The Health Care Blog – Page 248 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

During National Kidney Month, Protect Patients by Protecting Their Health Care Choices

Oct 30, 2018

By ALLYSON Y. SCHWARTZ and ELENA RIOS MD, MSPH

The recent coronavirus outbreak has millions of Americans thinking carefully about their health and wellness. For the 37 million of our friends and neighbors battling chronic kidney disease, however, health care risks that the rest of us often take for granted are never far from their mind.

Every year, 124,000 patients with kidney disease see their condition progress to end-stage renal disease (ESRD), also known as kidney failure and will require dialysis at least three times per week to survive.

Hannah, an ESRD patient in Henrico, Virginia, describes dialysis as “the most painful thing, physically and emotionally, I’ve had to endure.”

As a physician who represents medical providers in the Hispanic community – a demographic disproportionately impacted by kidney disease (Rios) – and a former lawmaker who worked to reduce the uninsured rate and improve quality of care (Schwartz), we know that stories like Hannah’s are all too common.

Facts, Conclusions, and More Questions on the Road to Solving Disparities

Oct 30, 2018• 2

By SCOTT COOK PhD

We tested whether new payment mechanisms could be harnessed in health care delivery reform to reduce health and health care disparities. Here’s what we found.

First, there were facts that couldn’t be ignored:

#1: Children in rural Oregon on Medicaid suffered more health-related dental challenges compared to children with private insurance, including the pain, systemic health problems and disruptions to education that come with them. Advantage Dental, the state’s largest provider of Medicaid services, was determined to do something about it.

#2: New mothers on Medicaid in a New York City hospital were less likely to have a postpartum care visit compared to privately insured women. As a result, they missed assessments and screenings for a number of health conditions, some of which can lead to chronic health problems throughout their lives. For many women, the postpartum visit is one of the few chances to engage them in ongoing health care. The providers and care teams at the Icahn School of Medicine and the Mount Sinai Health System wanted to find out what it takes to increase postpartum visit rates.

#3: In Fairfax County, Virginia, multi-racial and multi-ethnic populations being served in three County-funded safety-net clinics were less likely to receive the typical high-quality care provided for hypertension, diabetes, and cervical cancer screening when compared to their Hispanic counterparts. The providers and teams at the Community Health Care Network stepped forward to address the issue.
Continue reading…

Silencing Noisy Health Care?

Oct 30, 2018

By MATTHEW HOLT

As you’ve probably heard (enough!) from me and Indu Subaiya over recent months on video, at Health 2.0 or here on THCB, we are finally arriving at the point where health care tech is “flipping the stack” — where we realize that we can’t practice the old way, and instead need to move the care of the chronically ill to an always on, always monitoring, always measuring, always messaging tech platform.

But we need to figure out a way to both create that platform and the services for the people who need help–without overwhelming them. Too often we are putting too much technology into patients’ and clinicians’ lives and creating too much noise. While I’ve been aping Bob Wachter calling for an air traffic control function in health care, one of the most interesting new companies in health tech/services, Livongo, has been working on a related idea. They’ve been promoting it by looking to #SilenceNoisyHealthCare on Twitter and Linkedin recently

Tuesday 30th at 1 ET – 10 PT I’m hosting a webinar with Livongo’s CEO Glen Tullman & & Chief Medical Officer Jennifer Schneider, M.D. Jessica DaMassa tweeted that Glen and I are in a cage match, and it is an Oxford v Cambridge affair (although Jennifer brings some Stanford & Hopkins class to the proceedings).

But what’s really going on is that Livongo is adopting a new philosophy that they think will silence the noise and fix the patient experience. What do they mean by that? Join me on the webinar to learn more.

All Health Policy Is Local: The Case of the Individual Mandate Penalty in New York

Oct 29, 2018• 2

By CHRISTINE EIBNER PhD, SARAH NOWAK PhD, MS, PREETHI RAO PhD

Although signed into law in 2010, the Affordable Care Act has been in constant flux, with key aspects changing due to time-dependent provisions, Supreme Court decisions and shifts in U.S. policy. The effects of changes to the ACA on health insurance enrollment and premiums often depend on state regulatory decisions and other state-specific factors. The elimination of the individual mandate penalty is a prime example of this when applied to New York state, which has unusual rules in its individual insurance market.

