The Health Care Blog – Page 196 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Another MCQ Test on the USMLE

Oct 29, 2019• 1

By BRYAN CARMODY, MD

One of the most fun things about the United States Medical Licensing Examination (USMLE) pass/fail debate is that it’s accessible to everyone. Some controversies in medicine are discussed only by the initiated few – but if we’re talking USMLE, everyone can participate.

Simultaneously, one of the most frustrating things about the USMLE pass/fail debate is that everyone’s an expert. See, everyone in medicine has experience with the exam, and on the basis of that, we all think that we know everything there is to know about it.

Unfortunately, there’s a lot of misinformation out there – especially when we’re talking about Step 1 score interpretation. In fact, some of the loudest voices in this debate are the most likely to repeat misconceptions and outright untruths.

Hey, I’m not pointing fingers. Six months ago, I thought I knew all that I needed to know about the USMLE, too – just because I’d taken the exams in the past.

But I’ve learned a lot about the USMLE since then, and in the interest of helping you interpret Step 1 scores in an evidence-based manner, I’d like to share some of that with you here.

However…

If you think I’m just going to freely give up this information, you’re sorely mistaken. Just as I’ve done in the past, I’m going to make you work for it, one USMLE-style multiple choice question at a time._

Climate Change is not an ‘Equal Opportunity’ Crisis

Oct 28, 2019• 3

By PHUOC LE, MD and SAM APTEKAR

In the last fifteen years, we have witnessed dozens of natural disasters affecting our most vulnerable patients, from post-hurricane victims in Haiti to drought and famine refugees in Malawi. The vast majority of these patients suffered from acute on chronic disasters, culminating in life-threatening medical illnesses. Yet, during the course of providing clinical care and comfort, we rarely, if ever, pointed to climate change as the root cause of their conditions. The evidence for climate change is not new, but the movement for climate justice is now emerging on a large scale, and clinicians should play an active role.

Let’s be clear: there is no such thing as an “equal opportunity” disaster. Yes, climate change poses an existential threat to us all, but not on equal terms. When nature strikes, it has always been the poor and historically underserved who are most vulnerable to its wrath. Hurricane Katrina provides an example of how natural disasters target their victims along racial and socioeconomic lines even in the wealthiest nations. Writes TalkPoverty.org, “A black homeowner in New Orleans was more than three times as likely to have been flooded as a white homeowner. That wasn’t due to bad luck; because of racially discriminatory housing practices, the high-ground was taken by the time banks started loaning money to African Americans who wanted to buy a home.” Throughout the world, historically marginalized communities have been pushed to overcrowded, poorly-built, and unsanitary neighborhoods where natural disasters invoke much greater harm.

Why I’m Not Buying Healthcare’s AI Hype…Yet | Enrico Coiera, Macquarie University

Oct 25, 2019

By JESSICA DAMASSA, WTF HEALTH

Everyone seems to be amazed by artificial intelligence (AI) and machine learning in healthcare, but Enrico Coiera, Professor of Medical Informatics at Macquarie University, is not impressed — yet. Instead of designing algorithms, he advocates for designing “human-machine systems” that work with the best parts of the health system, the people. An interesting anecdote about how AI can go wrong? Diagnoses of thyroid cancer in South Korea have increased 15 times, but not because of a higher prevalence of the disease…it’s because of more sensitive AI diagnostics that are over-diagnosing people and rendering many with chemo and other treatments they don’t need. So, what should technologists do to ensure that tech doesn’t fail patient outcomes? Enrico gives his best advice for a healthcare industry that’s “in love with technology and can’t often see the simple solution for the sexy tech one.”

Filmed in the HISA Studio at HIC 2019 in Melbourne, Australia, August 2019.

Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt. 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.

Addressing Digital Health’s Gender Gap | Dr. Kudzai Kanhutu, HIC 2019 & Royal Melbourne University

Oct 25, 2019

By JESSICA DAMASSA, WTF HEALTH

It’s no surprise that digital health — the union of two traditionally male-dominated fields, medicine and IT — has similar problems when it comes to gender gaps in pay and leadership positions. How is this playing out in Australia? Dr. Kudzai Kanhutu, Deputy Chief Medical Officer at Royal Melbourne University and Chair for HIC 2019, weighs in on inclusivity and diversity in healthcare and the other key themes she hoped would rise to the surface at HIC19.

