The Health Care Blog – Page 26 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Will Trump and RFK Jr. Revive His Covid Pandemic Performance?

Nov 14, 2024

By MIKE MAGEE

It has been a collision of past, present and future this week in the wake of Trump’s victory on November 6, 2024. The country, both for and against, has been unusually quiet. It is unclear whether this is in recognition of political exhaustion, or the desire of victors to be “good winners” and no longer “poor losers.”

Who exactly are “the enemy within” remains to be seen. But Trump is fast at work in defining his cabinet and top agency officials. In his first term as President, Trump famously placed himself at the front of the line of scientific experts sowing confusion and chaos in the early Covid response.

His 2024 campaign alliance with Robert F. Kennedy Jr. suggests health policy remains a strong interest. As his spokesperson suggested, his up-front leadership led to a resounding victory “because they trust his judgement and support his policies, including his promise to Make America Healthy Again alongside well-respected leaders like RFK Jr.”

For those with a memory of Trump’s checkered, and disruptive management of the Covid crisis, it is useful to remind ourselves of those days not long ago, and consider if throwing Bobby Kennedy Jr. in the mix back then would have been helpful.

I have been revisiting the Covid pandemics I have prepared for a 3-session course on “AI and Medicine” at the University of Hartford’s Presidents College. The course includes a number of case studies, notably the multi-prong role of AI in addressing the Covid pandemic as it spun out of control in 2020.

The early Covid timeline reads like this:

America the Schizophrenic

Nov 13, 2024

By KIM BELLARD

I must admit, last week’s election took me by surprise. I knew all the polls predicted a close race, but I kept telling myself that the American I believed in would not elect such a man, again, knowing full well all the things he has said and done – in his personal, professional, and political lives. I was giving us too much credit.

Democrats might tell the public that Wall Street was hitting record highs, that GDP growth was among the best in the world, that unemployment was low, and that inflation was finally back under control, but voters didn’t believe them. For most people, the economy isn’t working.

When two-thirds of voters say the country is on the wrong track (NBC News), when almost three-quarters of Americans are dissatisfied with the way things are going in the U.S. (Gallop), when 62% of voters think the economy is weak and 48% say their personal financial situation is getting worse (Harvard CAPS/Harris) – well, threats to democracy tomorrow don’t compare to the price of eggs today.

Let’s face it: we are on the wrong road. We’re not on a road that is good for most people. We’re not on a road that is getting us ready for the challenges and opportunities that the 21^st century is bringing/is going to bring us. And we’re kidding ourselves about the America we believe in versus the America we actually live in. Our views about our country are delusional, they’re disorganized thinking, they may even be hallucinations. I.e., they’re schizophrenic.

For example:

Medicare’s Hidden Information Hurts People & Policy

Nov 12, 2024

By MICHAEL MILLENSON

Open enrollment season for Medicare, which began Oct. 15 and ends Dec. 7, triggers a deluge of information about various options. Since I’m a health care consultant and researcher as well as a Medicare beneficiary, I’ve looked critically at what we’re told and what we’re not. Unfortunately, information crucial both for the individual and for the broader policy goal of moving toward a “value-based” care system is often difficult to find or not available at all.

The most glaring example involves Medicare Advantage, the increasingly popular insurer-run plans that are an alternative to traditional fee-for-service Medicare. Plans receive a quality grade from one to five stars from the Centers for Medicare & Medicaid Services. Those grades are designed to incentivize providing the highest quality care for the money — the very definition of “value.” A high grade triggers both a boost in payment from Medicare and a boost in enrollment. Not surprisingly, almost three-quarters of people chose a plan with a 4-, 4.5- or 5-star rating, according to CMS.

Those ratings, however, should come with a large asterisk attached. It’s not just that the methodology can be controversial, particularly when a lower grade is meted out. It’s that the star ratings aren’t anchored in geography, as one would naturally expect; i.e., the rating is for the plan offered in my area. What is colloquially called a “five-star plan” is actually a plan that’s part of a five-star Medicare contract — and those two typically are not the same thing.

For instance, one large insurer contract that I tracked included at least 17 plans scattered across the country. It defies common sense to believe that care quality is identical among plans in, say, Rhode Island, Mississippi, Illinois, Colorado, and California just because they all share the same government contract number.

If you’re wondering who benefits from this not-very-transparent transparency, some insurers have been known to improve the rating of a low-performing plan with a small number of members by merging it into a contract with more members and a higher rating.