In 2019, consumers will no longer face financial penalties stemming from the ACA’s individual mandate, which requires most people to secure health insurance. Without pressure from the individual mandate to enroll, younger and healthier people might drop coverage, leading to premium increases. New York’s health insurance regulations and expansive safety-net programs could make the state’s insurance market particularly susceptible to premium increases after the penalty’s elimination.

New York uses what is known as “full community rating” in its individual health insurance market, which means that all adult enrollees, regardless of age or whether they use tobacco, are charged the same premium. In most states, the youngest adults in the market pay one-third of what older adults do, and tobacco users are charged 1.5 times as much as non-users. New York’s flat premium structure raises costs for younger enrollees and nonsmokers, making them more likely drop coverage when the penalty goes away.

Hospitals Can and Should Support Employees Who Are Victims of Domestic Violence: Here’s How

Oct 26, 2018• 6

By PATRICK HORINE

Every October we recognize Domestic Violence Awareness Month, an important opportunity to discuss this widespread social and public health problem and to take stock of what we can do better to protect victims of domestic abuse.

Unfortunately, the data shows us that health care is often a dangerous profession that is also rife with domestic abuse. Earlier this month a new poll of ER physicians revealed nearly half report having been physically assaulted at work (largely by patients and/or visitors in the ER). However, other data shows us that individuals in the health care professions – especially women—may be at greater risk of domestic abuse from a spouse or partner, while on the job as well. Data on domestic violence nationwide shows us one in four women are in a dangerous domestic situation, and one in four victims are harassed at work by perpetrators. Women make up 80 percent of the healthcare workforce and an even greater percentage in most hospitals. When we do the math, this means one in 20 female healthcare workers are likely to be harassed or even assaulted on the job.

Furthermore, given that hospitals and most healthcare organizations are “open” facilities where anyone can walk onto the premises this further heightens the risk of a violent incident happening in the workplace. Over half of the homicides committed by intimate partners occur in parking lots and public buildings. News stories like the ones about a California healthcare worked stabbed in the hospital parking lot by her estranged husband while her co-workers looked on are all too tragic and common.

The Futility of Patient Matching

Oct 25, 2018• 5

By ADRIAN GROPPER, MD

The original sin of health records interoperability was the loss of consent in HIPAA. In 2000, when HIPAA (Health Insurance Portability and Accountability Act) first became law, the Internet was hardly a thing in healthcare. The Nationwide Health Information Network (NHIN) was not a thing until 2004. 2009 brought us the HITECH Act and Meaningful Use and 2016 brought the 21st Century Cures Act with “information blocking” as clear evidence of bipartisan frustration. Cures, in 2018, begat TEFCA, the draft Trusted Exchange Framework and Common Agreement. The next update to the draft TEFCA is expected before 2019 which is also the year that Meaningful Use Stage 3 goes into effect.

Over nearly two decades of intense computing growth, the one thing that has remained constant in healthcare interoperability is a strategy built on keeping patient consent out of the solution space. The 2018 TEFCA draft is still designed around HIPAA and ongoing legislative activity in Washington seeks further erosion of patient consent through the elimination of the 42CFR Part 2 protections that currently apply to sensitive health data like behavioral health.

The futility of patient matching without consent parallels the futility of large-scale interoperability without consent. The lack of progress in patient matching was most recently chronicled by Pew through a survey and a Pew-funded RAND report. The Pew survey was extensive and the references cite the significant prior efforts including a 100-expert review by ONC in 2014 and the $1 million CHIME challenge in 2017 that was suspended – clear evidence of futility.

The November 6 Midterm Elections and Their Impact on Obamacare:Q&A

Oct 24, 2018• 2

By ETIENNE DEFFARGES

1) What is the likelihood the ACA will be repealed?

This straightforward question has a very simple answer: It depends on the results of the upcoming November 6 U.S. congressional elections.

