Medicare and Medicaid patients.  All those physicians who were going to give up Medicare patients will be re-thinking that, because to qualify for the stimulus money they have to prove that 44% of their volume is Medicare, or 30% is Medicaid. And this is calculated by individual physician, not by practice.

For a physician, the Medicare part of the program starts this year. But this year you only have to prove that you used electronic records for 90 days during the year, and that at least 50% of your patient encounters have to be at a practice using a certified EHR. That goes up with every passing year.

Another interesting incentive: the physician’s payment will be based on multiplying his or her allowable charges  by 75%, so seeing a Medicare patient and using an EHR should make the patient (me) worth 75% more to the physician who sees me, especially if he delivers professional services, and doesn’t just send me for an MRI or to a lab. The incentive doesn’t count  fees for surgicenters or technical components of a doctor visit. This will be Medicare Part B services. (A physician aiming to collect $18k in 2011 has to submit allowable charges of $24k to Medicare and she will get paid $24k+$18k).

Physicians have to choose whether they want to participate in the Medicare part of the incentive program, or the Medicaid part. For a busy primary care practice, I bet Medicaid patients begin to look more attractive.

Now, away from the money and on to the part that benefits the patient:

Your doctor will now have to use five decision-support alerts in her software, and will have to give you electronic access to your records within 48 hours of your request. The incentives encourage the patient to become part of the conversation, and the doctor to communicate with the patient electronically. The government wants people to use personal health records, and for the physician to communicate with those PHRs, and that is going to happen FAST.

Here’s what the EHRs these physicians adopt will be required to do for the physician to get the subsidy:

• Electronically select, sort, retrieve, and output a list of patients and patients’ clinical information, based on user-defined demographic data, medication list, and specific conditions.
• Calculate and electronically display quality measure results as specified by CMS or states.
• Electronically submit calculated clinical quality measures
• Electronically generate a patient reminder list for preventive or follow-up care according to patient preferences based on demographic data, specific conditions, and/or medication list.
• Implement automated, electronic clinical decision support rules (in addition to drug-drug and drug-allergy contraindication checking) according to specialty or clinical priorities that use demographic data, specific patient diagnoses, conditions, diagnostic test results and/or patient medication list.
• Automatically and electronically generate and indicate real-time, alerts and care suggestions based upon clinical decision support rules and evidence grade.
• Automatically and electronically track, record, and generate reports on the number of alerts responded to by a user.
• Electronically record and display patient records and connect with other providers
• Patient information: electronic copy upon request in 48 hours80%
• Patient access to electronic information (i.e. lab results) within 96 hours of availability10%
• Clinical summary of each patients’ insurance eligibility, and submit insurance eligibility queries to public or private insurers

All the major products do this in one way or another. This doesn’t make them easier to deploy or train staff on, or use. Or make the change management any easier (that’s the part I do).

However, this sounds very promising for both the patient and the physician. And it’s not part of health care reform legislation, it was part of the stimulus, so we know it’s going to happen.

Makes me remember when electronic claims processing came into widespread use — which was not until Medicare mandated sending them electronically in order for physicians to get paid.  You’d be surprised how fast paper claims disappeared:-)

Dear Senator Kerry,

Your reported call for “lies” about health care reform to be refuted is essential and requires an urgent response. To that end, may we – British health professionals and patients – respectfully expose those “lies” which are about our National Health Service, a service which our experience shows to work successfully for the benefit of all in this country.

Continue reading to see the full letter.

