The Health Care Blog – Page 304 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Watching Trumpcare Die

Jul 20, 2017• 6

By KIP SULLIVAN

It’s hard to know what “Trumpcare” is, but whether it’s “repeal” or “repeal and replace with something terrific,” it was and is going to fail. It was either going to fail to be enacted by Congress, or if it was enacted, it was going to set off such a bipartisan backlash it would be repealed, either by a chastened Republican Congress or a new Democratic Congress and president.

The reason Trumpcare was doomed was that health care is not like global warming or police shootings or use of military force in foreign countries: It is an issue a large majority of Americans agree on, and it is an issue voters can assess with their own eyes in their own kitchens.

Republican voters are almost identical to Democratic voters in what they want in a health care system. They want comprehensive coverage, low out-of- pocket costs and affordable premiums, freedom to choose their own doctors (they could care less about freedom to choose between Aetna and Humana), and freedom from interference by bureaucrats (be they public or private). Obamacare became a liability for Democrats because the public clearly perceived that the ACA could not meet those requirement for millions of Americans. The public now clearly perceives Republicans want to enact legislation that would be even worse than the ACA.

SMACK.health — the new way to think about health tech

Jul 20, 2017

By MATTHEW HOLT

I’ve also been having a bit of fun with creating a new site called SMACK.health, which uses the new .health domain extension. Well you knew you needed both a new definition to replace the fuzzy term “digital health” and .com is so 1999! But what am I talking about when I use the term SMACK.health, and why? I was asked to write a piece about technology in health for USA Today spin-off, and I’ve repurposed it here to celebrate the official .health launch.

There’s a big change coming to our health care experience — driven by technology. Health care is moving from a point-in-time event to one of continuous care. Think of your last doctor’s visit. You probably had a few minutes with a rushed clinician and were sent on your way. The next steps, such as correctly interpreting the instructions, getting prescriptions filled and figuring out next steps was left largely on you. Yet, most conditions, like diabetes, heart disease and asthma, require continual monitoring and management to avoid painful and costly complications. In fact, what happens outside the doctor’s office is more important than that meeting in it.

A new way

Relying on the old point-in-time interventions doesn’t work. To this point, most hospitals and doctors have only had information tools that record what they did in the visit or during the procedure. Instead, SMACK.health technologies will enable clinical teams to perform continuous care. SMAC stands for Social & Sensors, Mobile, Analytics and Cloud. These are the underlying technologies behind what we now use every day — Skype, texting, WhatsApp, iTunes, Facebook, Google, Amazon, et al. To reach patients wherever they are, thousands of relatively new companies are building similar technologies and services that will help a combination of today’s clinicians and tomorrow’s automated artificial intelligence systems manage patients — and help patients manage themselves. And hopefully they’ll be doing it with a big dose of empathy — hence our adding the “K for Kindness” to the SMACK.health lexicon.

Information influx

The other big change is going to come in what we use those technologies to do. For sure, patients are already way, way better informed than they were 15 or 20 years ago. They can access great content online, including information shared by other patients on sites like PatientsLikeMe, MedHelp and Smart Patients. Patients and their caregivers will use those tools to be better informed about their care and inform each other and their clinicians. But that’s not all. We are already seeing services like American Well, Teladoc and DoctorOnDemand (sometimes provided by current health insurers and hospitals) enabling video visits. A whole range of cameras, sensors and medical tools will make those services, and a host of others, better able to connect patients with clinical solutions.

What’s next

We are also going to use new technology to diagnose and treat. Computer algorithms from companies like PhysIQ are already remotely reading abnormal heart rates via disposable patches. Soon, a range of devices will be in the bathroom reading your spit, poop, blood, breath and vital signs. Companies like Philips and Nokia and startups Kinsa, uBiome and CloudDX are bringing them to market. They’ll first be used by the sickest patients, but soon they’ll be mainstream consumer goods. Finally, mental health, physical therapy and more are already being delivered by avatar-based artificial intelligence like Ginger.io and Reflexion Health.

