I’ve been covered by private insurance my entire life. Even more telling, I worked in the health insurance industry for — gasp! — some thirty years. It’s not just paid for my healthcare, it’s financed my life.
Today, though, for the first time in my life, I’m covered by public insurance — and I couldn’t be more relieved.
Now, I’m not going to go all Wendell Potter. I know many people have their health insurance horror stories, but, sadly, people have them about pretty much every part of the healthcare industry. I believe most people working in health insurance, like most people working in healthcare generally, sympathize with the people they serve and are just trying to do a good job.
The problem is that the health insurance model has outgrown the times. I’ll try to explain some ways how.
Once upon a time, most people had employer coverage, and those employers paid all or most of its cost. Those days are gone. Employer coverage is still the predominant form of private health insurance, and employers still pay the majority of its cost, but percentage of people with employer coverage continues to drop and the amount they pay for it continues to increase.
With cases of COVID-19 either disappeared or rapidly diminishing from places like Wuhan, Italy, New York, and Sweden, many voices are speculating that herd immunity may have been reached in those areas and that it may be at hand in the remaining parts of the world that are still struggling with the pandemic. Lockdowns should end—or may not have been needed to begin with, they conclude. Adding plausibility to their speculation is the discovery of biological evidence suggesting that prior exposure to other coronaviruses may confer some degree of immunity against SARS-CoV2, an immunity not apparent on the basis of antibody seroprevalence studies.
Opposing those viewpoints are those who dismiss the recent immunological claims and insist that rates of infections are far below those expected to confer immunity on a community. They believe that the main reason for the declining numbers are the behavioral changes that have occurred either under force of government edict or, in the case of Sweden, more voluntarily. What’s more, they remind us that the Spanish flu pandemic of 1918-1919 occurred in 3 distinct waves. In the summer of 1918 influenza seemed overcome until a second wave hit in the fall. Herd immunity could not possibly have accounted for the end of the first wave.
The alarmists may have a point. However, recent history offers a more instructive example.
Until early 2015, epidemiologists considered Mongolia to be exemplary in how it kept measles under control. In the mid-1990s, the country instituted a robust vaccination program with low incidences of outbreaks, even by the standards of developed countries. In the early 2000s, it adopted a 2-step MMR immunization schedule and, after 2005, its vaccination rates were upwards of 95%. From 2011 through 2014, not a single case of the virus was recorded, leading the WHO to declare measles “eradicated” from Mongolia in November 2014.
The novel coronavirus (COVID-19) has underscored the need for efficient and innovative emergency response. Major health organizations, such as the American Hospital Association, have provided resources that can be utilized for organizational preparedness, caring for patients, and enabling the workforce during the pandemic.
The Emergency Response Innovation Challenges asked innovators to develop a health technology tool to support the needs of individuals as well as health care systems affected by a large-scale health crisis, such as a pandemic or natural disaster. The Challenges saw a record number of applications— nearly 125 applications were submitted to the General Public Challenge and over 130 applications were submitted to the Health Care System Challenge.
I was driving home the other day, noticed all the above-ground telephone/power lines, and thought to myself: this is not the 21st century I thought I’d be living in.
When I was growing up, the 21st century was the distant future, the stuff of science fiction. We’d have flying cars, personal robots, interstellar travel, artificial food, and, of course, tricorders. There’d be computers, although not PCs. Still, we’d have been baffled by smartphones, GPS, or the Internet. We’d have been even more flummoxed by women in the workforce or #BlackLivesMatter.
We’re living in the future, but we’re also hanging on to the past, and that applies especially to healthcare. We all poke fun at the persistence of the fax, but I’d also point out that currently our best advice for dealing with the COVID-19 pandemic is pretty much what it was for the 1918 Spanish Flu pandemic: masks and distancing (and we’re facing similar resistance). One would have hoped the 21st century would have found us better equipped.
So I was heartened to read an op-ed in The Washington Postby ReginaDugan, PhD. Dr. Dugan calls for a “Health Age,” akin to how Sputnik set off the Space Age. The pandemic, she says, “is the kind of event that alters the course of history so much that we measure time by it: before the pandemic — and after.”
