The Health Care Blog – Page 314 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Why Science is Mistrusted

Apr 22, 2017• 9

By SAURABH JHA, MD

Recently, the Harvard Chan School of Public Health, in their press release, reported about the effect of surgical checklists in South Carolina. The release was titled, “South Carolina hospitals see major drop in post-surgical deaths with nation’s first proven statewide Surgical Safety Checklist Program.”

The Health News Review, for which I review, grades coverage of research in the media. Based on their objective criteria, the Harvard press release would not score highly.

The title exudes certainty – “nation’s first proven.” The study, not being a randomized controlled trial (RCT), though suggests that checklists are effective, far from proves it. At least one study failed to show that surgical checklists improve outcomes.

The press release’s opening line is “South Carolina saw a 22 percent reduction in deaths.” It reports relative risk reduction (RRR). Reporting RRR is now considered a cardinal sin in healthcare journalism, because RRR inflates therapeutic optimism by making the intervention sound more efficacious than it is.

Reform & Improve

Apr 20, 2017• 2

By JON KINGSDALE

With the failure of the Republican’s American Health Care Act (AHCA), what’s next? Congressional Republicans face the ugly choice of admitting defeat and funding the Affordable Care Act (ACA), including the cost-sharing reductions (CSRs) that they have tied up in federal court, de-funding the ACA and likely being blamed for its demise, or compromising with Democrats to improve it. In all likelihood, the next set of moves will focus on avoiding/shifting blame for the imminent crisis of health plan withdrawals that failure to fund CSRs would precipitate.

But the long-term problems with the ACA should be addressed: How to sustain health plan competition? How to simplify a nearly incomprehensible medical financing scheme? How to cover more of the uninsured? How to win enough moderate Republican support to de-escalate partisan wars over the ACA? Sooner or later, Congress needs to consider serious compromise proposals for improving the ACA.

So, what might they consider?

Were a bargain on improving the ACA to be struck, Democrats would insist that it ensure full federal funding and maintain goals related to covering most Americans. Taxes will be the “sticking point” for many Republicans, but not all: Senators Cassidy & Collins’ Patient Freedom Act (PFA) retains 95% of current funding.) On the other hand, the price of support from moderate Republicans probably includes making substantial changes that borrow heavily from the best ideas in the AHCA and the PFA. The approach proposed below does both.

I propose three goals for a bipartisan effort to “reform and improve” the ACA:

A Modest Health Care Economics Experiment to Fight Rising Costs

Apr 20, 2017• 34

By HAYWARD ZWERLING, MD

Healthcare providers, medical institutions, local pharmacies and pharmaceutical companies generally set the price of their products/services well above the payment they expect to receive from all insurers. These healthcare vendors set their fee schedule at 150%, 200% or 1,000% of the maximum payment they expect to receive from their most generous payor.

Here in Massachusetts, when a healthcare product or service is consumed and the patient has health insurance, the vendor submits a bill to the insurance company who specifies the “allowed fee,” which is considerably less than the “billed fee,” and the vendor “writes off” the balance of the “billed fee” from their books.

For example, I recently had some blood tests done at Quest Diagnostics. Quest Diagnostics sent a bill to my insurance company for $660. The “allowed payment” was $110, so Quest wrote-off $550 and the “allowed payment” of $110 was divided between me and my insurance company.

Health 2.0 has something important to tell you

Apr 19, 2017

By INDU SUBAIYA and MATTHEW HOLT

Important news about my day job at Health 2.0 from my partner Indu Subaiya and me! You can also see the press release here and watch a video discussion with HIMSS CEO Steve Lieber—Matthew Holt

Indu and Matthew are excited to announce that after 10 years of convening the Health 2.0 community through our events and programs around the world, our conference company has found a new home and a partner who will help us exponentially expand our reach and impact. Effective immediately, we are joining forces with HIMSS and will be established as a new Health 2.0 business unit within the enterprise that includes HIMSS North America, HIMSS Analytics, HIMSS Media, HIMSS Europe, HIMSS AsiaPacific and the Personal Connected Health Alliance.