Filmed in the HISA Studio at HIC 2019 in Melbourne, Australia, August 2019.

Leveraging Time by Doing Less in Each Chronic Care Visit

Oct 25, 2019• 3

By HANS DUVEFELT, MD

So many primary care patients have several multifaceted problems these days, and the more or less unspoken expectation is that we must touch on everything in every visit. I often do the opposite.

It’s not that I don’t pack a lot into each visit. I do, but I tend to go deep on one topic, instead of just a few minutes or maybe even moments each on weight, blood sugar, blood pressure, lipids, symptoms and health maintenance.

When patients are doing well, that broad overview is perhaps all that needs to be done, but when the overview reveals several problem areas, I don’t try to cover them all. I “chunk it down”, and I work with my patient to set priorities.

What non-clinicians don’t seem to think of is that primary health care is a relationship based care delivery that takes place over a continuum that may span many years, or if we are fortunate enough, decades.

Changing Health Behavior at the Population Level | Maureen Perrin, Public Health Epidemiologist

Oct 24, 2019

By JESSICA DAMASSA, WTF HEALTH

With everyone talking about health data and being able to impact population health thanks to AI and machine learning algorithms, it ONLY makes sense to talk to a good, ole’ fashioned Public Health Epidemiologist like Maureen Perrin about the science and the philosophy at work behind all that data. Smoking, sex, vaccinations, plastic straw bans — this interview has it all! (Well, mostly in the context of changing behavior at-scale to improve the overall health of very large populations of people.) As everyone from digital health startups to health systems look at data as a way to study then impact behavior change, Maureen reminds us that “data doesn’t always make a difference in terms of how we make decisions” as individuals. What else can you learn from someone who’s made it her life’s work to study how to influence behavior change to reduce everyone’s health risks? Watch and learn…

Filmed in the HISA Studio at HIC 2019 in Melbourne, Australia, August 2019.

Improving the Affordable Care Act Markets (Part 2)

Oct 24, 2019• 8

By JONATHAN HALVORSON

In a previous post, I described how some features of the Affordable Care Act, despite the best intentions, have made it harder or even impossible for many plans to compete against dominant players in the individual and small employer markets. This has undermined aspects of the ACA designed to improve competition, like the insurance exchanges, and exacerbated a long term trend toward consolidation and reduced choice, and there is evidence it is resulting in higher costs. I focused on the ACA’s risk adjustment program and its impact on the small group market where the damage has been greatest.

The goal of risk adjustment is commendable: to create stability and fairness by removing the ability of plans to profit by “cherry picking” healthier enrollees, so that plans instead compete on innovative services, disease management, administrative efficiency, and customer support. But in the attempt to find stability, the playing field was tilted in favor of plans with long-tenured enrollment and sophisticated operations to identify all scorable health risks. The next generation of risk adjustment should truly even out the playing field by retaining the current program’s elimination of an incentive to avoid the sick, while also eliminating its bias towards incumbency and other unintended effects.

One important distinction concerns when to use risk adjustment to balance out differences that arise from consumer preferences. For example, high deductible plans tend to attract healthier enrollees, and without risk adjustment these plans would become even cheaper than they already are, while more comprehensive plans that attract sicker members would get disproportionately more expensive, setting off a race to the bottom that pushes more and more people into the plans that have the least benefits, while the sickest stay behind in more generous plans whose premium cost spirals upward. Using risk adjustment to counteract this effect has been widely beneficial in the individual market, along with other features like community rating and guaranteed issue.

However, in other cases where risk levels between plans differ due to consumer preferences it may not be helpful. For example, it has been documented that older and sicker members have a greater aversion to change (changing plans to something less familiar) and to constraints intended to lower cost even if they do not undermine benefit levels or quality of care, like narrow networks. These aversions tend to make newer plans and small network plans score as healthier. Risk adjustment would then force those plans to pay a penalty that in turn forces enrollees in the plans to pay for the preferences of others.