PATIENT CHOICE: There is NO “death panel” in the UK NHS or anywhere else in the UK health care sector.
-Termination of a pregnancy is a personal decision if approved by two doctors. NO board or organization of any kind makes any decision about termination for fetal abnormality. Such decisions are personally made by those seeking such procedures after counselling by medical and other health professionals.
-Elderly people can get counselling and advice to help them determine their requirements for their future care, but only if they wish it. It is a service that provides information about issues such as living wills. This is similar to the US proposed Section 1233, which provides counselling and assistance to those wishing voluntarily to make their own arrangements for their future, medically and physically.
-Patients are normally registered with a family doctor practice of their choice. A patient is able to see a doctor immediately for urgent care in general practice although seeing his or her own family doctor for non-urgent care may require waiting a few days. If the patient requires referral for specialist opinion or treatment, they can choose whichever hospital they prefer.
CARE FOR THOSE WITH PRE-EXISTING CONDITIONS: In the US, people with pre-existing health problems are rarely covered by private insurance companies for those problems. Many do not change jobs for fear of losing cover for such conditions from their new insurers. The NHS is literally a life saver for those with pre-existing health problems – they are not denied care. It is vitally important that the NHS, and any government financed health plan anywhere, undertakes the care of such people.
CARE FOR THE ELDERLY: There is NO cut-off age for health care in the NHS. Senator Kennedy, like anyone else of that age, or older, and with health problems such as his, would have been treated by the NHS with the same high levels of care as someone younger. Care for the elderly includes free flu vaccinations, free medication, free operations as needed, nursing care visits, and help and adaptions for the home. Many hospitals now offer “hospital to home” programs for palliative and end of life care to enable very ill people to remain at home.

CARE FOR THE DISABLED: Professor Stephen Hawking of Cambridge University, recently awarded the Presidential Medal of Freedom by President Obama, is disabled and has always been under the care of the NHS. Professor Hawking is an outspoken admirer of NHS care. Like thousands of others who are disabled, he is entitled to free medical care and medicine, and he can get adaptions, equipment and home care to allow him to live at home.

FREE MEDICATION: NO ONE is denied medicine if they need it. All children up to the age of 16, pregnant women and adults over the age of 60, unemployed people, patients with cancer and many with chronic conditions, don’t pay for their medication from the NHS. 88% of medicines are dispensed without charge. For the minority who pay there is a standard charge of $11 dollars per prescription, regardless of the real cost of the drug. Some parts of the UK have abolished prescription charges altogether.

INSURANCE: Like the Healthy San Francisco medical plan, those in the UK can also take out private insurance, if they can afford it, although less than 1 in 8 currently do so. The co-existence of public and private coverage ensures complete freedom of choice.
THE COST: The NHS is funded by taxes and provides universal coverage while costing 8% of UK GDP. The US system currently costs 16% of GDP but leaves 45 million without insurance and a further 25 million underinsured.

BACKGROUND: The NHS was created in 1948. Its goal was to provide comprehensive medical care through taxation, universal coverage for the population which is free of charge at the point of care. It still does that despite the huge, and increasing, demands on its financial and practical resources.
The NHS is available free of charge to all regardless of ability to pay, and does not discriminate against those with pre-existing conditions. Importantly it gives freedom from fear of the financial consequences of illness.
Survey after survey shows that British patients express a high degree of satisfaction with the care they personally receive from the NHS. On average, British users of the NHS live longer and have a lower infant mortality rate than the US.
The NHS has shown itself to be open to – and often the source of – innovation. How the US manages its own health care reform will doubtless provide us with new ideas about how to improve some aspects of our own NHS service. In the same spirit, we respectfully draw to your attention what evidently works well here

Yours sincerely,

Sir George Alberti MD, PhD, PRCP
Past President of the Royal College of Physicians
Dean of Newcastle School of Medicine

Professor Alan Maryon-Davis FFPH FRCP
President, UK Faculty of Public Health

Professor Anthony Costello FRCP FRCPCH
Professor of International Child Health
Director of Institute of Child Health, UCL

Professor Andrew JM Boulton, MD, FRCP
Professor of Medicine, University of Manchester, UK
Consultant Physician, Manchester Royal Infirmary

Professor Mark B Gabbay MD FRCGP
Professor of General Practice
Head of Division of Primary Care
University of Liverpool

Professor Rodney Grahame CBE MD FRCP FACP
Consultant Rheumatologist, UCH
Honorary Professor at UCL, Department of Medicine

Professor Ian Banks
President of the Men’s Health Forum and member BMA Council

Professor Eileen O’Keefe
Professor of Public Health
London Metropolitan University

Professor Gill Walt
Professor of International Health Policy
Health Policy Unit,
Dept Public Health & Policy,
LSHTM, Keppel Street,

Professor Rosalind Raine

Reprinted from Gary Schwitzer’s blog (one of the pre-eminent health journalists and teachers)

Senator Merkin from Oregon wrote a piece in the Huffington Post yesterday that deserves your attention. You have to be concerned enough to remember when Frank Luntz, noted Republican pollster, drove all honest people crazy by turning English into Doublespeak and twisting words so they didn’t mean what we thought they did. Sen. Merkin says he’s back:

” I was shocked when I read a memo from Republican strategist Dr. Frank Luntz laying out plans to dismantle any effort to give all Americans access to quality health care. Dr. Luntz, the man who developed language designed to promote preemptive war in Iraq and distract from the severity of global warming, is at it again — this time with a messaging strategy designed to sink our historic opportunity for health care reform.”

