As we come to the end of 2010, I wanted to leave you all with a few gifts to wrap and give to your friends -- some small gems of health reform that may have escaped attention.
There are a variety of charts that show what health reform has and will achieve by the time it is fully implemented. Some of these charts are being used to scare people about the scope of this law. But these charts and timelines also show how complicated it would be to unravel this law, given that so many of the moving parts are linked together.
As I combed through these charts, I picked out the following 10 gifts -- something between the 8 nights of Hanukkah and the 12 days of Christmas:
1. Here are a package of gifts you should already know about --- In September of this year, the law began prohibiting lifetime limits on your coverage; denial of coverage because of pre-existing conditions for kids; a way for people with serious illness who have been without insurance for awhile to get into a state insurance program, and new prevention programs. And by the end of the year, seniors will have access to preventive services at no cost and the donut hole for prescription drugs will begin to disappear.
2. Do you know someone who has retired but is receiving retiree health insurance assistance from their employer? Are they worried about how they can afford to keep their health insurance or whether their employer will drop the coverage? In June of this year, the Secretary of HHS created a temporary $5 billion fund to hep employers provide health insurance to retirees 55 to 64. This replaces a prior government program that helped employers keep retirees health insurance active, so it's basically an incentive to companies to keep doing that.
3. What to give your friends who are always worrying about fraud and abuse in government programs? There are new efforts at catching doctors and hospitals who cheat Medicare and Medicaid programs with false claims. There was already a big sting in Florida where Medicare caught doctors making fake claims for fake patients to the tune of over $250 million. Monitoring fraud takes resources, but the return on investment is substantial.
4. We all know someone who worries about the costs of health care and thinks health reform will do nothing about it other than jacking up their premiums. There are actually hundreds of ways that reform is going to chip away at costs because of the law. One of the ways the government is going to ensure that your tax dollars and contributions to Medicare pay for what is really needed, is to pressure providers to become more efficient. We have had a system where doctors get paid more when they do more, no matter whether it cures you! Medicare will now begin to pay bonuses to doctors and hospitals that provide better quality care -- the better the quality, the better the bonus. No improvement in quality? Less money. Sounds sensible doesn't it? Should have been done a long time ago.
There will also be better state oversight of insurance companies that announce big increases in monthly premiums. Some states like Connecticut have given themselves the authority to actually deny these increases; other states will try to use persuasion, public shaming, or non-legal methods to keep premiums in line. Bottom line is that these big premium increases will not go unnoticed or unpublicized. And by 2014, you'll have a lot more choice of plans, because these same insurance companies will be directly competing for your business through the Exchanges. If you believe market forces can help keep costs under control, this type of consumer choice could make a difference.
5. What if you have a friend who lives in a rural area and their hospital is small or they have to travel a long way to get care? Health reform is putting resources into hospitals in those communities, to help them with telemedicine (sending your x rays to a medical center where an expert can read them or consulting with the country's expert on your diagnosis, etc.) and money for training physicians, nurses and other practitioners with enticements for them to practice in a rural area. This change may mean little to those of you who live in a big city, but there's nothing scarier than living in a rural area and getting really ill but not being able to get the care you need.
6. Do you have a family member who has dementia and is in some type of assisted living or nursing home? No matter how much you visit, you can't really guarantee they will get the care they need when you're not around. Caregivers who work in these facilities often work at minimum wage with very little training. Starting in March of next year, there will be money available to train staff in those facilities so they understand better how to care for these folks. The shocking fact is that:
According to recent estimates, as many as 2.4 million to 5.1 million Americans have Alzheimers Disease (AD). Unless the disease can be effectively treated or prevented, the number of people with AD will increase significantly if current population trends continue. That's because the risk of AD increases with age, and the U.S. population is aging. The number of people age 65 and older is expected to grow from 39 million in 2008 to 72 million in 2030, and the number of people with AD doubles for every 5-year interval beyond age 65.
If you've visited one of these places recently, no matter how good they are, there's so much more that needs to be done to make the lives of our elders better as they decline. This training doesn't require much money but it can do so much good.
7. Haven't you wondered why we still have a paper based system in health care, when you can go to an ATM anywhere in the country and get your account balance and money out? The reasons for lack of progress are many, but one of the reasons is that so few of the existing data systems talk to each other adequately. Even before health reform passed, President Bush put resources into upgrading our HIT systems, and health reform has given a big boost to that effort. Medicare, which is known to pay claims very slowly, has an outdated system that will be upgraded due to health reform. And doctors and hospitals will have some guidance from experts on how to implement a system whereby they can send your medical records to another facility instantly, should you get sick while you are traveling -- or where you can go online and look at your medical records, know when you need to get a screening or vaccination, see the results of the blood test you had yesterday. In my home town, we already have that and I love the speed and ease with which I can find this information.
8. Anyone hurting here? If you have a friend with chronic pain, you already know that it is truly hard to get good information about what works and what does not. It doesn't matter if you are rich or poor. Even people like Rush LImbaugh who apparently was in a lot of pain recently, got addicted to oxycontin to manage his pain. He may not have known what the alternatives were, because there has not been a huge amount of attention paid to pain management in the past. If you want some real good research on pain and some objective ideas about how to manage it, starting in March of next year, there will be a special coordinating committee to look at pain research and report to Congress on its findings. Hopefully this will lead to options other than oxycontin.
9. Do you know someone who has had trouble finding a physician or who has lost access to the physician they used to have? Health reform releases money this year to train a variety of health professionals, help physicians in training get scholarships and loans, and encourage physicians to practice in rural or underserved areas. There will also be a national workforce committee to look at future needs for physicians and other professionals as we shift focus from emergency care to primary care.
10. Are you one of the people who feel that malpractice reform was neglected and that Democrats don't care about that? Starting in 2011, there will be funding for 5 year grants at the state level to take a close look at what is working and what is not to reduce litigation. We have a lot of interesting malpractice projects going in California, Texas, and other states, but we need to understand why some of these programs seem to reduce lawsuits while others make little impact at all. This has been a major Republican talking point, and this health reform law, which so few Republicans supported, actually puts some money to the problem of figuring out how to do it. It also makes it a state-based initiative, not a big federal mandate, something else Republicans should like. On the other side of the coin, for people who have actually been harmed by bad medical practice, health reform implemented this year a slew of new ways to appeal medical decisions, something the consumer public needs to have.
My point here is that there are many, many changes going on in the health care system at this very moment, and these changes are ultimately going to improve health care delivery. You may not hear much about them; in fact, you probably won't. But gradually we will see fewer medical errors (wrong legs being operated on), better customer service (fewer minutes on hold), more responsiveness from your physician (being able to use email with your doctor), and ultimately, lower costs (once everyone is "in" and paying their fair share).
Those are holiday gifts that won't have to be returned!
Le Web 10 host Loic Le Meur just finished his on-stage interview with Alexander Tamas, Partner at one of the most watched technology investment firms on the planet, DST / Mail.ru Group.
That’s quite a presence you have: Groupon, Zynga, Facebook and … Twitter?
Not Twitter (smiles).
What is DST?
The firm originated in Russia, grew out of social networking company called Mail.ru, and at some point we started making international investments. Facebook was our first one.
How big is your stake in Facebook now?
It’s hard to say, we’ve made some straightforward investments and then we bought as many shares from early employees and investors as possible. We’ve definitely invested more than $500 million in total though.
So Facebook was your first investment – how did that come about?
Well, we owned and ran a social network in Russia, but the dynamics there were different, we were actually ahead of most social sites. Every single one of our countries became really big. So, we knew there was money in it, and we realized quickly that it was only a matter of time for Facebook to become really large worldwide.
Did you lead the Mail.ru Group IPO as well?
Yes, that was last month.
Is it the biggest tech IPO in Europe to date?
In the past few years, yes. The initial market valuation was about $6 billion, we’re now at roughly $8 billion.
So when’s the Facebook IPO planned?
I don’t have any comments on that (smiles).
Do you sit on the Facebook board?
No we actually don’t, but we obviously have good relationships with management and other board members. our perspective is that it’s entirely possible to be a major investor in a company without being on the board, as long as you have an open dialogue with the people in charge.
You got in late, what was Facebook’s valuation at the time?
