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The Public Health Enemy at the Gate

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President Donald Trump  keeps getting kicked around in court when challenges are brought against his ban on travel from seven predominantly Muslim nations. Trump says he wants to halt the flow of people who might be planning attacks. What we cannot forget is that the kind of attack he has in mind is not confined to bombs and shootings. Trump is terrified that immigrants bring diseases with them. If racism fails, public health will likely afford Trump the rationale he seeks for making it difficult for those he does not like to enter our country.

The president is a self-described germaphobe. He has doubts about vaccines. He likely does not wake up every day to thrill at the latest advances in science. This is a president who might possibly let an infectious disease do what he has so far not been able to accomplish by impugning the country or religion of immigrants he doesn’t like: provide the basis for a ban.

The threat of a pandemic is yet another avenue he could possibly embrace to create a Fortress America. He might demand more walls, quarantine stations at airports and one-way tickets home for every potential human vector — including the frail, kids and pregnant women. No one who is sick, might be sick or who can be smeared as the source of Americans getting sick would get in.

Pandemic flu, Zika, yellow fever, West Nile and a host of other maladies are likely to keep popping up over the next four years. The news media are great at stoking fear about all of them. Public officials are ill-prepared to know what to do about any of them.

Don’t Get Too Distracted By the Smoke Coming Out of Washington

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Health care has risen to the top of the national agenda and Washington policymakers are once again debating how to affordably provide coverage and care for Americans. It is a discussion we welcome. But in the meantime, let’s not lose sight of the fundamentals that will ultimately produce greater value for our health care dollars.

At the heart of a high-performing health system is quality outcomes. For consumers to make informed decisions, they’ll need more data—reliable, actionable data. Health plans operating in managed care are accustomed to demonstrating their value and in fact have performed well under such scrutiny.

The National Committee for Quality Assurance (NCQA), a national organization dedicated to measuring and improving health quality, has published annual evaluations of every private, Medicare and Medicaid health plan in the country for more than a decade.

A Measure of Insight on MACRA

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Featured Presentation: http://bit.ly/2lhvpjM

A 2016 study by Researchers at Weill Cornell Medical College and the Medical Group Management Association found that physicians and their staff spend between 6 and 12 hours per week processing and reporting quality metrics to the government – at a cost of $15.4 billion a year.

As a recent Health Catalyst MACRA survey confirms, that burden is expected to significantly worsen in 2017 and beyond as physicians struggle to report quality metrics for the Medicare Access & CHIP Reauthorization Act (MACRA) – the federal law that changes the way Medicare pays doctors. Commercial health insurers are expected to follow the government’s lead with similar programs of their own. In complex organizations, successfully achieving performance targets and submitting accurately for MACRA incentives will require integrating multiple measures across financial, regulatory and quality departments.

Trump Issues Obamacare Proposed Rule to “Increase Patients Health Insurance Choices For 2018”

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CMS this morning released the following statement:

The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule for 2018, which proposes new reforms that are critical to stabilizing the individual and small group health insurance markets to help protect patients. This proposed rule would make changes to special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers, and actuarial value requirements; and announces upcoming changes to the qualified health plan certification timeline.

“Americans participating in the individual health insurance markets deserve as many health insurance options as possible,” said Dr. Patrick Conway, Acting Administrator of the Centers for Medicare & Medicaid Services.  “This proposal will take steps to stabilize the Marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options. They will help protect Americans enrolled in the individual and small group health insurance markets while future reforms are being debated.”

The rule proposes a variety of policy and operational changes to stabilize the Marketplace, including:

  • Open Enrollment Period: The rule proposes to shorten the upcoming annual open enrollment period for the individual market. For the 2018 coverage year, we propose an open enrollment period of November 1, 2017, to December 15, 2017.  This proposed change will align the Marketplaces with the Employer-Sponsored Insurance Market and Medicare, and help lower prices for Americans by reducing adverse selection.
  • Special Enrollment Period Pre-Enrollment Verification: The rule proposes to expand pre-enrollment verification of eligibility to individuals who newly enroll through special enrollment periods in Marketplaces using the HealthCare.gov platform. This proposed change would help make sure that special enrollment periods are available to all who are eligible for them, but will require individuals to submit supporting documentation, a common practice in the employer health insurance market. This will help place downward pressure on premiums, curb abuses, and encourage year-round enrollment.
     
  • Guaranteed Availability: The rule proposes to address potential abuses by allowing an issuer to collect premiums for prior unpaid coverage, before enrolling a patient in the next year’s plan with the same issuer. This will incentivize patients to avoid coverage lapses.
     
  • Determining the Level of Coverage: The rule proposes to make adjustments to the de minimis range used for determining the level of coverage by providing greater flexibility to issuers to provide patients with more coverage options.
     

Teaching Health Delivery Science in the Digital Age

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Our health system is facing an existential crisis. We’re not alone. As the largest hospital in the western United States and a member of the 2016-17 U.S. News & World Report Best Hospitals Honor Roll, Cedars-Sinai Medical Center is known for its exceptional quality of care… but also for its high cost of care. In an era of value-based healthcare financing and full-risk contracts, it is an existential challenge for health systems like Cedars-Sinai to bend the cost curve while maintaining or improving patient outcomes, satisfaction, and safety. If we can’t bring down costs, then insurance companies may take their business elsewhere.

