Category: Uncategorized

Resisting the Rush to Judgement On the Affordable Care Act

Dec 9, 2013• 47

By David Blumenthal, MD

A full, fair reckoning of the impact of the Affordable Care Act (ACA) will take years. In an earlier blog post, we outlined some of the measures—such as reductions in rates of uninsurance and underinsurance and trends in health care costs and quality—by which the law should be judged and the time frames over which those judgments should be made.

In the mean time, however, the rush to reckoning seems irresistible. These interim conclusions could prove as faulty as the ACA websites, but they should at least be informed by the best information available. As of this writing, this is what we know about the major shortcomings and accomplishments of the ACA.

KEY SHORTCOMINGS:

Poor management of the launch of the federal website, HealthCare.gov. The reasons for this failure are still emerging, but are likely multiple: management failures by the Obama administration, poor performance by its contractors, design flaws in the legislation itself, the decision by so many states not to run their own websites, a toxic political environment, and other factors.
Poor messaging by the President. In retrospect, President Obama should have prepared the public better for the inevitability that some Americans would be left worse off by the law because of higher insurance prices or the need to switch health plans.
Failure to prepare fully in advance for adverse impacts of the implementation of the ACA. There may have been more such preparation than meets the eye but if, for example, the administration had anticipated that private health plans might be cancelled, the policy response could have been waiting on the shelf. Instead, there was a last-minute scramble under the media spotlight.

KEY ACCOMPLISHMENTS:

Provision of health insurance to: 7.8 million young Americans covered under a parent’s health plan who likely would not have been able to do so prior to the law’s passage, including 3 million who were previously uninsured; more than 200,000 Americans covered through state marketplaces as of November 25, 2013; and 26,794 covered through the federal marketplace as of November 2, 2013.

Probably Illegal and Unquestionably Stupid: Covered California’s Release of Personal Health Information.

Dec 9, 2013• 10

By SETH J. CHANDLER

The Los Angeles Times has reported that Covered California, the largest state’s health insurance exchange under the Affordable Care Act, has started releasing to insurance agents throughout the state the names and contact information of tens of thousands of persons who started an application using the state’s online system but failed to complete it.

The Covered California director Peter Lee acknowledges the practice but says that the outreach program still complies with privacy laws and was reviewed by the exchange’s legal counsel. “I can see a lot of people will be comforted and relieved at getting the help they need to navigate a confusing process,” explained Lee.

I am hardly as confident as Covered California’s lawyers apparently were that this practice was legal.

The law requires that disclosures to third parties be necessary and I do not see why Covered California could not have contacted non-completers directly and ask them if they wanted help from an insurance agent rather than disclosing their identity to insurance agents. But even if the practice could be said to be borderline legal, it is difficult to imagine a practice more likely to sabotage enrollment efforts in California — and, since California’s interpretation could be precedent for other states — elsewhere.

For every person unable to complete their application online in California and who will, with the comforting help provided by insurance agents, now want to complete it, there are likely 10 who will be turned off by the cavalier attitude towards privacy exhibited by this government agency. Beyond a violation of ACA privacy safeguards, the action is either a sign of desperation about enrollment figures, even in a state that boasts of its success such as Peter Lee’s California, or monumental stupidity.

If California wanted to create an adverse selection death spiral, it would be difficult to be more effective than, without notice or consent, releasing personally identifiable information to insurance agents.

Mandela’s AIDS Legacy of Silence and Courage

Dec 9, 2013• 1

By Arthur Caplan

Even the greatest among us can stumble.

As the world mourns the passing of Nelson Mandela, it is important to look at the one area where the iconic former president of South Africa slipped — AIDS. The most outstanding moral figure of our age did not do what was needed as HIV began to destroy the country he loved. But his actions after he realized his failures are an important part of his legacy.

South Africa is beset with the worst epidemic of HIV in the world. According to the United Nations, out of a South African population of just over 51 million, 6.1 million of its citizens were infected with HIV in 2012, including 410,000 children under the age of 14. An estimated 240,000 South Africans died in 2012 from AIDS. There are 2.5 million children orphaned because of the disease. The grim social, economic and medical toll AIDS has exacted on Mandela’s country is almost beyond description.