If the Republicans retain control of both the House and the Senate, the probability that the ACA will be repealed is very high: The Republicans would be emboldened by such a victory and would most probably attempt in 2019 to repeal the health care law—again. It is worth remembering that in July of last year, the repeal of the ACA (a version of which had passed the House in May) was defeated in the Senate by the narrowest of margins, because three Republican Senators, Susan Collins, Lisa Murkowski, and the late and much regretted John McCain, voted against the repeal. This is very unlikely to happen again, although one would also have to consider the margins by which the Republican would have gained control both Chambers after these November midterms. In July of 2017, the Republicans held a 52-48 advantage in the Senate. Given ever-increasing polarization, such a margin, plus Republican control of the House, would likely spell the end of the ACA in 2019.

If the Democrats gain control of either the House of Representatives or the U.S. Senate, then the ACA will remain the law of the land. The only issue in the horizon will be the lawsuit filed in February of this year by a coalition of 20 states, led by Texas and Wisconsin. This lawsuit claims that Obamacare is no longer constitutional after the Republicans eliminated in December of 2017 the tax penalty associated with the ACA’s individual mandate. The 20 Republican attorney generals argue that without the tax penalty, Congress has no constitutional authority to legislate the individual mandate. Even if this case reaches the Supreme Court, one has to remember that the Court affirmed twice the constitutionality of the ACA, in June of 2012 and then 2015, with Chief Justice John Roberts voting with the majority on both occasions.

2) What do recent congressional changes to the ACA mean for those who buy insurance on health care exchanges?

Health in 2 Point 00 Episode 55

Oct 23, 2018• 1

We missed our chance to do a Happy Hour Health in 2 Point 00 at Connected Health in Boston (but let’s be honest, those are usually not the most cogent pieces of information in health and technology). Join Jessica DaMassa as she gets my take on the conference starting with #S4PM’s event, where I met some incredible people, including Patty Brennan and Doug Lindsey, who spoke about their experiences with health care knowledge (deploying it and creating it!). Danny Sands and e-Patient Dave even had quite the musical performance there, singing about e-Patient blues. Susannah Fox, Don Berwick, Don Norman were at Connected Health 18, presenting their new initiative, L.A.U.N.C.H. I even interviewed Jesse Ehrenfeld, the chair elect of AMA, and his spoke to him about the digital health play book that the AMA just released. A company to take note of that wasn’t at #CHC is Devoted Health, who just raised $300m. Devoted is looking at building a better Medicare Advantage “payvider” for seniors. If you are interested in Guild Serendipity’s conference which empowers and engages female CEOs and Cofounders, come join us in San Francisco October 26-27, SMACK.health is sponsoring the women’s health houses – Matthew Holt

A conversation about Health Policy with Elizabeth Rosenthal

Oct 22, 2018• 7

By SAURABH JHA, MD

The acclaimed author of “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back” physician, and now Editor-in-Chief of Kaiser Health News, Dr. Elizabeth Rosenthal speaks to me about health policy and how it has changed over time.

Listen to our conversation at Radiology Firing Line Podcast.

About the author:

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

THCB Spotlights: Livio AI

Oct 19, 2018

By ZOYA KHAN

Today we are featuring another #TechCrunchDisrupt2018 THCB Spotlight. Matthew Holt interviews LivioAI, which is an AI hearing aid created by Starkey Technologies. Worldwide, there are 700 Million people with hearing loss but only 10% wear a device to help them. That number is appalling especially because there are a number of co-morbid illnesses linked with hearing loss, like cognitive and physical decline! That is where LivioAI comes in to play. LivioAI is completely controlled by your iPhone, tracks all types of movements (it is always counting your steps so the steps you miss when you put down are also accounted for), classifies acoustic environments to measure your social engagement (it can register the difference between a noisy restaurant and a library to figure out how much you are participating in a situation), and even translates foreign languages directly into your ear with its voice-activated platform. It is connected with Apple Health and Google Fit and can measure data to observe patterns of co-morbid illnesses. It is the new Fitbit, but for the ear! As LivioAI’s motto goes “Hear better, Live better.”