Tag: Susan Dentzer

Requiem for the CLASS Act

On Friday, the stepchild of health reform died at the hands of the Obama administration, and the obits for the troubled long-term care program were mostly similar recitations of why the administration was not going forward to implement that portion of the Affordable Care Act, how it was part of Ted Kennedy’s legacy, and how gleeful Republicans were at its demise.

The media amply quoted Senators Mitch McConnell of Kentucky and John Thune of South Dakota. Thune’s quote in The New York Times, “the Obama administration ignored repeated warnings about the financial solvency of this massive new entitlement,” gives a flavor of what they said.

The CLASS Act, short for the Community Living Assistance Services and Support Act, was a voluntary program where people could join a government plan to pre-fund some of the long-term care they might need in the future. Under the plan they would pay premiums during their working years. If they later became disabled and needed assistance, they would be entitled to a daily cash benefit of say, $50, that they could use to buy services such as a personal care attendant, home improvements that would let them stay in their house, or even to help pay nursing home costs.

Supporters saw the CLASS Act as a first step toward a national long-term care insurance program like those in other countries. Whatever its technical flaws, supporters argued that it would begin to solve the dilemma millions of families face—how to pay for a loved one’s care. Many politicians and the insurance industry weren’t keen on that idea since it could also be a first step to a publicly-financed insurance program (anathema to insurance sellers) and might cut into the market for long-term insurance, a product that has never really become a big seller primarily because of its high cost. The CLASS Act barely made it into the final bill.

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Tackling Rising Pharmaceutical Prices: 50 Shades of Gray

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Here’s the problem with high and rising pharmaceutical prices:  It’s not just one problem, but many.  Addressing them will require a range of solutions – many of them difficult to execute, and possibly tough medicine to swallow.

These were key takeaways from the recent U.S. Department of Health and Human Services Pharmaceutical Forum,which I moderated.  A broad group of stakeholders participated, including patients, consumer groups, pharmaceutical companies, pharmacy benefits managers, insurers and others.  The key issues: Obtaining the greatest value for the dollars we spend on drugs –and having a vital biopharmaceutical sector that produces vaccines, effective treatments,and cures, at affordable costs for patients and the nation.

Having slowed along with the rest of health care spending in recent years, pharmaceutical spending is now roaring ahead. Total pharmaceutical sales, now about $400 billion annually, are projected to reach as high as $590 billion in 2020, according to Doug Long, vice president of industry relations at IMS Health. New National Health Expenditure data show that national retail prescription drug spending grew 12.2 percent in 2014 – a sharp increase over 2.4 percent growth in 2013  — in large part due to increased spending for new drugs, such as cures for Hepatitis C.

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What’s Missing in the Debate Over Employer Wellness Programs

Susan-Dentzer-For-PostBy now, Americans are no doubt getting used to debates that put show over substance and skirt the genuinely profound issues the nation faces. But although we may have come to expect as much in this political season, we deserve better when it comes to contemplating the role of employers in improving employees’ health.

A recent “debate” sponsored by the Population Health Alliance about employer wellness programs – the various health promotion and disease prevention strategies that about half of U.S. employers offer,  such as weight loss, smoking cessation and onsite gym classes – fell into the depressing pattern of highlighting the largely irrelevant at the expense of the important. The debate, which took place last November 2 at the alliance’s 2015 Forum in Washington, DC, pitted two frequent combatants:Al Lewis, founder of Quizzify and co-author of a book critiquing wellness programs, and Ron Goetzel, senior scientist at Johns Hopkins University’s Bloomberg School of Public Health and leader of the “Promoting Healthy Workplaces” program supported by the Robert Wood Johnson Foundation.

The ostensible topic was whether wellness programs benefited employees, companies, and society at large, but the debate never actually addressed this broad question. Most of the time, the session’s verbal jousting focused on a far narrower issue: whether companies saw any financial return on investment (ROI) on the dollars they plow into wellness programs.

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America’s Nursing Crisis

Many of the nation’s nurses understandably erupted in anger when the co-hosts of ABC’s The View mocked Miss America contestant Kelley Johnson for her pageant-night monologue about being a nurse — and for wearing scrubs and a “doctor’s stethoscope” (their words) in the talent competition. The co-hosts, Joy Behar and Michelle Collins, have since apologized, especially for implying that only doctors use stethoscopes. “I didn’t know what the hell I was talking about,” Behar later said.

It would be easy to attribute this episode solely to the ignorance of some TV personalities, but as most nurses know, the problem goes far deeper. The fact is that much of the nation doesn’t really understand nursing, either.

It’s true that the public rates nursing in Gallup surveys as the most honest and ethical profession. Yet it’s unlikely that most Americans understand the range of critically important roles that nurse’s play across the health care continuum, from health promotion, prevention, and research, to palliative and hospice care.

How many Americans know that patients who obtain organ transplants will have far more contact with – and obtain more hands-on care from – a transplant nurse than a surgeon? Or that two-thirds of all anesthetics given to US patients are delivered by certified registered nurse anesthetists, rather than anesthesiologists with medical degrees?

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Opening the Care Conversation Through Open Notes

Susan DentzerIt’s a memory aid.

It’s truth serum.

Using it can transform relationships forever.

These may sound like come-ons for the type of product typically hawked on late-night television.  But in fact, they’re some of the things people are saying about OpenNotes.

OpenNotes isn’t a product, but an idea: That the notes doctors and other clinicians write about visits with patients should be available to the patients themselves. Although federal law  gives patients that right, longstanding medical practice has been to reserve those visit notes for clinicians’ eyes only.

But Tom Delbanco and Jan Walker, a physician and nurse at Beth Israel Deaconess Medical Center in Boston, have long seen things differently.

Their personal experiences with patients, and inability to access care records for their own family members, persuaded them that the traditional practice of “closed” visit notes had to change.  So, with primary support from the Robert Wood Johnson Foundation, they launched what has now become a movement.

In 2010, Delbanco, Walker and colleagues led a study in which more than 100 primary care doctors from three health systems began sharing notes online with patients. Patients got secure messages prompting them that the notes were available, and reminders to read notes before their next appointments.

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What Do Women Know About Obamacare That Men Don’t?

Susan DentzerFor the second year running, more women than men have signed up for coverage in health insurance marketplaces during open enrollment under the Affordable Care Act. According to the Department of Health and Human Services, enrollment ran 56 percent female, 44 percent male, during last year’s open enrollment season; preliminary data from this year shows enrollment at 55 percent female, 45 percent male – a 10 percentage point difference.

What gives? An HHS spokeswoman says the department can’t explain most of the differential. Females make up about 51 percent of the U.S. population, but there is no real evidence that, prior to ACA implementation, they were disproportionately more likely to be uninsured than men – and in fact, some evidence indicates that they were less likely to be uninsured than males .

What is clear that many women were highly motivated to obtain coverage under the health reform law – most likely because they want it, and need it.

It’s widely accepted that women tend to be highly concerned about health and health care; they use more of it than men, in part due to reproductive services, and make 80 percent of health care decisions for their families . The early evidence also suggests that women who obtained coverage during open enrollment season last year actively used it.  Continue reading…

Toxic Stress

“Speed kills,” warns the traditional highway sign about the dangers of haste and traffic deaths. Now, we know that stress kills, too.

Toxic stress, at any rate. The human body’s response to normal amounts of stress—say, a bad day at the office—is likely to be brief increases in the heart rate and mild elevations in hormone levels. But a toxic stress response, stemming from exposure to a major shock or prolonged adversity such as physical or emotional abuse, can wreak far more havoc.

In children, science now shows that toxic stress can disrupt the developing brain and organ systems.

The accumulated lifelong toll of stress-related hormones sharply raises the risk of chronic diseases in adulthood, ranging from heart disease and diabetes to depression and atherosclerosis.

Thus, the message from a panel of experts to the Robert Wood Johnson Foundation’s Commission to Build a Healthier America was at once simple and challenging: Create a healthier environment for—and increase coping mechanisms and resilience in—the nation’s most vulnerable and stress-ridden children and families.

At a June 19 meeting in Washington, DC, the commission heard testimony from a child development specialist, an economist, and community development professionals, among others. Together, they described more of the social and economic effects of toxic stress, but also the evidence that significant investments in individuals, families and communities can turn the tide.

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