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The Growing Problem of Military Suicides

By MSW@USC STAFF

U.S. veterans are dying by suicide at an alarming pace.

The national veteran suicide rate was almost 30 per 100,000 people in 2015, or about 20 deaths every day, according to the Department of Veterans Affairs. The age-adjusted rate of suicide among veterans increased more than 30 percent from 2005 to 2015, compared to an almost 20 percent increase among the non-veteran population. Female veterans in particular saw a 45 percent spike over that time period.

“Military life is hard for a variety of reasons, including an increased exposure to trauma, frequent moves that disrupt one’s social support networks and prolonged separations due to deployments,” said Carl Castro, associate professor, retired U.S. Army colonel and director for USC’s Center for Innovation and Research on Veterans and Military Families (CIR).

To address climbing suicide rates among active-duty service members and veterans, the USC Center for Artificial Intelligence in Society (CAIS), in collaboration with USC CIR and the USC Viterbi School of Engineering External link , will use artificial intelligence to examine engagement on social networks by military personnel to identity risks such as depression and anxiety.
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Where is Relationship, Authority, and Trust in Health Care Today?

By HANS DUVEFELT MD Dr. Hans Duvefelt, A Country Doctor Writes, AI

Healthcare is on a different trajectory from most other businesses today. It’s a little hard to understand why.

In business, mass market products and services have always competed on price or perceived quality. Think Walmart or Mercedes-Benz, even the Model T Ford. But the real money and the real excitement in business is moving away from price and measurable cookie cutter quality to the intangibles of authority, influence and trust. This, in a way, is a move back in time to preindustrial values.

In primary care, unbeknownst to many pundits and administrators and unthinkable for most of the health tech industry, price and quality are not really even realistic considerations. In fact, they are largely unknown and unknowable.

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Is CareMore Health’s Population Health Management Model Disruptive?

By REBECCA FOGG Rebecca Fogg

Fueled by Americans’ urgent need for better chronic disease care and insurers’ march from fee-for-service to value-based payments, innovation in population health management is accelerating across the health care industry. But it’s hardly new, and CareMore Health, a recent acquisition of publicly-traded insurer Anthem, has been on the vanguard of the trend for over twenty years.

CareMore Health provides coordinated, interdisciplinary care to high-need patients referred by primary care physicians in nine states and Washington, D.C. The care encompasses individualized prevention and chronic disease management services and coaching, provided on an outpatient basis at CareMore’s Care Clinics. It also includes oversight of episodic acute care, via CareMore “extensivists” and case managers who ensure effective coordination across providers and care sites before, during and after patient hospitalizations.

The majority of CareMore patients are covered by Medicare Advantage or Medicaid, and company-reported results, as well as a Commonwealth Fund analysis, indicate that the patient-centered, relationship-based model leads to fewer emergency room visits, specialist visits and hospitalizations for segments of the covered population. They also suggest that it leads to cost efficiencies relative to comparable plans in its markets of operation.

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Hotlines Aren’t Enough to Help People at Risk of Suicide

By CARA ANGELOTTA MDCara Angelotta, suicide prevention, health policy

Contrary to popular belief, the risk of suicide does not increase around the holidays. But, according to the Centers for Disease Control and Prevention, annual suicide rates in the U.S. have risen nearly 30 percent since 1999.

Much of the media coverage following the high-profile suicides of Kate Spade and Anthony Bourdain has followed recommended best practices to reduce risk of suicide contagion or “copycat” suicides by including warning signs a person may be at risk of suicide due to depression and contact information for the national hotline for suicide prevention. This overly simplistic approach implies that we can prevent all suicides by reaching out to loved ones in emotional distress and advertising the existence of mental health treatment.

As a psychiatrist who treats individuals hospitalized for acute suicide risk, I am concerned that much of the media coverage has belied the complexity of suicide. While we do not yet fully understand why suicide rates are rising, we do know that suicide is a complex public health problem that will require a multifaceted approach to reduce deaths. Increased awareness of depression as a treatable medical illness is an important but insufficient response to the suicide epidemic.

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The Disruptive Potential of Employer-Centered Care

By LAWRENCE LEISURE 

When it comes to health care prices, the burden piled on payers can seem almost cartoonishly heavy. News stories on the state of the industry read as though some satirist decided to exaggerate real systemic flaws into cost-prohibitive fiction. A particularly painful example hit the presses earlier this year, when a writer for Reuters revealed that the cost of a full course of oncology treatment skyrocketed from $30,447 in 2006 to $161,141 in the last few years. The change was so unbelievable as to verge on dark comedy — but there isn’t much to find funny in the situation when lives and health outcomes are on the line.

For the average employee in my home of Silicon Valley, the price crunch is challenging regardless the size of your paycheck. For local employers, however, the dilemma can be even more pointed. Today, employees of companies, large and small, expect their employer to provide comprehensive health care benefits and are largely unaware of or insensitive to the factors exacerbating market problems today. Providing these benefits, however, is easier said than done.

Employers and insurers alike face a multitude of barriers to connecting employees with affordable care. Recent research suggests that prices will increase at an average clip of 5.8% annually between now and 2024, well above the expected rate of inflation. Even worse, the increased consolidation of healthcare providers has drastically undermined the negotiating power that payers would otherwise have in more competitive markets. In Northern California, for example, major health systems, including Sutter Health, sparked outrage and protest as they have managed to amass enough of the region’s hospitals, outpatient facilities, and primary care offices to diminish regional competitors and set what many view as unacceptably high rates — all the while knowing that the lack of local competition makes it challenging for the major health insurers to push back.

