By IYUE SUNG

Americans typically don’t switch health insurance, and that has not changed much with healthcare reform. Despite controversy with the converse scenario – the ability to keep the same insurance – and the introduction of health insurance marketplaces, data from ACAView suggests switching behavior has been modest.

For this latest ACAView research, our team set out to determine how the ACA’s insurance coverage expansion has influenced patient behavior in switching insurance coverage. We looked at patients’ switching patterns, and how those have shifted for a subset of patients who have visited primary care providers at the same practice at least once a year between 2013 and 2014 and/or between 2014 and 2015.

Our research revealed five key findings:

In Medicaid expansion states, over 40% of uninsured patients obtained insurance the following year, in both 2014 and 2015. In comparison, in non-Medicaid expansion states, about 25% of previously uninsured patients obtained insurance during the same time periods. Conclusion: Medicaid expansion has allowed a higher proportion of previously uninsured patients in continuous care to obtain insurance.

In Medicaid expansion states, the proportion of commercially insured patients switching to Medicaid coverage – though rare – has doubled. In 2014, 1.2% of commercially insured patients in continuous care switched to Medicaid coverage. Prior to coverage expansion, only 0.6%  switched to Medicaid coverage in the subsequent year. (In 2015, this proportion increased to 1.6%.)

With coverage expansion, the percentage of commercially insured patients who switch coverage the subsequent year has increased: from 15.0% pre-expansion to 18.3% in 2014 and 17.3% in 2015. This may occur because some commercially insured patients switch to plans on the health insurance marketplaces because they are eligible for subsidies.

The switching behavior of people who changed plans or payers had no notable impact on utilization. Whether patients switched commercial insurance plans with the same payer, or they switched payers, there were no clear changes in either visit frequency or relative value units (RVUs) per visit.

Patients with a range of chronic conditions[1] (high cholesterol, hypertension, and diabetes) are less likely to switch insurance coverage. In contrast, patients diagnosed with mental disorders were more likely to receive insurance coverage.

Continue reading…

By PO-HAO CHEN, MD

Arthur C. Clark and Stanley Kubrick predicted supercomputers more intelligent than humans.  In 2001: A Space Odyssey, the HAL states, with typical human immodesty, “The 9000 series is the most reliable computer ever made… We are all, by any practical definition of the words, foolproof and incapable of error.” Forty years later, IBM’s Watson pummeled humans in Jeopardy – a distinctly human game.

Watson is a big shot oncology fellow at MD Anderson – he is already impressing nurses and the attendings.  The supercomputer presented patients in the morning rounds, parsed data within seconds, and made few mistakes. The real oncology fellow, the human I mean, flabbergasted by the efficiency of his binary colleague, relayed to the Washington Post, “Even if you work all night, it would be impossible to be able to put this much information together like that.” Watson doesn’t have to worry about duty hour restrictions.

CEO of IBM, Ginni Rometty, claims that Watson 2.0 will interpret medical imaging like a radiologist.  In its third iteration, the supercomputer will “debate and reason.” Why hire radiologists who sap productivity with lunch breaks and sleep?  Watson will never complain about the dearth of vegan food in the cafeteria, never get tired, and – best of all – never whine about Medicare reimbursement cuts.

But forgive me for snoring at night without fear of the Robo-Radiologist. The reasons are simple.

Continue reading…

By JORDAN SHLAIN, MD  + (UPDATED)

In an age where the importance of data, statistics and predictive modeling win big games for baseball teams and make fat money for high-frequency traders, we are at the dawn of a new age of transparency in healthcare  It behooves every actor, in every sector, to use this new perspective to constructively illuminate best practices and design an infrastructure for true operational, clinical and logistic efficiencies at large scale and the local level – all in the spirit of getting the patient the best outcome.   

Every modern industry uses ‘big data’ to understand  the dynamics of their market landscape. This in turn, enables them to make decisions and develop strategies for gaining market share and building their brands. Fortress medicine has received a shot over the bow regarding the power of this new data perspective and needs to craft visionary, courageous yet mindful strategies that includes the bright light of outcomes into their private practices, clinics and large institutions. Propublica, in a seminal article, Making the Cut, shows us the power of transparency in complications rates during surgery. Doctors and their patients, since the dawn of medicine, have existed in a world without clarity around outcomes – there was not way to meaningfully collect it and analyze it. What Yelp has done for small business and Zagat has done for fine restaurants, CMS just did for the medical profession….and it just might be a needed dose of datacillin to start an honest conversation about what this all means.Continue reading…

By ALVERNIA NURSING                          SPONSORED CONTENT

Although Pennsylvania is the sixth most populous and ninth most densely populated state in the Union, based on information from the United States Census Bureau from 2010 and 2013, it also is home to a significant amount of rural areas. According to the Pennsylvania Rural Health Association, 48 of the 67 counties in the state are classified as rural, and all but two counties have rural areas. Approximately 27 percent of Pennsylvanians lived in rural counties in 2010, The Center for Rural Pennsylvania reports.Continue reading…