In 1990, when Mandela was released from a 27-year prison sentence, the rate of HIV infection among adult South Africans was less than 1 percent. When the anti-apartheid activist was elected president four years later, AIDS was on it way to being an out-of-control plague, with infection rates doubling every year. In 1998, the rate of HIV infection among adults in South Africa was almost 13 percent, with 2.9 million people HIV positive.

Mandela and his party were more or less indifferent to AIDS throughout his five-year tenure. There were other huge challenges in rebuilding the new post-apartheid nation — but the indifference was not just a matter of priorities. Mandela and his party did not want to admit they had a problem.

Why they did not take prompt action to slow the epidemic’s spread is not clear. Perhaps Mandela and his people — like United States President Ronald Reagan and his administration in the 1980s — found the disease and its modes of transmission too repellent to acknowledge. Maybe they did not want to tarnish the new state with a problem that at the time carried so much stigma and shame.

HealthLoop: A Health 2.0 Story

Dec 9, 2013

By Prerna Anand

HealthLoop, Inc. has been developing a feedback system that creates a communication loop between patients and providers, to help keep track of the treatment progress in between clinic visits. This ‘loop’ consists of reminders, questions and care instructions based on the treatment plan. Patients are urged to regularly check-in online, providing feedback on the prescribed timely ‘action items’ and answers clinical questions based on where they along the recovery process. The system also alerts the doctor if a patient appears to be at risk of a complication, treatment failure or hospital readmission.

Today, HealthLoop announced that it raised $10M in Series A. The round was led by Canvas Venture Fund, an early-stage venture fund managed by the Morgenthaler Technology Investment Company. Other investors include Subtraction Capital.

HealthLoop has been a part of the Health 2.0 since its debut in 2009. The Health 2.0 Spring Fling: Boston 2009 provided the first sneak preview of its cloud-based automated patient follow up solution. It formally demoed at the Health 2.0 San Francisco Fall Conference 2011 stage, as a part of the annual Doctors 2.0 panel which showcases latest tools transforming physician practices. The same year, HealthLoop made another appearance at the Europe Fall Conference in Berlin as a part of the ‘Cool tools to connect stakeholders and promote the co-production of health care’ panel. We invited them back to our San Francisco Fall 2012 conference to as a part of the showcase of technologies transforming care delivery.

HealthLoop was also among the top five finalists of the DC to VC HIT Showcase 2012. Health 2.0 and Morgenthaler Ventures, the parent company behind HealthLoop’s key investor, jointly organize this event every year to find and promote the most promising health tech startups from across the nation.

Power Up: What’s Next in Technology for Youth and Wellness

Dec 9, 2013• 4

By Jamia Wilson & Deb Levine

It’s time for those of us working in health tech to power up—and use our health tech muscle to make a real and lasting difference in young people’s lives.

In video games, power ups restore game characters’ health, increase their strength, shield them from damage, give them special abilities, and help them beat the odds. In health tech, power ups can help us find winning solutions for improving young people’s health and wellness.

Power Ups for Youth Health Tech:

Data-Driven (+1 Power Up) – Data can inform new research and spark insights, and well-visualized data can transform perceptions and change behavior. Young people prefer when information is shown, rather than stated. Use data visualizations to help young people understand how they fit into the big picture.
Connected (+1) – Health tech cannot be tied down by time, place, or even platform. A safe, connected, networked, multi-platform mindset should be our default.
Agile (+5) – We need to learn quickly what works, keep what does, and discard what doesn’t. You only get one chance with young people, so you’d better make it good.
Innovative (+10) – At its best, health tech will be creative and even disruptive. Let’s focus on radically accelerating and scaling our best solutions.
Authentic (+25) – Trust is the most indispensable currency for dealing with youth. Period.