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Consumers are Dishing On Healthcare Experiences—Be Part of the Conversation

By KARYN MULLINS 

Consumers aren’t taking their healthcare providers’ words for it anymore. They’re taking charge and leading a digital revolution where individuals have the power to make their own educated decisions about care.

According to the Healthcare Consumer Insight & Digital Engagement report by Binary Fountain, a leading online reputation management platform, 51 percent of people who have a physician share their personal healthcare experiences via online ratings, review sites and social media.

Once shared, this information is immediately available to the entire world with just the click of a button. And people are taking full advantage of this. In fact, 80 percent of respondents in the 2018 Customer Experience Trends in Healthcare report by Doctor.com have used the internet to make a healthcare-related search in the past year. Another 81 percent said they read reviews about a referred provider.

Consumers’ accessibility to detailed, personalized experiences could make or break medical sales companies. Unfortunately, if these trends aren’t addressed appropriately, medical sales teams around the country will feel the impact.

By further empowering the general public, medical sales leaders can give their teams the tools needed to excel in the field. Here’s how:Continue reading…

How to Become an Empowered Patient | ePatient Dave de Bronkart

“When doctors today say patients should stay off the Internet, I know they’re wrong.” — ePatient Dave de Bronkart

Dave de Bronkart (aka ePatient Dave) credits online communities of other patients – and access to clinical research he found on his stage 4 cancer diagnosis – to saving his life more than a decade ago. Fast forward, and this patient advocate has taken his mantra, “Let Patients Help,” to the TedTalk stage and beyond.

As health care continues to shift its focus from ‘patients’ to ‘consumers,’ how can we all be better, more empowered participants in this system that, despite its best efforts, remains closed, difficult to understand, and challenging to navigate?

I caught up with Dave to talk about his definition of what it means to be a ‘consumerist patient advocate’ and get his suggestions for how we can all better partner with our doctors and nurses when it comes to improving our health. The magic ingredient is data – namely, access to it in a frictionless and open way – so that we can be fully involved in learning about our health and able to set priorities when it comes to preserving it.

How did access to health data prevent serious health consequences in Dave’s life? He’s got more than one story to prove this point – oh, and a great little rap (yes, that kind of rap) at the end.

Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health

The Burning Question: Who Will Foot the Bill for America’s Increasing Burn-Care Costs?

By CELIA BELT 

Each year in the United States, half a million Americans will be treated for burns so severe as to require hospitalization. The “survivors”—including more than three hundred children each day and a drastically increasing number of U.S. military members since the turn of the millennium—can be expected to undergo arduous, agonizing surgeries and painful rehabilitation lasting for years.

The emotional and physical trauma of these fellow citizens is not a pretty picture, nor is it an inexpensive one. According to estimates, patients with severe burns with no complications can expect a whopping $1.6 million bill for treatment over the cost of their lifetime. For patients who do go on to develop complications as the result of severe burns, hospital bills can run more than $10 million.

Where is that money coming from? Partly, it comes from you and me in the form of increased healthcare premiums. But oftentimes, it comes from directly people like me, the cofounder of the Moonlight Fund, a Texas-based non-profit organization for burn survivors and their families. We’re often tasked with raising funds to help with the costs of expensive procedures in addition to the emotional support and caregiver assistance our organization was founded for. Many times, I’ve reached into my own pocket—not because I’m a saint, but because I’ve been there.  As a childhood burn survivor myself, scalded over 32% of my body, I’m well aware that infections resulting from burns—which occur in one out of three cases—add between $58,000 and $120,000 to treatment costs.  Skin breakdown—which happens one out of two times—adds up to $107,000 more. Disfigurement and scarring? Up to $35,000 on top of that. Then, of course, there are the psychological issues associated with severe trauma. 57% of burn victims need help for these, help that costs as much as $75,000 per patient.

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A Conversation About the Dangers of Overhydration with Professor Timothy Noakes

By SAURABH JHA MD

Professor Timothy Noakes, a South African exercise scientist and emeritus professor at the University of Cape Town who has run over 70 ultramarathons, speaks to me about the dangers of overhydration in endurance sports.

Listen to our conversation at Radiology Firing Line Podcast.

Saurabh Jha is a contributing editor to THCB and host of Radiology Firing Line Podcast of the Journal of American College of Radiology, sponsored by Healthcare Administrative Partner

Life-Saving Data That Is Nowhere To Be Found: Hospitals’ C-section Rates

By DANI BRADLEY MS, MPH 

The United States is the only developed nation in the world with a steadily increasing maternal mortality rate — and C-sections are to blame. Nearly 32% of babies are born via C-section in the United States, a rate of double or almost triple what the World Health Organization recommends. While C-sections are an incredibly important life-saving intervention when vaginal delivery is too dangerous, they are not devoid of risks for mom or for baby. Hospitals and doctors alike are aware, as it’s been widely reported that unnecessary C-sections are dangerous — and hospitals and doctors agree that the number one way to reduce this risk is to choose a delivery hospital with low a C-section rate. However, information on hospitals’ C-section rates is incredibly hard to find, which leaves women in the dark as they try to make this important choice.

In an effort to help women make informed decisions about where to deliver their babies, we set out to collect a comprehensive, nationwide database of hospitals’ C-section rates. Knowing that the federal government mandates surveillance and reporting of vital statistics through the National Vital Statistics System, we contacted all 50 states’ (+Washington D.C.) Departments of Public Health (DPH) asking for access to de-identified birth data from all of their hospitals. What we learned might not surprise you — the lack of transparency in the United States healthcare system extends to quality information, and specifically C-section data.
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