According to Merkin, Luntz is out to kill health care reform even though he knows Republicans won’t get what they want, either. This is the original zero sum game.

“Dr. Luntz lays out multiple ways that opponents of health care reform can trick and manipulate the American public. One strategy that stood out to me is to call efforts to reform our broken health care system a “bailout for the insurance industry.” This statement is developed to serve the same interests who stopped at nothing to derail health care reform in the 90′s, who blocked health care coverage for low-income children, and whose top Medicare priority for 15 years has been transferring money from seniors and taxpayers to the insurance industry.”

Even the insurance industry is now engaged in constructive negotiations about how to repair the health care system…however, Dr. Luntz’s new game plan to stop change is being embraced by leaders in the Republican Party. In a briefing where Dr. Luntz presented his strategy to Republican House members, Rep. Mike Pence from Indiana, the chairman of the House Republican Conference, made it official by saying, “Frank is back.”

The bad thing about all this manipulation of languages is that when voters get confused and can’t really follow the issue, they vote no. It would be awful if the result of Luntz’s work was to get Americans to call their representatives to oppose the very thing the country needs most.

Image via Wikipedia

Relying on a story from the Pew Research Center for People and the Press, Joe Scarborough called Obama the most polarizing President of our times on Twitter Friday. Because I have an empty life, most of which is frittered away on Twitter (I’m being sarcastic) I followed the conversation over the weekend, and it certainly depressed me.

People on Twitter who are on the “left” called Scarborough a racist, and accused him of supporting such activities as waterboarding and of ‘inciting rage.” He answered many of them back, citing facts and information, trying to call for fairness. He didn’t get down to the fighting words, either. He tried to have a “conversation.”

I am not a Republican, nor am I a conservative. My business buddies in Arizona have often accused me of socialist leanings when I talk about the universal right of Americans to health care.

But I listen to “Morning Joe” as often as I can wake myself at 3AM, which is when it airs in Arizona and California, and as much as I don’t always agree with Joe, I find he’s at least open to Obama’s presidency and willing to praise Obama for what he does well. And if you read the article from the Pew Center, it does lead off with how much gap there is in Obama’s approval ratings between Republicans and Democrats — 61%. Many Republicans I know think Obama is making us into Europe and going to take away our right to defend ourselves and hand the country over to Hugo Chavez in exchange for a book.

As Joe is finding out, it’s getting harder and harder, even in the world of Facebook, Twitter, and Friendfeed, with all the tools available to us, for people who disagree to have a “conversation.” Is there no place for independent thought? Respectful arguments?

Saturday afternoon I went to a supposed Town Hall presented by the Progressive Democrats of Arizona, the Health Care Now organization, and a couple of other democratic organizations.

The meeting, which was supposed to present details on a half dozen competing health care plans, devolved into a tirade on the single payer system and a harangue about why to support the single payer alternative making its way through the House of Representatives “before it’s too late.”

I don’t really know how I feel about single payer plans. I am on Medicare, and it seems to work extremely well. But that’s because I can afford one of the highest priced supplements, not a Medicare Advantage plan, and not just plain vanilla. Everyone should be on Medicare, and everyone should pay for it.

Before Medicare, I had what everyone in the US who is either self-employed or a small business person has, a catastrophic plan with a very high deductible — made higher every year as the premiums kept escalating.

I certainly don’t want “rationing,” in the way single payer plans often present it: denying people treatment after a certain age, making them wait for tests until they’re sicker. But I don’t delude myself that mandating health insurance will make everyone buy it. In Arizona, auto insurance is mandatory, and 50% of vehicles are uninsured.

Anyway, I got disgusted during the “Town Hall” at people supposedly on “my side” and walked out. I couldn’t learn anything, and I found their enthusiasm for their own blind point of view embarrassing. What’s more, they argued with one another, using phrases like “we can’t say that — the Sean Hannitys will be all over us.” They weren’t arguing the merits of anything, but just about how best to present their own point of view so it could slide by the right. How is that Progressive? It’s re-gressive.