The health care system faces huge changes adapting to the realities of these new technologies. But when it does, it will improve the experience for patients and clinicians. And it will bring patients and society better health outcomes.

Matthew Holt is the publisher of THCB and Chair, Health 2.0 Conferences

Is Trumpcare Dead?
Was It Ever Really Alive?

Jul 18, 2017• 32

By JOHN IRVINE

Senators Mike Lee and Jerry Moran said yesterday that they would not vote for the Better Care Reconciliation Act, effectively killing the legislation. As anybody who has been following this story would have predicted, President Trump reacted publicly on Twitter on Tuesday morning, vowing to let the ACA marketplace collapse and then rewrite the plan later.

Senate Majority leader Mitch McConnell attempted a quick punt this morning, calling for an immediate Senate vote on the House bill, a trick card that if it worked, would give Republicans two years to work things out.

Unfortunately for McConnell, it probably won’t.

The White House sees the failure as saying more about the political establishment in Washington than itself, which shouldn’t be all that surprising. Caught up in the drama of the Watergate-Russia emails-Trump family narrative, major media outlets like the Washington Post and the New York Times see a historic defeat rather than a temporary setback. That may or may not turn out to be true. Predictably, conservative commentators and the alt-right believe the defeat says more about the mainstream media and the Deep State than it does about the Trump Presidency. For their part, Democrats clearly think they have found their issue and can be expected to continue to exploit it using legislative Viet Cong tactics (attack on social media, melt into the jungle, lob snarky public Molotov cocktails) to punish Republicans and keep the story on the front page.

One thing is clear. Instead of repealing and replacing Obamacare, the GOP now has to rewrite and replace its own plan. Doing that would be difficult under the best of circumstances, but in the current climate in Washington it is difficult to see how it would be possible without a major shift in the political landscape.

All of this is bad news for hospitals and health plans and a frightening development for consumers, although not the really bad news some had feared. The President’s threat to let the insurance marketplace die and then “figure it out” sounds good as a rallying cry to the troops on social media, but is not the kind of thing that investors and CEOs like to hear. Realistically though, at this point everybody knew that the uncertainty would likely continue through the year (best case) or a year or longer (worst case) as the gridlock in Washington plays out. As depressing and frustrating as it is that the uncertainty will continue, by this point the industry is used to it. Insiders will continue to look for ways to minimize risk and for business opportunities to capitalize on the uncertainty.

Trump’s plan to allow the insurance exchanges to collapse is the kind of confrontational talk Trump and his advisors relish. In theory, the idea could work. There are in fact signs that it already is, as major insurers leave the marketplace and consumers hesitate before committing to expensive insurance policies. In reality, however, the collapsing exchanges will create a political crisis that is even worse than the current one for the administration, with news cycle after news cycle dominated by stories of terminally ill cancer patients and parents with children with horrible diseases and no insurance coverage. At this point, it will be difficult for the party doing the collapsing to point at the other side and say “It was them. They did it!”

Parsely Health Interview & Job Ad!

Jul 18, 2017

By MATTHEW HOLT

A little while back I caught up with former Health 2.0er Robin Berzin. (I first ran this video interview on Facebook). She’s a functional medicine doctor and now CEO of Parsley Health, a direct pay/concierge functional medicine clinic that also uses lots of new health tech. It’s operating in New York, Los Angeles and San Francisco. Robin has an interesting model and is also looking for help. (And I’m running this ad for love not money!) Any MDs out there wanting to try a new route, see her blurb below the interview.

Parsley Health is hiring top primary care doctors at its centers in NYC, SF, and LA. At Parsley Health we practice whole-person Functional Primary Care focused on nutrition wellness and prevention along with advanced diagnostic testing. In addition we are building a groundbreaking new technology platform for primary care and offer both virtual and in-person services. If you are a physician and are looking to join a collaborative modern practice please visit our job description here or email your CV to jo**@***********th.com. Preference given to board-certified internal medicine and family medicine trained MDs with additional training in functional medicine. Additional clinical training available.