Health 2.0 and HIMSS share a single mission, to improve health outcomes by leveraging the best that technology has to offer. While terms change through the years, that common end goal hasn’t and won’t moving forward.

Our integration with HIMSS is a transformative opportunity to bring the knowledge and expertise from Health 2.0’s global network of entrepreneurs, developers and end-users together with that of clinicians, IT professionals, health care executives, policy leaders and other stakeholders to make a sustainable difference.

We are at a critical inflection point in the evolution of the health technology industry. Exciting advances in data science and AI, precision medicine and genomics, sensors and hardware to name just a few, coupled with the increased rate of adoption of digital health technologies by health care providers, payers, life science companies and communities require a level of collaboration like never before.

And yet, start-ups face barriers to access and distribution while large organizations face challenges in vetting and selecting new technology partners. Working with HIMSS, we will be able to create even more vibrant formats for interaction and more efficient mechanisms for innovation to spread throughout the healthcare system.

Countries around the world want to share models and best practices, to import and export health technology innovation while growing their own markets and their market reach globally. Working with HIMSS, we will be able to combine and expand our global footprint to be better ambassadors as well.

Indu will join HIMSS as executive vice president for the newly established Health 2.0 business unit and continue to co-host Health 2.0’s Annual Fall and Wintertech conferences with Matthew, while he will be our globe-trotting ambassador and continue to host and develop our international business.

Since 1961, HIMSS has focused on its vision of improving health and healthcare with the best use of information technology. Now, more than 55 years later, it continues on this path to improve the quality and affordability of, and access to, healthcare.

Health 2.0 was born from a need for consumers to take charge of their health using new technology frameworks that disintermediated access to health information and services. Over the past 10 years the Health 2.0 community has spawned an ecosystem of companies that helped bridge the gap between the institutional world of care delivery. We were bound to meet in the middle.

As with all great partnership journeys, we know this is not an ending, but a beginning. When it comes to technology, there will always be a new frontier. It’s going to take all of us to explore that frontier together and to translate new ideas into the industry standard. We need both the foundation and the means to continually experiment to make good on our mission to leverage the best technology has to offer in helping us live healthier lives.

Onwards and together,

Indu & Matthew

Indu Subaiya is Co-Chairman & CEO of Health 2.0, and Matthew Holt is Co-Chairman of Health 2.0

Al Lewis Talks about Al Lewis

Apr 18, 2017• 2

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Are Europeans Ready to Become Health Consumers?

Apr 18, 2017• 1

By PASCAL LARDIER

“Health consumers” – the concept is a little foreign to our conception of health services in Europe. As Europeans we tend to think that if it touches our health it should be free. In this context, how can we count on health consumers to fuel the development of the Health 2.0 industry in Europe?

There are some cases where we are ready to get our wallets out. We’re more inclined, for instance, to pay for our wellness than we are to pay for our health. We’re OK to pay for an activity tracker; we think a diabetes management solution should be covered and reimbursed. There are also a few niches where we don’t hesitate to become health consumers: the market of fertility solutions is a good example.

With the wide range of Health 2.0 apps and solutions out there, we’re rediscovering the concept of choice along with a different kind of empowerment… as customers.

What are the other ways Europeans are turning into empowered health consumers?

The Strange Making of the “Marketplace Stabilization Rule”

Apr 17, 2017• 1

BY DAVID INTROCASO

On April 13 CMS published the agency’s final “market stabilization” rule. The proposed rule was summarized by THCB’s editors on February 15, the day it was published, and on March 22 THCB published my essay in which I noted CMS provided no evidence any of the proposed reforms would actually stabilize the state marketplaces. The final rule, ostensibly a carbon copy of the proposed, finalizes the six proposed changes without, again, providing any evidence these changes will stabilize the markets by increasing enrollment and issuer participation.