Analysis on peer accountability focused community building efforts in making lifestyle changes through digital therapeutic programs
Before we jump ahead to the medicine piece, what the heck does a community even mean? In the past, communities were more likely associated with a group of people living in the same physical location such as a neighborhood, school, or a town. I remember my neighborhood soccer community very well, for instance. Instead of being born into or trying to fit in, community is something we choose for ourselves and express our identities through. With the advancement of accessing the high-speed internet globally, today’s community has no physical or geographical boundaries.
Community builder Fabian Pfortmüller brilliantly explains the difference between communities and other groups. He asserts that unlike project teams or companies who are optimizing for external purposes (collective goals); communities optimize for internal purposes (the relationship and the shared identity). His definition of a community deeply resonated with me and the communities that I had the opportunity to build.
By DALLAS M. DUCAR, MSN, PMHNP-BC, RN, CNL and KATIE WOLF, MBA
We’re not in Kansas anymore. Kansas has rescinded an executive order that dramatically empowered and expanded its healthcare workforce as COVID-19 cases soared. In the best interest of patients now and in the future, other states must not follow Kansas’ example.
The story of coronavirus is far from over in the United States and the impacts to our healthcare systems continue. America’s clinical workforce began this battle at a deficit and, in certain states, continues under those conditions. For years, studies outlined shortages of medical doctors and predicted gaps to worsen over time. Prior to the presence of COVID-19, a contentious debate emerged as to how to address the deficit of physicians. Nurse practitioners (NPs) lobbied for broader clinical autonomy to help bridge this gap. At present, rapid influxes of critically ill patients have strained our healthcare systems to a breaking point laying bare the resource constraints in our healthcare system.
Alex Azar, the Secretary of Health and Human Services responded to this need by sending a letter to governors to expand the 290,000NPs in the United States, bolstering our provider workforce during this time of crisis. Empowering NPs to independently treat patients has needlessly been a long-standing point of contention in healthcare. Increasing the breadth of NP autonomy makes sense in the face of COVID-19. Wisely, since the start of the pandemic, the number of states allowing NP autonomy jumped from 22 states to 48. This structural change to healthcare is long overdue and should remain in perpetuity. However, at the end of May, Kansas became the first state to expire this expansion of NP authority.
NPs are independently licensed and trained to diagnose and prescribe medications and treatments. This role grew organically out of the field of nursing, to provide holistic and patient-centered care to their communities. Nurses become nurse practitioners by choice, honing their skills through years of training at patients’ bedsides, and are part of the most trusted profession in the United States.
As COVID-19 cases soar across the country, the federal government has lost control of the situation. Amid the Trump Administration’s happy talk and outright dismissal of the crisis, the U.S. is experiencing a forest fire of contagion and hospitalizations, and an upsurge in COVID-related deaths has already begun.
Other countries like Taiwan, South Korea, Germany, Australia and New Zealand have controlled their outbreaks, which is why their COVID-19 infections and deaths have been minimal or trending downward in recent months. To replicate those nations’ strategies of testing, contact tracing and quarantining, the U.S. Congress would have to appropriate about $43.5 billion, according to one estimate. But as we know, Senate Republicans won’t pass such a bill without Donald Trump’s prior approval—and that’s unlikely as long as his main focus is on reopening the economy.
We can hope that electoral victory by the Democrats in November will change this equation, but Joe Biden won’t take office until January if he wins. Meanwhile, the coronavirus is chewing up America. We can’t afford to wait six months to blunt the impact of this horrible disease. However, there is a solution that doesn’t depend on federal leadership: states can form compacts that would form the basis for collective action to get us out of the trap we’re in.
Interstate compacts are very common in the U.S. Various pacts cover everything from clean water and clean air to medical licensure, mental health and interstate transportation. For example, under the Middle-Atlantic Forest Fire Protection Compact, which includes Ohio, West Virginia, Virginia, Pennsylvania, New Jersey, Delaware, and Maryland, member states assist one another in fire prevention and suppression and firefighter training.