Regulatory Capture Tests the New Administration

Jul 17, 2017• 3

By ADRIAN GROPPER, MD

The bipartisan 21st Century Cures Act charges HHS / ONC to deal with two issues that previous laws (HIPAA and HITECH) and the Obama HHS left in-progress: information blocking and longitudinal health records. ONC needs to deal with these two issues at a time when there are calls to delay or rescind some Meaningful Use regulations, in an administration that does not favor regulations, with some vendors already starting to ship Meaningful Use Stage 3 EHR products, and while the budget for ONC is still undetermined. ONC can’t be too careful.

Judging by the agenda, the July 24 21st Century Cures Act Trusted Exchange and Common Agreement (TFCA) Kick-Off Meeting is a step in the wrong direction. Listening to the “health IT stakeholders” is a prescription for advancing the interests of the health IT stakeholders instead of dealing with patients and physicians as the stakeholders. Framing the issue as “National Trust Frameworks and Network-to-Network Connectivity” is a recipe for continued ineffective interoperability as the “stakeholders” line up for another round of regulations that promote rent-seeking middlemen with catchy names like Direct Trust, and CommonWell.

The Most Important Questions About the GOP’s Health Plan Go Beyond Insurance and Deficits

Jul 13, 2017• 5

By ROSS KOPPEL and JASMINE MARTINEZ

Ending healthcare for those who need it will not make them or their problems disappear. On the contrary, the GOP plan will shatter American families and the economy. Nothing magical happens if we stop caring for the elderly, the ones who need vaccinations, the small infections that can be treated for $2 worth of antibiotics, the uncontrolled diabetics, and those with contagious diseases who clean our schools’ offices and homes. They don’t just get healthy.

As George Orwell said in Down and Out in Paris and London, “the more one pays for food, the more sweat and spittle one is obliged to eat with it.” Cutting care only exacerbates illnesses, infection, disability, the effects of age and the costs to society. The burdens continue or increase but the cost is shifted to American families, businesses, and states.

Fifteen years ago, one of the authors showed that lost productivity from workers caring for Alzheimer’s patients cost US businesses over $60 billion a year. Employee-caregivers, usually at the peak of their responsibilities and corporate experience, quit, prematurely retired, were constantly distracted, or engaged in presentism (e.g., at work but focused on mom burning down the house). Business cost were incurred by the need to replace workers, extra training of replacement workers, and increased pressure on other workers to cover for caregivers. The more expensive the employee, the longer and more costly the search and the longer the time to get them up to speed. But that study examined just a miniscule number of patients and workers compared to the tens of millions of people affected by the proposed GOP bill. As noted, it’s not only those needing care, but our society and our families that must deal with the elderly, ill, disabled, under and uninsured, children not receiving even ordinary care, people not being screened for preventable illness, and countless others.Continue reading…

Which Is More Efficient: Employer-Sponsored Insurance or Medicaid?

Jul 13, 2017• 12

By SAURABH JHA, MD

An old disagreement between Uwe Reinhardt and Sally Pipes in Forbes is a teachable moment. There’s a dearth of confrontational debates in health policy and education is worse off for it.

Crux of the issue is the more efficient system: employer-sponsored insurance (ESI) or Medicaid. Sally Pipes, president of the market-leaning Pacific Research Institute, believes it is ESI. Employers spend 60% less than the government, per person: $3,430 versus $9,130, per person (according to the American Health Policy Institute). Seems like a no brainer.

Pipes credits “consumerist and market-friendly approaches to health insurance” for the efficiencies. She blames “fraud,” “improper payment,” and “waste” for problems in government-run components of health care.

But Uwe Reinhardt, economist at Princeton, counters that Medicaid appears inefficient because of the risk composition of its enrollees. Put simply, Medicaid recipients are sicker. Sicker patients use more health care resources. Econ 101.

The points of tension in their disagreement are instructive.

