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Tag: COVID-19

The Need for Measuring Clinician-Patient Cost-of-Care Conversations

By MORENIKE AYOVAUGHAN, NELLY GANESAN, EMMY GANOS, and JOSH SEIDMAN

It is no surprise that beyond COVID-19 health risks, the pandemic has also caused significant disruption to the lives of everyone in America. It has caused exacerbating financial pressures and ongoing job losses. An estimated 42 million people have lost their job since March 2020, which has increased the number of uninsured. The loss of coverage has the potential to yield catastrophic healthcare costs for those seeking care during the period.

It is no surprise that beyond COVID-19 health risks, the pandemic has also caused significant disruption to the lives of everyone in America. It has caused exacerbating financial pressures and ongoing job losses. An estimated 42 million people have lost their job since March 2020, which has increased the number of uninsured. The loss of coverage has the potential to yield catastrophic healthcare costs for those seeking care during the period.

While the pandemic has exacerbated coverage challenges, it also highlights gaps that existed long before the outbreak. Prior to COVID-19, average out-of-pocket costs were on the rise with an estimated 24% of Americans spending over $1,000 per year on direct medical care and surprise medical billing. The pandemic-induced economic disruption reinforces the need for physicians and patients to embrace conversations regarding cost in the clinical setting; avoiding such discussion may result in patients foregoing care and not realizing their options.

Patients should be able to rely on their clinicians to help them understand the costs of their care, including losses associated with the time away from work and transportation expenses for visits. Our past research, and the research of others, has demonstrated that these conversations are valued and can be impactful in helping patients understand their options to address concerns upfront. And yet, the concept of having a Cost-of-Care (CoC) conversation is merely optional. These conversations are not typically supported with access to price information, nor are they consistently viewed as a routine part of practice. Cost conversations are not consistently documented, lack standardization, and structure. Furthermore, physicians have not adequately been trained to address CoC conversations with their patients.  

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How to Pandemic-Proof Our Health Care Payment System

By AISHA PITTMAN and SETH EDWARDS

The pandemic has focused many policymakers’ attention  on strategies to make the healthcare system better. The obvious answer is one that we know is efficacious, if perhaps not the sexiest: value-based care.

The current healthcare payment system – built around the fee-for-service (FFS) model in which healthcare providers are reimbursed for the quantity versus quality of care – required $175 billion in bailouts and temporary modifications to remain whole during the crisis, a stance that’s unsustainable for both providers and payers.

The Centers for Medicare & Medicaid Services (CMS) admitted as much with its renewed national commitment to value-based care in late June: The movement to value is happening now.

The worth of value-based care models has long been detailed, from more coordinated care to lower costs. In fact, a recent survey conducted by our organization Premier Inc. found that healthcare providers in alternative payment models (APMs) were better positioned to respond to COVID-19 and support reopening plans through the rapid deployment of telehealth, care management and data analytics. These are the types of population health capabilities the industry must focus on spreading – and incenting – in the near future.

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COVID herd immunity: At hand or forever elusive?

By MICHEL ACCAD, MD

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.  

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Robert Wood Johnson Foundation Innovation Challenges Blog Post Announcing Semi-Finalists

SPONSORED POST

By CATALYST @ HEALTH 2.0

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.

As COVID-19 brought to light the lack of emergency response preparedness in the health care system, the Robert Wood Johnson Foundation (RWJF) and Catalyst saw an opportunity to highlight digital health’s potential to support health care stakeholders and the general public. RWJF and Catalyst partnered to launch two Innovation Challenges on Emergency Response for the General Public and Emergency Response for the Health Care System. 

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. 

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Too Many Small Steps, Not Enough Leaps

By KIM BELLARD

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 Post by 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.”  

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Collective State Action Is Needed to Fight This Pandemic Right Now

By KEN TERRY

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.

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Repurposing a Universally Installed EHR App Into an Effective COVID-19 Early Detection System

By SCOTT WEINGARTEN, MD

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.

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The Trump COVID Legacy: Bad Timing. Lots of Questions. Few Answers.

By MIKE MAGEE, MD

What a strange irony. Trump decides, full-bravado, to challenge China to a trade war just months before China unwittingly hatches a virulent pandemic that collapses our deeply segmented health care system and our economy simultaneously. And rather than cry “Uncle”, our President then fires the WHO just as their experts are heading to China to attempt to unravel the mystery of COVID-19.