As hopefully most of you know, Rep. John Lewis, civil right icon and longtime member of Congress, died this past Friday. Rep. Lewis was often described the “conscience of Congress” – perhaps a low bar in today’s Congress but important nonetheless — for his unwavering commitment to social justice. I have always been struck in particular by one of his quotes:
Rep. Lewis must have been heartened by the fact that, in 2020, plenty of people are, indeed, making noise and getting into good trouble, necessary trouble over issues that he cared deeply about, like Black Lives Matter and voting rights. There are others who are better able to write about those people and that trouble. So I’d like to talk about his call to action with respect to healthcare.
If you are working today in healthcare — especially in the United States — or, for that matter, someone getting healthcare or having a loved one get it, then you should be making some noise and getting into good trouble, because our healthcare system most definitely makes it necessary.
It should come as no surprise that we’re not very happy with our healthcare system, rating it lower than do citizens in most other developed countries. And for good reason: it’s the world’s most expensive while delivering sub-par health results and leaving tens of millions without financial protection. Even our physicians don’t like it. Even our latest, best effort for improving the sorry state of our healthcare system — the Affordable Care Act – is under risk of repeal due to a lawsuit brought by 18 states and backed by the Trump Administration.
Every day, too many of us suffer in the healthcare system, ranging from waits to indignities to critical mistakes, and some face financial ruin due to the care — whether good or bad. Most of us suffer in silence, or only complain to our friends and family. We don’t see a lot of mass protests about the pitiful state of our healthcare system, and I have to wonder why.
COVID-19 exposed our country’s lack of centralized coordination when it comes to managing and preventing disease spread. Today, our public health system relies on flawed data and obsolete technology that fails to accurately track current and suspected cases, risk stratify patients, monitor disease progression or predict future spread. Not only do these blind spots create opportunities for the disease to spread, they also undermine the ability to safely plan for economic recovery.
What may surprise some, though, is the fact that we don’t have to start from scratch in order to build an effective system that stems the spread of COVID-19. In large part, the infrastructure we need is already here.
In 2009, Congress passed the HITECH Act, which allocated roughly $30 billion for providers to purchase electronic health records (EHRs). As a result of this stimulus, EHRs went from relative obscurity to ubiquity, and today about 96 percent of all providers are users of EHRs. Five years later, Congress passed the Protecting Access to Medicare Act (PAMA), which requires healthcare providers to consult with an approved Clinical Decision Support Mechanism (CDSM) in order to receive reimbursement for advanced imaging procedures for Medicare beneficiaries.
The net result of these two laws is that there is now visibility into nearly every patient-provider interaction in the United States at the moment that care is delivered, through more than a dozen CDSMs that have been certified by CMS. Although PAMA was intended for use with imaging, it’s not difficult to add on and repurpose decision support apps to conduct symptom surveillance for COVID, enabling healthcare workers to spot cases more reliably and earlier in the disease progression for prompt action.
The average American elementary school class includes two students living with one or multiple food allergies. That’s nearly six million children in the United States alone. And these numbers are climbing. There was a staggering 377 percent increase in medical claims with diagnoses of anaphylactic food reactions between 2007 and 2016, two-thirds of these were children.
As parents, we want the absolute best for our children. For many years, guidance around food introduction was unclear. Parents were told that babies, and especially those considered at risk for food allergies, should avoid some allergy-causing foods such as peanuts until they were three years old.
But thanks to ongoing research from our nation’s top allergists and immunologists, we are beginning to learn more and more about food allergies, including what new and expecting parents can do to reduce the risk of their children developing food allergies. In fact, studies now show that introducing a variety of foods early is the best course of action and has been shown to reduce the occurrence of certain food allergies like peanuts for many children.
For instance, the partially FARE-funded Learning Early About Peanut Allergy (LEAP) study showed a remarkable 80 percent reduction in peanut food allergies in high-risk infants who were exposed to peanut foods at a young age. Shortly after LEAP, there was the Enquiring About Tolerance, or EAT, study. This project, led by top medical researchers at Kings College London, found significant reductions in allergies to both peanut and egg after introducing small amounts of the foods into infants’ diets. The LEAP-on study soon followed, and had the same children from the original LEAP study remove peanut from their diets for 12-months. The results showed that they maintained their tolerance to peanut, indicating early introduction to babies can result in long-lasting protection from peanut allergy.