The Entertainment Presidency: A Primer For Health Care Professionals

Jul 11, 2017• 4

By RICHARD GUNDERMAN, MD and BENJAMIN GRAY, MD

Many physicians have expressed dismay at the conduct of US president Donald Trump. But whether colleagues find his politics objectionable or congenial, his conduct bold or vulgar, and the man himself an imbecile or a genius, it is important for healthcare professionals to understand that the Trump presidency is a predictable consequence of our times. In particular, it is an entirely natural outgrowth of the forms of media that characterize our age.

The Medium Becomes the Message

In 1964, media theorist Marshall McLuhan famously declared the medium the message. McLuhan argued that the consciousness of a people is more profoundly shaped by media themselves – for example, Gutenberg’s movable print, radio, or television – than by the content they convey. To understand the character of a presidency, McLuhan would argue, we need to shift our attention from specific policies to the media by which the president operates.

When candidates Abraham Lincoln and Stephen Douglas engaged in their famous 1858 debates for an Illinois Senate seat, broadcast media had not yet been invented, and the newspaper dominated. As print media, newspaper articles could examine a candidate’s position on an issue in great depth, and 19^th century debate audiences expected candidates to develop real arguments for their policies. As a result, each of the Lincoln-Douglas debates was formatted to last three hours.

Today’s media prefer sound bites. In fact, McLuhan argued that the medium of television operates “at the speed of light.” It permits “no continuity” and “no connection.” Instead, he said, with television, “It’s all just a surprise.” In contrast to the time Lincoln took to carefully craft his arguments, a television president might be expected to rely less on argument than on astonishment, not taking the time to trouble himself over non-sequiturs and contradictions.

Shopping For a Health Insurance Plan Again. Seriously?

Jul 10, 2017

By PAUL KECKLEY

On the golf course, my son Jason has an uncanny ability to hit any tree within earshot of his intended target line. It’s fait accompli in his book. And his reaction is always the same: “seriously!”

The same is his plight with health insurance. Though a self-employed healthy single male with a successful career and no need for government assistance in buying coverage, he just got this letter from his insurer:

“The last seven years within the health insurance market have led all of us to decisions we have never before considered. It has remained a very challenging environment as the debate over the 2010 Affordable Care Act (ACA) continues today.

At TRH Health Insurance Company, we have arrived at another critical decision point, which, unfortunately, will affect you. This letter (and the enclosed notification letter as required by the ACA) is our notice that we will not be offering plans in the non-subsidized marketplace in 2018. Your current plan remains effective through December 31, 2017.”

It’s the third time in five years he’s been dropped. Though paying his premiums dutifully and shrinking his coverage to reduce his monthly cost, his premium has increased more than 10% every year. And he’s healthy.

As the GOP Senate leadership weighs its options in moving toward a Repeal of the Affordable Care Act and its replacement, their greatest political risk is the potential that up to 22 million will lose their insurance coverage per the Congressional Budget Office’ most recent score. They have bet their political calculus on stories like Jason’s, one of 18 million in the individual insurance market whose premiums have skyrocketed. More than 8 million of these get a subsidy to buy their policy because their incomes fall below 400% of the federal poverty level. Those subsidies are likely to go away. For the rest, like Jason, it’s a crap shoot. Individual insurance plans that feature less coverage, narrow networks, high premiums, high out of pocket costs and the high likelihood the underwriter will cancel the policy the next year is standard fare. Or, they just choose to go without.

Join Our Free Webinar About Advancements and Challenges in Patient Matching

Jul 10, 2017

By JILL MERRIGAN

Join Health 2.0’s Matthew Holt and Indu Subaiya in discussion with Adam Culbertson, Innovator-In Residence, HIMSS; Abel Kho, Associate Professor of Medicine and Preventive Medicine in the Feinberg School of Medicine at Northwestern University; and Tom Leary, VP of Government Relations, HIMSS. We’ll be talking about the challenges, such as technical and political hurdles to matching patients. Additionally, hear about current projects underway to advance this challenging problem.