With the ongoing, cascading catastrophe of Trump’s mishandling of COVID-19, it is easy to lose sight that the next pandemic (fueled by global warming, global trade, and human and animal migration) is just around the corner. And we haven’t even begun to nail down the origin story of this one.

Unraveling the transmission trail requires international cooperation. As one expert recently noted, “Origin riddles for other new infectious diseases often took years to solve, and the route to answers has involved wrong turns, surprising twists, technological advances, lawsuits, allegations of cover-ups, and high-level politics.”

What we do know is that there are originators, intermediate hosts, and human super-spreaders….and COVID-19 appears to have begun in China.  These are not new insights. We’ve seen this playbook before.

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The 2020 Pandemic Election

The 2020 US election will be vicious, with a nasty pandemonium following a nasty pandemic.

By SAURABH JHA, MD

When the COVID-19 pandemic is dissected in the 2020 presidential election debates, Donald Trump will be at a disadvantage. The coronavirus has killed over 100,000 Americans and maimed thousands more. The caveat is that deaths per capita, rather than total deaths, better measure national failure, and by that metric the US fares better than Belgium, Italy and the United Kingdom. New York City owns a disproportionate share of the deaths, but this hyperconnected megapolis is an outlier whose misfortunes can’t be used to draw conclusions about administrative competence for the country as a whole.

Nevertheless, even after introducing nuance, the numbers aren’t flattering. President Donald Trump may claim that the US dodged the calamity predicted by the epidemiological models, which foretold millions of deaths. To be fair, we don’t know the counterfactual — Jeremiads aren’t verifiable. The paradox of successful mitigation is that we can’t see the future we dodged, precisely because we avoided it.

Reducing the death count logarithmically, rather than merely arithmetically, won’t be celebrated because as bad as the worst case scenario could have been, the situation still looks awfully bad. Many still disbelieve the high death toll predicted by epidemiologists early on, particularly Trump supporters who believe the response to the virus, specifically the economic shutdown, has been criminally disproportionate. One can’t simultaneously believe that COVID-19 is no more dangerous than the seasonal flu and that Trump saved millions from the coronavirus. The constituency that acknowledges the lethality of COVID-19 and credits Trump for decisive action against it is small.

Triangle of Incompetence

Trump’s challenger, former Vice President Joe Biden, will charge that fewer Americans would have died had the Trump administration acted earlier. Trump may be accused of having blood on his hands, but such rhetoric is unnecessary. Biden’s team can simply show a montage of Trump’s bombast where he downplayed COVID-19’s lethality, dismissed doctors’ concerns about the shortage of personal protective equipment or exaggerated how well the US was containing the pandemic. Incidentally, the most iconic picture of the administration’s scornful indifference is the current vice president, Michael Pence, visiting a hospital without a mask, surrounded by health-care workers wearing masks.

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Doctors and Democracy: Why Vote-By-Mail is Good Public Health

Rob Palmer
Josh Hyman
Isaac Freedman

By ROB PALMER, ISAAC FREEDMAN, and JOSH HYMAN

Suppose tomorrow you were informed that patients could no longer have medications delivered to their homes. Thus, in the midst of the worst pandemic in recent history, your patients would have to go to pharmacies to get essential medications. Undoubtedly, you’d be puzzled, wondering why your patients must needlessly put themselves and others in harms’ way to care for their own health. In light of the change, you might even debate if it’s worth the risk of getting your own medications. 

Thankfully, the common-sense practice of delivering medication to people’s homes seems here to stay. Yet many people will face a similar issue on election day this November: Fifteen states severely restrict who can vote by mail. In these states, millions of citizens will be forced to choose between exercising their right to vote and safeguarding their own health. 

So long as SARS-CoV-2 remains a threat, in-person voting is a public health crisis. Unless we want to risk a spike in new COVID-19 cases, with the concomitant deaths and strain on the healthcare system, it is critical to ensure that anyone who wants to vote in the upcoming general election can use mail-in voting. Indeed, a peer-reviewed study published in May found a statistically significant increase in COVID-19 cases in the weeks after the Wisconsin primary, specifically in counties with higher in-person votes per voting location. The study also found a decrease in COVID-19 cases in counties with the highest rates of absentee ballots. Unsurprisingly, the study’s authors exhort policy makers to “expand the number of polling locations or encourage absentee voting for future elections.”

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