In 2024, nearly 33 million people, or 54% of Medicare beneficiaries, were enrolled in an MA plan, according to KFF (formerly the Kaiser Family Foundation). KFF expects that number to increase to nearly 36 million in 2025. It’s a long-accepted truism that “All health care is local.” Medicare beneficiaries deserve local plan information.

THCB Gang Episode 143, Friday November 8

Nov 8, 2024

Joining Matthew Holt (@boltyboy) on #THCBGang on Friday November 8 are THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); Principal of Worksite Health Advisors Brian Klepper (@bklepper1); patient safety expert and all around wit Michael Millenson (@mlmillenson); and digital health investment banker Steven Wardell (@StevenWardell). There may well be a discussion about an election.

You can see the video below live (and later archived) & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Heat-related illnesses are preventable; here’s how

Nov 6, 2024

By PHIYEN NGUYEN & KRISTINA CARVALHO

As we enjoy the crisp air of fall, a harsh reality remains: our planet is heating up. With more frequent and intense heat waves, 57.5 million Americans are living in areas with dangerously hot summer conditions, yet many states remain unprepared for the heat crisis already unfolding.

Impact of Heat on Health

Extreme heat poses a growing health threat, causing more deaths in recent years in the United States than any other weather-related event. Heat-related illnesses (HRIs), such as heat exhaustion and heat stroke, are on the rise, particularly among the elderly, children, outdoor workers, and individuals with certain preexisting medical conditions.

Not all communities are affected equally. Low-income neighborhoods and communities of color, often situated in urban “heat islands,” face greater exposure and have less access to cooling resources. Moreover, extreme heat worsens air pollution and spreads disease-carrying insects, exacerbating health risks.

Without stronger protections, HRIs will continue to escalate, especially among populations who are already at increased health risks. Heat standards are a key part of the solution.

What are Heat Standards?

Heat standards are regulations that protect workers from excessive heat by requiring breaks, water access, and emergency procedures to prevent HRIs. Yet few states have heat standards in place.

In 2005, California was the first state to implement a mandatory HRI prevention standard requiring water, shade structures, and rest breaks for outdoor workplaces when temperatures exceed 80°F. Employers are also required to educate their workers about HRIs and have additional precautions in place when the temperatures exceed 95°F. A few months ago, California even expanded protections to include indoor workplaces when it is over 82°F inside.

Washington, Colorado, and Oregon followed suit with similar policies, though without indoor regulations. On the other hand, Minnesota’s heat standard only applies to indoor workspaces. But it’s unique in that it also applies to care facilities such as nursing homes and daycares, protecting the elderly and young children. Lastly, Maryland just passed a heat standard that applies to all outdoor and indoor workers across all industries.

All other states, including warm ones like Arizona, have no established heat standards. Texas and Florida have even tried to prevent their cities and towns from mandating that employers provide heat protections like water breaks.

Heat Standards Work!

Although formal studies are limited, there’s enough observational data to suggest that heat standards are effective at keeping people safe and healthy.

For example, California saw a 30% decrease in reported HRIs following implementation of its heat standard in 2005. Similarly, HRI-related medical visits in Oregon dropped by 75% in the year after the state enacted its standard. What’s more, that was in spite of having more days with temperatures above 80°F as well.

In short, HRIs are preventable. And they’re also cost-effective.

Inventors (and Innovators) Wanted

Nov 5, 2024

By KIM BELLARD

I thought about writing about the election, but I’m too anxious – and a little terrified – about it, so I’ll take a pass. I was intrigued by Oracle Health’s promise of an AI-driven, “next-generation” EHR, or the news that OpenAI was introducing ChatGPT search, but I felt that each was inevitable and yet that both would prove underwhelming in the short term.

So I decided to write about invention.

The November issue of IEEE Spectrum magazine is all about invention, starting with the tantalizing overview Why the Art of Invention Is Always Being Reinvented. “Invention doesn’t come from some innate genius, it’s not something that only really special people get to do,” says Stephanie Couch, executive director of the Lemelson MIT Program.

Still, authors Eliza Strickland and Peter B. Meyer warn, “…the limits of what an individual can achieve have become starker over time. To tackle some of the biggest problems facing humanity today, inventors need a deep-pocketed government sponsor or corporate largess to muster the equipment and collective human brainpower required.”