$2 Trillion+ in New Taxes for Single Payer, or $50 Billion to Strengthen ObamaCare? Next Question, Please

Oct 23, 2019• 2

By BOB HERTZ

It is not wise for Democrats to spend all their energy debating Single Payer health care solutions.

None of their single player plans has much chance to pass in 2020, especially under the limited reconciliation process. In the words of Ezra Klein, “If Democrats don’t have a plan for the filibuster, they don’t really have a plan for ambitious health care reform.”

Yet while we debate Single Payer – or, even if it somehow passed, wait for it to be installed — millions of persons are still hurting under our current system.

We can help these people now!

Here are six practical programs to create a better ACA.

Taken all together they should not cost more than $50 billion a year. This is a tiny fraction of the new taxes that would be needed for full single payer. This is at least negotiable, especially if Democrats can take the White House and the Senate.

Aussie Series: Health Tech Workforce

Oct 23, 2019

By JESSICA DAMASSA, WTF HEALTH

A few weeks ago, WTF Health took the show on the road to Australia’s digital health conference, HIC 2019. We captured more than 30 interviews (!) from the conference, which is run by the Health Informatics Society of Australia (hence the HISA Studio branding) and I had the opportunity to chat with most of the Australian Digital Health Agency’s leadership, many administrators from the country’s largest health systems, and a number of health informaticians, clinicians, and patients. I’ll be spotlighting a few of my favorites here in a four-part series to give you a flavor of what’s happening in health innovation ‘Down Under.’ For much more, check out all the videos on the playlist here.

This is the final post in our series, and in it I’m sharing four interviews on the theme of the future of the health tech workforce. This was a huge topic of conversation at HIC19 — dominating the discussion more than at any other conference I’ve been to in the US or Europe — and what struck me was all the different ways Aussies are looking at ‘workforce preparedness.’

There’s Kerryn Butler-Henderson, Associate Professor for Digital Health at the University of Tasmania, who is leading a Health Information Workforce Census that will take place in 2020. She’ll be “counting” the health data analysts, healthcare informaticians, health information managers, clinical coders and health librarians (more on what that job does in the interview) in not only Australia, New Zealand, and Tasmania, but also the US, UK, Canada, and Middle East to give us a larger look at the demographics of this part of the industry. A surprising take-away from her previous work in this space? More than 70% of health information workers are over the age of 45, signaling a shortage that could come up pretty quickly if we don’t start doing a better job of recruiting for the field.

Improving the Affordable Care Act Markets (Part 1)

Oct 22, 2019• 3

By JONATHAN HALVORSON, PhD

With each passing year, the Affordable Care Act becomes further entrenched in the American health care system. There are dreams on both the far left and far right to repeal and replace it with something they see as better, but the reality is that the ACA is a remarkable achievement which will likely outlast the political lifetimes of those opposing it. Future improvements are more likely to tweak the ACA than to start over from scratch.

A critical part of making the ACA work is for it to support healthy, competitive and fair health insurance markets, since it relies on them to provide health care benefits and improve access to care. This is particularly true for insurance purchased by individuals and small employers, where the ACA’s mandates on benefits, premiums and market structure have the most impact. One policy affecting this dynamic that deserves closer attention is risk adjustment, which made real improvements in the fairness of these markets, but has come in for accusations that it has undermined competition.

Risk adjustment in the ACA works by compensating plans with sicker than average members using payments from plans with healthier members. The goal is to remove an insurer’s ability to gain an unfair advantage by simply enrolling healthier people (who cost less). Risk adjustment leads insurers to focus on managing their members’ health and appropriate services, rather than on avoiding the unhealthy. The program has succeeded enormously in bringing insurers to embrace enrolling and retaining those with serious health conditions.

This is something to celebrate, and we should not go back to the old days in which individuals or small groups would be turned down for health insurance or charged much higher prices because they had a history of health issues. However, the program has also had an undesired effect in many states: it further tilted the playing field in favor of market dominant incumbents.