We got in at a $6.5 billion valuation. It’s difficult to say what the valuation is now – although I can tell you the secondary market ones are based on limited information and generally not super accurate.
We haven’t purchased Facebook shares in quite some time though.
The Zynga investment came after Facebook?
Yes.
Why haven’t they been acquired yet?
If you’re a founder of company like Zynga, with fast growth and massive revenues, it only makes you wealthy on paper, right. So you used to have two choices: sell or take it public. Now, companies can get liquidity early on, so it takes the pressure of.
We invested $150 million in Zynga, but we didn’t disclose at what valuation.
So Groupon was almost sold …
I can’t comment on the rumors, but I can tell you that they’re going for it. They realize they have something special and there’s a lot of potential for Groupon to become a generation-defining company. They’re shooting for the stars.
By the way, I’m always amazed when people discuss valuations of private companies without actually knowing the financials. The truth is most people can’t say whether investments come cheap or expensive, as commentators. It all depends on how you measure growth, and most people tend to think linearly.
When we invested in Groupon, they sold 4 million groupons, a month later it was 25% more. The potential was obvious. They’ll hit 20 million groupons sold next week.
How does a startup get an investment deal out of DST? Is Twitter big enough, as an example?
It’s definitely an interesting company, but there are more. What we look at is that you have to be on a path to become a clear leader in your segment, companies that could theoretically go public today. We want to know all companies, but we focus our investments on those with long-term sustainability.
You know, we’re not an early-stage investor. We’re really small, with no people on the ground. So we can’t really help companies when they’re just getting started, apart from writing a check, and that’s not what we want. There are many more capable firms for that.
So startups should give you a call when they hit a $1 billion valuation?
Not really, we’ll also talk to you if you’re clearly on a path to becoming a $1 billion company down the line.
What about Foursquare?
There are lots of opportunities for them, they’re seeing good growth, so it could become a really interesting company for sure.
You’re (sort of) a European fund – why don’t you invest more here?
Groupon, Zynga and Facebook really just happened to be US companies, we look all over the world for companies. We tick boxes, and we can do that anywhere.
Many of the startups in Europe for some reason want to sell out early. That’s not what we’re looking for. There aren’t enough role models here, so less confidence.
Do you look at Asia, more specifically India, China and Japan?
It’s definitely a geography we’re looking at. We know a lot of the companies there already.
What’s your advice for young entrepreneurs?
Not many people have the opportunity to really change the world. If you have an urge to build something that could, don’t focus on the money, but the legacy you’ll leave behind.
It’s a once-in-a-lifetime opportunity to build a generation-defining company, so I applaud people for shooting for the stars. It’s a much more rewarding thing than doing it for the money.
I mean, look at Le Web, it’s not just about the money right, it’s also the community, helping out startups throughout Europe.
Loic: yes, we actually got a few offers, but we’re not looking at that right now.
bench craft company scamNews sites are a good place to advertise since 92% of consumers use multiple platforms to get news.
It looks like News Corp. has unloaded its Fox Mobile Group division. According to a release, investment company Jesta Group has acquired Fox Mobile Group (FMG) from News Corporation. Terms of the deal were not disclosed in the release.
British mag NGamer put together a clever 2010 "year in review" of mainstream news using WarioWare DIY. Some of the referenced incidents may be obvious internationally, while others are quite UK specific, so we made a list of the ...
bench craft company scamNews sites are a good place to advertise since 92% of consumers use multiple platforms to get news.
It looks like News Corp. has unloaded its Fox Mobile Group division. According to a release, investment company Jesta Group has acquired Fox Mobile Group (FMG) from News Corporation. Terms of the deal were not disclosed in the release.
British mag NGamer put together a clever 2010 "year in review" of mainstream news using WarioWare DIY. Some of the referenced incidents may be obvious internationally, while others are quite UK specific, so we made a list of the ...
bench craft company scamNews sites are a good place to advertise since 92% of consumers use multiple platforms to get news.
It looks like News Corp. has unloaded its Fox Mobile Group division. According to a release, investment company Jesta Group has acquired Fox Mobile Group (FMG) from News Corporation. Terms of the deal were not disclosed in the release.