Tell that to UTEP student Tayia Oddonetto. While an undergraduate, she had an epiphany. “During class, the professor said that if someone discovered how to turn brine, water with a high salt concentration, into something of value, it’d be revolutionary for the planet. At that moment, I told myself I was going to be the one who found the solution for brine, and that thought has never left me.”

And she did it. Instead of the more common reverse osmosis (RO) method of desalination, which at best converts 85% of salt water into fresh water and leaves a problematic 15% of concentrated brine, Ms. Oddonetto used something called salt-free, electrodialysis metathesis. As the press release describes it: “Salt-free electrodialysis metathesis treats brine by passing it through ion exchange membranes, thin sheets or films, and electrical currents that work to separate salt from water at the molecular level.”

Her approach produced over 90% fresh water, and generated higher levels of valuable metals and minerals that can be repurposed across several industries including technology, health and food.

Patty Hayward, Talkdesk

Nov 4, 2024

Patty Hayward is GM of Healthcare and Life Sciences at Talkdesk. Talkdesk runs the technology for contact centers that helps companies across health care connect and manage their consumers. You’ve probably unknowingly used their technology when you call (or now text or email) your health plan, your provider system or call into one of those numbers on the drug adverts. Patty told me about the business of technology for contact centers, and how the transition is happening between voice to text and for that matter from on-prem to cloud. They’re also deeply integrated with Epic. Pretty interesting view into a not-often-thought-about part of the puzzle.–Matthew Holt

The Penn State College of Medicine Oath vs. “Doomscrolling.”

Nov 3, 2024

By MIKE MAGEE

Two years ago, prior to the 2022 election, mental health experts alerted the medical world to their version of an assessment scale for yet another new condition – “doomscrolling.”

As defined in the article, “Constant exposure to negative news on social media and news feeds could take the form of ‘doomscrolling’ which is commonly defined as a habit of scrolling through social media and news feeds where users obsessively seek for depressing and negative information.”

As the distressing recent MSG Rally well broadcast, there apparently are no guard rails remaining in Trump-led “doom making.” But that does not mean that the majorities that oppose him have to fall victim as well.

Optimism is a choice and an effective political message. No one can deny a range of legitimate concerns. Faced with continued background noise from residual effects of the pandemic, we’ve been forced to absorb global warming induced weather disasters, renegade AI, sectional warfare around the globe, and the fact that (inexplicably) most elected Republican leaders have chosen to compromise all values and decency to preserve their jobs.

With real challenges like these, our troubled world needs to stay focused on values and resilience. This means aligning our humanity with our approach to self-governance. John J. Patrick PhD, in his book Understanding Democracy, lists the ideals of democracy to include “civility, honesty, charity, compassion, courage, loyalty, patriotism, and self restraint.”

We live under a constitutional and representative democracy, as do two-thirds of our fellow citizens in over 100 nations around the world. The health of these democracies varies widely. The case for democracy emphasizes its capacity to enhance dignity and self-worth, promote well-being, advance equal opportunity, protect equal rights, advance economic productivity, promote peace and order, resolve conflicts peacefully, hold rulers accountable, and achieve legitimacy through community based action.

One of the challenges of democracy is to find the right balance in pursuing “the common good” which has dual (and often competing) arms. One arm is communitarian well-being and the other, individual well-being. Blending personal and public interests is complex.

Both nursing and medicine have worked to bridge this gap through “professionalism,” and launched new graduates by voicing “oaths” or promises to themselves, their colleagues, and our society as a whole.

Andrea Ippolito, CEO, Simplifed

Oct 31, 2024

Andrea Ippolito has combined her personal experience as a mum struggling with breast feeding, and her professional career as an entrepreneur and engineer at Athenahealth building integrations with EMRs. She’s now the CEO of Simplifed which has built a network of lactation consultants, and much more, and has placed it in the workflow of that most important part of health care — pre and post partum. How did she do it and what’s it like? She told and showed Matthew Holt.

THCB Gang Episode 142, Thursday October 31

Oct 31, 2024

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday October 31 at 1pm PST 4pm EST are patient advocate Robin Farmanfarmaian (@Robinff3); health economist Jane Sarasohn-Kahn (@healthythinker); futurist Jeff Goldsmith: and digital health guru Fard Johnmar (@fardj). Yes, it’s the pre-election special on Halloween!

You can see the video below live (and later archived) & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.