I find myself wishing they would have a substantive conversation about the best way to provide universal affordable access to care on “Morning Joe.” Between Joe and Mika, they could elevate the dialogue and present the competing issues. They could talk about personal responsibility, outcomes management, education and prevention, changing the incentives, and using technology wisely. Oh, and also about our litigious society and what it has done to the way doctors practice and driven up the costs of care with CYA testing. They could have politicians and policy wonks come to the table. They could advance the discussion.

Because whether Joe Scarborough knows it or not, he’s heading toward becoming an Independent, just like I did.

When Coastside Family Medical Center in Half Moon Bay suddenly closed its doors, both the insured and the uninsured members of the comunity suffered.  The insured had no idea that they were part of the “cause” of the problem; the CFMC was unable to get legal recognition as a clinic for the poor because we, the insured, “ruined it” for our uninsured neighbors by being too prosperous.

I look at this as a microcosm of what could happen in any community any day, so I’m sharing the information below about the economics of running a family practice under today’s health laws. The information was provided by the Half Moon Bay Chamber to its members. It shows where we are as an industrialized nation in making health care accessible to our citizens. Remember, this clinic is 30 miles from a major city.

*The Board of CFMC would like to take this opportunity to clear up som
misconceptions.*
The Board of CFMC greatly regrets having to close the clinic and wishes that
we could have done more to make the transition less painful for both the
patients and staff. We are very grateful to the staff that has worked so
hard over the years and in this difficult time to provide the best health
care possible to Coastside residents. We’re also very appreciative of
community members who jumped in and tried to provide positive assistance for
those who needed immediate help.

The directors want the community to fully understand how hard and how
emotional this was and how hard we worked to keep the clinic open. We
realize the closing was less than smooth and that many of you are angry.
Please know that all of us deeply regret the ‘perfect storm’ that derailed a
timely notification and closure. Please also understand that we did not
cause those events to occur, whether the questionable conclusion of the
county or the unpardonable ethical lapse of the payor that held the check.
We are devastated at the loss of the clinic that we have patronized for up to 30 years and that we worked so hard to keep alive for eight years. We
hope the community will join us in trying to change the health laws thatended our vision after eight productive years.

Now that Obama has told people that health IT is on his radar screen for public investment, all the interest groups are lining up.  Below are some excerpts from a blog post by the head of the Commission on Health Information Technology,

a nonprofit group that certifies  electronic health records for standards, functionality and interoperability. For a while now, health record products have been applying for certification by his group. Plus, he’s a former physician. He’s not uninformed.  But I can’t really agree with him.

“… even a 1% improvement in the efficiency of our $2.2 trillion healthcare spend would put us in positive payback territory… Most doctors know they need EHRs and many will respond to an economic push right now.  And the industry supplying those EHRs is a competitive, diverse marketplace that will respond to growing demand with increased capital investment and job growth.”

I disagree that most doctors know they need EHRs. I’ve been working with small practices trying help them decide on deployment for years, and the word in the physician community, at least in Arizona, is that most of the deployments do not save time or costs as they are supposed to.  This is partially because the products are complex and require a great deal of training as they are built now. The worst are the industry leaders in use by many hospitals. The doctors are trying to wait it out until they can retire, except for the younger ones who grew up with IT and demand it. This creates enormous conflict in any practice of more than a single doc: each provider has a different theory and a different need and a different favorite.

To make it more complex, the turnover in medical support personnel, front office and back office, is often frequent, so the training on these complicated products is ongoing and expensive. Support, services and training are the model by which some of these software companies increase their revenues.

“Outright grants may be appropriate for providers in rural and underserved areas, and for safety-net clinics, but in other environments financial incentives should be structured as a series of incremental rewards for progressive achievements.  In the private sector, the Bridges to Excellence program sets an excellent example, while the recently launched Medicare EHR Demo provides a public sector prototype.  These programs offer initial incentive payments for purchasing appropriate technology – a certified EHR — then a second round of money when successfully implemented.  Beyond that, bonuses are paid only as the provider demonstrates improvements in quality or efficiency.  Healthcare payment reform and healthcare IT — twins separated at birth – must grow up and mature together to achieve their full potential.”

I am about to see if my  ownproviders are part of the Arizona Medicare EHR demo so I can sign up. But the people who see Medicare patients, already squeezed by lower Medicare payments, may have difficulty finding the time to implement software while seeing the huge volumes of patients they must now see to keep their offices open.
“…some of the stimulus funds should be used to develop the skilled workforce needed.  It may be possible to redeploy IT personnel from other industries to lay broadband infrastructure for healthcare, but we’ll also need to boost health IT training programs.  And doctors and nurses being asked to change their habits are best motivated by one of their own – a clinician champion.  There are plenty of clinicians who have successfully led these projects, and we can’t afford to have their experience locked up within their own organizations — let’s find a way to put them on a health IT inspirational speaking circuit.”

Speaking circuit? We’ve had those for a while, but the doctors are too busy to show up!

Here’s the only part I think has any hope.  Shift from the doctors (the supply side) to the demand side. Otherwise EHRs are a band-aid.

“You’ve also wisely recognized the need to redirect our health efforts toward prevention, helping people make better choices early in life, and eventually reducing the burden of expensive interventions near the end.  To do this, we need to empower citizens with health knowledge, allowing them to make better health choices and to become more discriminating healthcare consumers.  Personal Health Records (PHRs) will emerge as a platform for this new information flow.  The organization I lead is also preparing to certify these PHRs, to ensure they are secure, private, and can exchange information with EHR systems in doctors’ offices and hospitals.  Projects in this field are a promising area for government investment.”

This part I would like. Many citizens want their records in their hands, and if the central repositories (insurers, pharmacies, hospitals, Medicare/Medicaid) could be “forced” (incented) to dump their data into a PHR, we could help solve this problem. I have a PHR, but I can’t populate it very easily, and since part of it consists of scanned pieces of paper, I can’t search it or see trends. I look for someone like Microsoft or Google to help with this; they are already in the space with products I’ve tried.

“…our  current model is amenable to improvement with an assist from better information.  With better data on prices charged and quality of care delivered, we can reform payment to reward clinicians for the quality or their work, instead of just for the quantity.  With EHRs that easily intercommunicate, we can reward better teamwork among providers to re-integrate care despite our fragmented healthcare business model.  And with empowered health consumers and an online connection that extends beyond the occasional visit to the doctor, we can motivate healthy lifestyles and prevention, eventually reversing the growing burden of chronic diseases.”

Amen, brother. Bring on Health.2.0! It’s already out there in hundreds of online patient communities trading information. That’s where the inspirational speaking tour should begin — with the patients, not the doctors.

“One sine qua non for any future sustainable U.S. health system is the necessity to empower, rather than undercut each citizen’s right to choose health care and take responsibility for his/her own wellness. Countless chronic diseases result from the neglect of basic wellness measures. The blame for underutilizing such proactive, cost-saving approaches lies directly with the official policy of blind reliance on drugs and surgery, whatever the cost. The public has been lulled into medical apathy on the false assumption that if something goes wrong, fix-it mechanics will tune up your body the way a garage tunes up your car.”–Deepak Chopra

“[S]pecial interests are especially numerous and influential in the health-care system. Health care comprises one-sixth of our economy… since cutting costs is tantamount to cutting profits for many of these special interests, it is reasonable to expect (an) all-out war to defeat reform.”–former Sen. Tom Daschle

The premise of this site is the empowered health care consumer. As patients, as consumers, and as providers, we have to partner with the payers, whether they be employers, governments, or ourselves. Often we undermine our own health, thinking we will get a last-minute bailout. When we get the bill and realize there is no bailout, we’re angry.

Well, welcome to the future, in which “Health 2.0″ can produce healthy communities through readily available information. There is plenty of reputable health information online, most of it since Web 1.0, including such well-known sites as WebMD and Medscape. There are sites such as EmpowHer dedicated to women’s health issues, We will point to the trusted places here. We will also help by pointing to reputable insurance providers and ways to navigate the health care system, often entered by consumers when they are at their most vulnerable.

Our vision is to be a trusted source for an empowered consumer. To do that, we will build a community of people who can share experience and information. Aggregating and filtering information that already exists, we hope to create some shortcuts you can use.

If you would like to add your wisdom to this site, let’s talk.