British mag NGamer put together a clever 2010 "year in review" of mainstream news using WarioWare DIY. Some of the referenced incidents may be obvious internationally, while others are quite UK specific, so we made a list of the ...
bench craft company scamNews sites are a good place to advertise since 92% of consumers use multiple platforms to get news.
It looks like News Corp. has unloaded its Fox Mobile Group division. According to a release, investment company Jesta Group has acquired Fox Mobile Group (FMG) from News Corporation. Terms of the deal were not disclosed in the release.
British mag NGamer put together a clever 2010 "year in review" of mainstream news using WarioWare DIY. Some of the referenced incidents may be obvious internationally, while others are quite UK specific, so we made a list of the ...
bench craft company scamNews sites are a good place to advertise since 92% of consumers use multiple platforms to get news.
It looks like News Corp. has unloaded its Fox Mobile Group division. According to a release, investment company Jesta Group has acquired Fox Mobile Group (FMG) from News Corporation. Terms of the deal were not disclosed in the release.
British mag NGamer put together a clever 2010 "year in review" of mainstream news using WarioWare DIY. Some of the referenced incidents may be obvious internationally, while others are quite UK specific, so we made a list of the ...
bench craft company scamNews sites are a good place to advertise since 92% of consumers use multiple platforms to get news.
It looks like News Corp. has unloaded its Fox Mobile Group division. According to a release, investment company Jesta Group has acquired Fox Mobile Group (FMG) from News Corporation. Terms of the deal were not disclosed in the release.
British mag NGamer put together a clever 2010 "year in review" of mainstream news using WarioWare DIY. Some of the referenced incidents may be obvious internationally, while others are quite UK specific, so we made a list of the ...
bench craft company scamNews sites are a good place to advertise since 92% of consumers use multiple platforms to get news.
It looks like News Corp. has unloaded its Fox Mobile Group division. According to a release, investment company Jesta Group has acquired Fox Mobile Group (FMG) from News Corporation. Terms of the deal were not disclosed in the release.
British mag NGamer put together a clever 2010 "year in review" of mainstream news using WarioWare DIY. Some of the referenced incidents may be obvious internationally, while others are quite UK specific, so we made a list of the ...
bench craft company scamNews sites are a good place to advertise since 92% of consumers use multiple platforms to get news.
It looks like News Corp. has unloaded its Fox Mobile Group division. According to a release, investment company Jesta Group has acquired Fox Mobile Group (FMG) from News Corporation. Terms of the deal were not disclosed in the release.
British mag NGamer put together a clever 2010 "year in review" of mainstream news using WarioWare DIY. Some of the referenced incidents may be obvious internationally, while others are quite UK specific, so we made a list of the ...
bench craft company scamNews sites are a good place to advertise since 92% of consumers use multiple platforms to get news.
It looks like News Corp. has unloaded its Fox Mobile Group division. According to a release, investment company Jesta Group has acquired Fox Mobile Group (FMG) from News Corporation. Terms of the deal were not disclosed in the release.
British mag NGamer put together a clever 2010 "year in review" of mainstream news using WarioWare DIY. Some of the referenced incidents may be obvious internationally, while others are quite UK specific, so we made a list of the ...
bench craft company scamNews sites are a good place to advertise since 92% of consumers use multiple platforms to get news.
It looks like News Corp. has unloaded its Fox Mobile Group division. According to a release, investment company Jesta Group has acquired Fox Mobile Group (FMG) from News Corporation. Terms of the deal were not disclosed in the release.
British mag NGamer put together a clever 2010 "year in review" of mainstream news using WarioWare DIY. Some of the referenced incidents may be obvious internationally, while others are quite UK specific, so we made a list of the ...
bench craft company scamNews sites are a good place to advertise since 92% of consumers use multiple platforms to get news.
It looks like News Corp. has unloaded its Fox Mobile Group division. According to a release, investment company Jesta Group has acquired Fox Mobile Group (FMG) from News Corporation. Terms of the deal were not disclosed in the release.
British mag NGamer put together a clever 2010 "year in review" of mainstream news using WarioWare DIY. Some of the referenced incidents may be obvious internationally, while others are quite UK specific, so we made a list of the ...
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