BetterFit Technologies Joins Forces with Ginger.io

Dec 9, 2013

By Indu Subaiya

In this exclusive interview Indu Subaiya, CEO of Health 2.0 talks with Ginger.io’s CEO Anmol Madan and Julia Winn, previous CEO of BetterFit Technologies, to discuss how their respective companies came together to make sense of the duality of active and passive patient data collection. They also dive into the challenges facing clinicians to make timely interventions across a large-scale patient population and how Ginger.io is creating the solution.

Join Health 2.0 at the 2013 mHealthSummit on Monday December 9th in Washington DC to see Julia Winn demo how BetterFit Technologies has integrated with Ginger.io on the panel Future of Self-Tracking and Personalized Medicine. Register here.

Indu Subaiya: Let me start by welcoming you, Anmol and Julia, to the conversation. We’re looking forward to having you at Health 2.0. Why don’t we begin by starting with you, Anmol. Give us a bit of a background and history of Ginger.io. We had you present at Health 2.0 in 2011. Tell us a bit about your roles in the company and how you’ve developed in the last couple of years.

Anmol Madan: We’ve been around for about 2 ½ years and presented at Health 2.0 in our very early days. At Ginger.io we work with passive mobile phone data and behavior analytics for chronic patient populations. For providers and other players in the health care ecosystem, we help them manage their patient populations better so we help identify which of their patients are likely asymptomatic at that point of time. The idea is to enable doctors, nurses, and also family members and friends to reach out to their patients and support them when they need help the most.

Indu Subaiya: The term that you use often in describing what you do is ‘passive data’. Can you tell us a little bit more about what that means specifically and how you distinguish passive data from other types of data that consumers are collecting about themselves?

Anmol Madan: Absolutely. Every one of us is carrying a mobile phone and it’s an incredibly powerful diary of your life because it has all sorts of sensors built in. There is a tremendous amount of data generated, and the complexity around interpreting this data, delivering insights, and making them actionable is a really interesting problem for us at Ginger.io.

A Message To My Patients

Dec 8, 2013• 6

By ROB LAMBERTS, MD

Thank you.

Thank you, my patients for all you have done for me. Thank you for the encouragement and support. Thank you for believing in me enough to join me in this crazy new way to do health care. Thank you for giving me the honor of being the one you call “my doctor.”

Your trust motivates me to work harder to justify that faith in me – a faith I often don’t have and, one I certainly wouldn’t have without you. I hope and pray this holiday season is a blessing to you. May you find peace in this time of year so often without peace.

May you also have a happy and healthy new year. May you stay out of the ER, away from the hospital and, yes, away from doctors. May you have no need for lab tests, procedures, x-rays and medications (and if you must have medications may they be very cheap.)

If, however, you do get sick, remember that I am here to help you get well, feel better or avoid getting any worse. And if I cannot do any of these, I will still be there to stand by your side through the hard times, and to offer whatever comfort I can give. Doing these things is what it means to me when you call me “my doctor.” It is why that is such an honor.

Again, thank you for all you do for me. God bless you.

Dr. Rob

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at More Musings (of a Distractible Kind),where an earlier version of this post first appeared.

The Really Bad Math Behind the Social Security Cuts

Dec 8, 2013• 22

By Stephen Soumerai

Among the sacrifices Congressional representatives placed on the altar of deficit negotiations is an “inflation adjustment” that will shave “only” a few hundred dollars from an average, newly retired Social Security beneficiary’s income each year. But the cruel hoax is that the reduction will amount to as much as $1600 when the beneficiary is older, poorer, and sicker. Many seniors already have a tough time paying for food, rent, and medical care.

Even worse, reductions in beneficiaries’ incomes may well cost government more for potentially preventable hospital and long-term care. Senator Elizabeth Warren and other New England lawmakers should be lauded for splitting from Democratic representatives and the Administration regarding this ill-conceived proposal.

Many senior citizens are already vulnerable to economic hardship. A recent US Census analysis that counts rising medical expenses found that over 1 in 6 elderly people live in poverty, unable to meet basic living expenses, and almost 20% more are living just above the poverty line. Social Security is the only or largest source of income for about 70% of seniors; the average monthly check is only about $1200.

The typical retirement savings of seniors is a paltry $50,000 — barely enough to get through several years’ living expenses, let alone 20-30 years of retirement. This is not the result of cavalier actions by the older generation; these are the Americans whose home values have plummeted, whose defined-benefit pension plans have been decimated or disappeared, and whose retirement accounts were eviscerated by the Wall Street meltdown of the last decade. Yet the current proposal punishes these Americans as if they were at fault for their poverty.

Fidelity Investments has estimated that the average retired couple will need more than $200,000 to pay their out-of-pocket medical expenses during retirement, and that figure is probably conservative.

The arithmetic of Social Security benefit reductions just doesn’t fit with this reality.

Is Obamacare Responsible For the Recent Slowdown in Health Care Costs?

Dec 6, 2013• 58

By ROBERT LASZEWSKI

That is what we have been told the Obama administration will claim today as they begin the job of reselling Obamacare.

Is Obamacare even partly responsible for the slowdown in health care costs?

That is silly.

First, Obamacare is not a health care reform law; it is a health insurance reform law. No one on either side of the debate has ever argued anything different.

Does the law have some limited cost containment features in it?

Yes. But these are either pilot projects or are years from being fully implemented.

I have heard the argument that the Medicare cuts that were made to help pay for the program are examples of cost containment efforts that are having a short-term impact on controlling costs. The Democrats need to be careful with this one. I recall their countering Republican “Mediscare” claims by saying the Medicare cuts were not significant.

In a letter last year accompanying the Medicare Trustee’s report, the Medicare actuary said, “The [Obamacare Medicare cuts] will affect Medicare price levels more gradually, but a strong likelihood exists that, without very substantial transformational changes in health care practices, payment rates would become inadequate in the long range.”

Translated: The Obama Medicare provider cuts are not having a big impact in the short-run but will be unsustainable over the longer-term.

Why “Liking” Your Plan Is Not the Point

Dec 6, 2013• 34

By Daniel Skinner

In recent weeks, President Barack Obama has been appropriately raked over the coals for saying, multiple times, “If you like your health care plan, you’ll be able to keep it.” He shouldn’t have said it. The problem is, he shouldn’t have said it for entirely different reasons than most Americans think.

Let’s begin with a basic question: What does it mean to “like” one’s plan? And what is the value of this statement? All of this came to a head at an October 30 Congressional hearing with the Secretary of the Department of Health and Human Services, Kathleen Sebelius.

At the hearing, in a cantankerous challenge to Sebelius’s credibility, Tennessee Rep. Marsha Blackburn highlighted two constituents, Mark and Lucinda, who “like their plans,” but were being told they could not keep them because of the Patient Protection and Affordable Care Act (ACA), so-called “Obamacare.” A long-entrenched individualist rhetoric provided the framework for Blackburn’s point, namely that we should allow Mark and Lucinda to keep their plans in the name of individual freedom, just because they “like” them.

For purposes of argument, let’s assume that what Mark and Lucinda’s insurers are saying—that the cancellations are a result of the ACA—is true. But, as we do this, let’s also keep in mind that just because insurers claim premium hikes and cancellations are because of the ACA doesn’t mean that it’s true. In fact, it seems to be true only rarely and, even then, often as a half-truth.

But, anyway, let’s assume it is true. The question then becomes: why is it true? The problem is that this individual freedom is made possible by the assurances of a social safety net. This brings us back to the existential foundation of the ACA, namely that the choice to not carry health insurance—or to carry poor health insurance that individuals may find out, at some point, doesn’t cover something important—simply dumps those individuals into social institutions such as emergency rooms and local care centers, and does so in an extremely wasteful way. This returns us to the problem we started with and a question of whether or not ACA opponents are concerned with solving the problem of building a sustainable health care system.

In other words, Blackburn’s logic, as inspirational as it might be to some, bathed as it is in the rhetoric of freedom, is not premised on an analysis or understanding of health insurance, but deference to Mark and Lucinda to make their own choices, consequences be damned.