To meet the challenge, healthcare systems like ours must become facile with managing and interpreting big data; learn how to implement health information technology in clinical practice; perform continuous self-assessments to ensure high-quality, safe and effective care; measure and address patient preferences and values; master the principles of digital health science; and, ultimately, ensure all these activities are cost-effective. This is exceedingly hard to do, but there is a science for doing it all. It’s called health delivery science.

We recently launched a new Master’s Degree program in Health Delivery Science (MHDS) at Cedars-Sinai, the first of its kind in the nation. Having struggled with the challenges of adapting to the requirements of value-based healthcare, we’ve learned enough lessons to fill not only a textbook, but an entire curriculum. So, we decided to develop a comprehensive degree program to teach others about our own successes and failures. We hope that other organizations can benefit from our blueprint. This article outlines our new curriculum as a framework for how to define and teach health delivery science in the digital age.

Travel Ban Is Revealing—but Does Not Threaten American Medicine

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A 90-day ban on travel from seven countries has sparked tremendous outpourings of worry or outright opposition by some 33 medical organizations.

“The community is reeling over the order, fearing that it will have devastating repercussions for research and advances in science and medicine,” states an article in Modern Healthcare.

Certainly the order is disrupting the lives of individual physicians who have won coveted positions in American medical institutions and were not already in the U.S. when the order was issued. Also their employers have a gap in the work schedule to fill. War tears people’s lives apart, however innocent they may be. And countries that sponsor terrorism have effectively declared war on the U.S.

But is American medicine so fragile that it can’t survive a 90-day delay in the arrival of physicians, most of them trainees, from Iran, Iraq, Libya, Syria, Yemen, Somalia, and Sudan? After all, every year more than a thousand seniors in U.S. medical schools do not land a position in a post-graduate training program through the annual computerized “Match” of graduates with internships.

Say You’re Sorry, Donald

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I’ve never met Dr. Suha Abushamma or Dr. Kamal Fadlalla. 

But of all the frustrating stories circulating since President Trump issued an executive order barring immigrants from several predominantly Muslim countries, their travails hit closest to home. 

Both Suha and Kamal are internal medicine resident physicians. From Cleveland Clinic and Brooklyn Interfaith Medical Center, respectively. Like me, they have endured the rigorous calling that is American medical training, including not only graduation from medical school, but also the completion of four board exams, a vigorous interview process, acceptance to a medical residency and ultimately working long hours caring for very sick patients.

Should We Blame Technology For the Growth In Healthcare Spending?

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Should we blame technology for the growth in healthcare spending?  Austin Frakt, a healthcare economist who writes for the New York Times, thinks so.  Citing several studies conducted over the last several years, he claims that technology could account for up to two-thirds of per capita healthcare spending growth.

In this piece, Frakt contrasts the contribution of technology to that of the ageing of the population.  Frakt notes that age per se is a poor marker of costs associated with healthcare utilization.  What’s important is the amount of money spent near death.  If you’re 80 years old and healthy, your usage of healthcare services won’t be much more than that of a 40-year-old person.

Mobile Apps Are Reflecting the Changing Role of the Patient in the Healthcare Ecosystem

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By ALINE NOIZET

The 4th edition of Trophées de la Santé Mobile took place last week in Paris which showcased the best French healthcare mobile apps in different categories.

The winning apps were clearly showing the changing role of the patient in the healthcare ecosystem. The patient is at the center, more informed, and plays an important role in his or her own health. Since the patient has a better understanding of his or her own health, they can detect a disease earlier, co-create their own treatment with the doctor, and adjust it based on the information being continuously collected through apps or wearables.

The winner of the Grand Trophée for this 2017 edition was Novi-Chek, an app that empowers and informs diabetic patients. Developed by Roche Diabetes Care France, Novi-chek is an app for patients who have recently been diagnosed with Diabetes type 1. It supports them during the 1st month of the disease, explaining what diabetes type 1 actually is, the treatments available, why they need to auto-check their glucose level, and how diabetes will impact their everyday life. The patient can also use the app to set up alarms to check glucose levels or enter useful information to track the diabetes.

An Open Letter to Kaiser Permanente Northern California

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I am writing this letter because for two months I tried to get ahold of Darryn Carter, a case manager at your company who was assigned to process a complaint I filed about care I received that I feel was harmful and irresponsible.

The legal and rational reason for this current writing is this: the letter I received from Darryn Carter rejecting my complaint claim stated that I have a legal right to see the documentation and evidence used to make the decision about my case. I would like to see that evidence file, and I have not been able to get in touch with Mr./ Ms. Carter or anyone else at Kaiser to send the file.

The emotional and human reason I want to talk with Darryn Carter–and I think it’s appropriate to share this reason too, given that you are a care provider–is that I believe I received bad care at Kaiser, and yet no one at Kaiser has ever listened to what I have to say about it, despite months of my trying to tell someone. My concern and frustration, which is so strong that it drove me to spend a Saturday writing this letter, is not primarily about the bad care I believe I received but rather the wholehearted dismissal that your organization has levied through an unnavigable bureaucracy. This dismissal has kept me up nights, sometimes crying, sometimes fuming, sometimes brooding, always feeling that special type of indignity reserved for a patient with a care provider who blatantly and systematically refuses to care.