Briefly, the final rule will reduce the 2018 enrollment window from three months or to six weeks, or from November 1 to December 15. The rule narrows the definition of guaranteed availability by allowing issuers to apply re-enrollment payments to outstanding debt. The rule will require 100 percent verification for enrollees’ attempting to acquire insurance during a Special Enrollment Period (SEP) and places other payment, eligibility and exceptional circumstances restrictions on SEP enrollment. The rule finalizes an increase in de minimus variation from +/- 2 percent to -4/+2 percent except for bronze plans which increases to -4/+5 percent. The rule will allow states to determine plan network adequacy or make a determination using an issuer’s accreditation status. The rule finalizes a reduction from 30 to 20 percent of plan providers being defined as an Essential Community Provider (ECP). For plans that cannot meet the 20 percent determination, CMS will allow for a narrative explanation.
Continue reading…

Struggling to Get Customers, Revenue and Traction in the Digital Health Market?

Apr 17, 2017

By ELENA LIPSON SPONSORED POST

Imagine the peace of mind and confidence you will feel if you had a quick, proven process to take your solution or concept from its current state to one that generates sustainable revenue, hoards of customers and value to the healthcare ecosystem.

Elena Lipson has been working with organizations and entrepreneurs in the digital health community for more than 15 years to help them successfully bring new products and services to market, identify and engage new customers and partners, and grow their market share.

For the first time, she is offering a free webinar training to the Health 2.0 community to share the three steps you need to create a blueprint for your digital health solution that will get you customers, accelerate your path to revenue, and help you go to market quickly even if:Continue reading…

The 401W: A Wellness Program Even Al Lewis Could Love

Apr 17, 2017• 1

By AL LEWIS

I’ve been quite vocal about supporting only wellness done for employees and not to them…but what if there could be a “conventional” wellness program – even including screening, HRAs etc. – that both you and I could love?

People manage what’s measured and what’s paid for. If employers want people to stay healthy in the long run, why not measure and pay for health in the long run?

Why not give people the incentive to stay healthy during their working years, instead of giving them the incentive to pretend to participate in programs of no interest, just to make a few bucks? Or, worse, give employees the incentive to learn how to cheat on biometrics, and how to lie on health risk assessments. Attempts to create a culture of health often create a culture of resentment and deceit.

Short-term incentives haven’t changed weight, as noted behavioral economist Kevin Volpp has shown. Nor have they changed true health outcomes – it is easily provable that wellness has almost literally never avoided a single risk-sensitive medical event. So-called outcomes-based programs, ironically, are more about distorting short-term outcomes than achieving long-term outcomes. They have more in common with training circus animals to do tricks in exchange for treats than they do with helping employees improve long-term health.

MACRA Is Broken. It Needs to Go Away Now.

Apr 15, 2017• 17

By KIP SULLIVAN

At its January 12, 2017 meeting, the Medicare Payment Advisory Commission (MedPAC) made it clear they had reached the conclusion that the Merit-based Incentive Payment System (MIPS) cannot work (see my last post ). MIPS is the larger of the two programs within MACRA; the Alternative Payment Model (APM) program is the other. The commission’s primary rationale for its conclusion about MIPS is that it’s not possible to measure physician “merit” (cost and quality) at the individual physician level.

But rather than recommend that Congress repeal MACRA (the Medicare Access and CHIP Reauthorization Act), MedPAC decided to try to fix it. At the January and March 2 meetings, the commissioners discussed a staff proposal to amend MIPS substantially and to tweak the APM program. Those discussions went nowhere.

I give MedPAC credit for finally stating unequivocally that MIPS cannot work. But MedPAC should never have volunteered to fix MACRA. It can’t be done. By proposing modest amendments to MACRA and thereby implying it’s fixable, they stepped into an intellectual tar pit. I will illuminate this tar pit by describing the commission’s unproductive discussion about the staff’s proposed amendments to MACRA. To give you a sneak preview of what that discussion was like, I give you two excerpts from the transcript of the January meeting: