THCB

Categories

Above the Fold

A Message To My Patients

• 6

By ROB LAMBERTS, MD

Thank you.

Thank you, my patients for all you have done for me.  Thank you for the encouragement and support. Thank you for believing in me enough to join me in this crazy new way to do health care. Thank you for giving me the honor of being the one you call “my doctor.”

Your trust motivates me to work harder to justify that faith in me – a faith I often don’t have and, one I certainly wouldn’t have without you.  I hope and pray this holiday season is a blessing to you. May you find peace in this time of year so often without peace.

May you also have a happy and healthy new year. May you stay out of the ER, away from the hospital and, yes, away from doctors. May you have no need for lab tests, procedures, x-rays and medications (and if you must have medications may they be very cheap.)

If, however, you do get sick, remember that I am here to help you get well, feel better or avoid getting any worse. And if I cannot do any of these, I will still be there to stand by your side through the hard times, and to offer whatever comfort I can give. Doing these things is what it means to me when you call me “my doctor.”  It is why that is such an honor.

Again, thank you for all you do for me. God bless you.

Dr. Rob

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at More Musings (of a Distractible Kind),where an earlier version of this post first appeared.

The Really Bad Math Behind the Social Security Cuts

• 22

By Stephen Soumerai

Among the sacrifices Congressional representatives placed on the altar of deficit negotiations is an “inflation adjustment” that will shave “only” a few hundred dollars from an average, newly retired Social Security beneficiary’s income each year. But the cruel hoax is that the reduction will amount to as much as $1600 when the beneficiary is older, poorer, and sicker.  Many seniors already have a tough time paying for food, rent, and medical care.

Even worse,  reductions in beneficiaries’ incomes may well cost government more for potentially preventable hospital and long-term care.  Senator Elizabeth Warren and other New England lawmakers should be lauded for splitting from Democratic representatives and the Administration regarding this ill-conceived proposal.

Many senior citizens are already vulnerable to economic hardship.  A recent US Census analysis that counts rising medical expenses found that over 1 in 6 elderly people live in poverty, unable to meet basic living expenses, and almost 20% more are living just above the poverty line. Social Security is the only or largest source of income for about 70% of seniors; the average monthly check is only about $1200.

The typical retirement savings of seniors is a paltry $50,000 — barely enough to get through several years’ living expenses, let alone 20-30 years of retirement.  This is not the result of cavalier actions by the older generation; these are the Americans whose home values have plummeted, whose defined-benefit pension plans have been decimated or disappeared, and whose retirement accounts were eviscerated by the Wall Street meltdown of the last decade. Yet the current proposal punishes these Americans as if they were at fault for their poverty.

Fidelity Investments has estimated that the average retired couple will need more than $200,000 to pay their out-of-pocket medical expenses during retirement, and that figure is probably conservative.

The arithmetic of Social Security benefit reductions just doesn’t fit with this reality.

Continue reading…

Is Obamacare Responsible For the Recent Slowdown in Health Care Costs?

• 58

By ROBERT LASZEWSKI

That is what we have been told the Obama administration will claim today as they begin the job of reselling Obamacare.

Is Obamacare even partly responsible for the slowdown in health care costs?

That is silly.

First, Obamacare is not a health care reform law; it is a health insurance reform law. No one on either side of the debate has ever argued anything different.

Does the law have some limited cost containment features in it?

Yes. But these are either pilot projects or are years from being fully implemented.

I have heard the argument that the Medicare cuts that were made to help pay for the program are examples of cost containment efforts that are having a short-term impact on controlling costs. The Democrats need to be careful with this one. I recall their countering Republican “Mediscare” claims by saying the Medicare cuts were not significant.

In a letter last year accompanying the Medicare Trustee’s report, the Medicare actuary said, “The [Obamacare Medicare cuts] will affect Medicare price levels more gradually, but a strong likelihood exists that, without very substantial transformational changes in health care practices, payment rates would become inadequate in the long range.”

Translated: The Obama Medicare provider cuts are not having a big impact in the short-run but will be unsustainable over the longer-term.

Continue reading…

Why “Liking” Your Plan Is Not the Point

• 34

By Daniel Skinner

In recent weeks, President Barack Obama has been appropriately raked over the coals for saying, multiple times, “If you like your health care plan, you’ll be able to keep it.” He shouldn’t have said it. The problem is, he shouldn’t have said it for entirely different reasons than most Americans think.

Let’s begin with a basic question: What does it mean to “like” one’s plan? And what is the value of this statement? All of this came to a head at an October 30 Congressional hearing with the Secretary of the Department of Health and Human Services, Kathleen Sebelius.

At the hearing, in a cantankerous challenge to Sebelius’s credibility, Tennessee Rep. Marsha Blackburn highlighted two constituents, Mark and Lucinda, who “like their plans,” but were being told they could not keep them because of the Patient Protection and Affordable Care Act (ACA), so-called “Obamacare.” A long-entrenched individualist rhetoric provided the framework for Blackburn’s point, namely that we should allow Mark and Lucinda to keep their plans in the name of individual freedom, just because they “like” them.

For purposes of argument, let’s assume that what Mark and Lucinda’s insurers are saying—that the cancellations are a result of the ACA—is true. But, as we do this, let’s also keep in mind that just because insurers claim premium hikes and cancellations are because of the ACA doesn’t mean that it’s true. In fact, it seems to be true only rarely and, even then, often as a half-truth.

But, anyway, let’s assume it is true. The question then becomes: why is it true? The problem is that this individual freedom is made possible by the assurances of a social safety net. This brings us back to the existential foundation of the ACA, namely that the choice to not carry health insurance—or to carry poor health insurance that individuals may find out, at some point, doesn’t cover something important—simply dumps those individuals into social institutions such as emergency rooms and local care centers, and does so in an extremely wasteful way. This returns us to the problem we started with and a question of whether or not ACA opponents are concerned with solving the problem of building a sustainable health care system.

In other words, Blackburn’s logic, as inspirational as it might be to some, bathed as it is in the rhetoric of freedom, is not premised on an analysis or understanding of health insurance, but deference to Mark and Lucinda to make their own choices, consequences be damned.

Continue reading…

A Global Movement Prepping For Lift Off

By MATTHEW HOLT

I’ve been a busy world traveler lately. The focus of the health care tech and policy crowd in the US has been on the fix to one high visibility website. Before I talk about the rest of the world it’s worth noting that the Administration painted itself into a corner here.

When healthcare.gov failed on take-off they didn’t make the obvious choice of letting other brokers and plans enroll people directly–and worry about correcting subsidies on the back end. I spoke with one big online broker this week who told me that his company still couldn’t get reliable access to the subsidy calculator API, and so can’t enroll people. I suggested the solution to that back in October but apparently no one is listening at HHS–although Sen Mary Landrieu was. The White House was however listening to the Fox news crowd ranting about cancelled insurance policies and made the bad policy (if necessary political) call to allow current individual market policies to continue–even if they are rightly now illegal under the ACA.

But elsewhere the impetus that the US has been seeing on the health technology side–with over $2 billion in venture funding this year–is spreading. The UK just confirmed that it’s releasing the equivalent of $800 million for new health technology, and we just returned from a very successful Health 2.0 Europe conference. All kinds of activity is going on over there–did you know there were over 100 digital health start-ups in Finland & the Baltics alone? Well, you do now.

Today the Health 2.0 international roadshow is in Sao Paulo, Brazil–a city that has the size and energy of New York–albeit before Guliani cleaned up the graffiti. And yes, even in Latin America, there’s lots of activity in using technology to change health care. I’ll tell you more next time, but it’s clear that there’s way more than one website in healthcare.
Hope to see you in Brazil or at at our Health 2.0 at the mhealth Summit Session in DC on Monday.
–
-Matthew Holt

Innovation In Care Transitions: Who’s Buying?

• 1

MEETINGS

A few weeks ago Lisa Suennen, founding partner of Psilos Group and fledging best-seller author, wrote “Times of massive system transformation, such as we are in today, pave the way for new market entrants and disruptive technologies a la Clayton Christensen’s stories about other industries that have endured dramatic change. ”  She was talking about health insurance exchanges, but could just as well have been talking about care transitions.

Health 2.0 Advisors is the Innovation Analytics and Acceleration business unit of Health 2.0, helping companies make sense of the – often ‘noisy’ – innovation landscape. Recently, innovation in care transition improvement became an important area of demand among hospitals and many startups have been developing new technologies, tools, and solutions to improve care transitions. Next week, Health 2.0 Advisors will be publishing a report that synthesizes barriers to adoption of such innovation in hospitals, lessons learned from those who succeeded, and share information about untapped areas of opportunity.

This report is based on a project done for the Gordon and Betty Moore Foundation, which included interviews with (100+) CIOs, CMIOs of hospitals, as well as startups of varying sizes and degrees of success in working with hospitals.

Check out the special presentation of highlights from this report during the mHealth Summit in Washington D.C. on the 8th. The report will be available for download after that and I will write a follow up post with some additional highlights and perspectives. If you want to receive a copy of this report but cannot make it to the mHealth Summit, send an email to ma***@********on.com and we will email you the download link after the mHealth Summit presentation.

True or False? I’m Better Off Waiting

• 6

By THCBist

East Coast THCB reader writes:

“Ok. Here’s my situation. I’ve tried signing up for coverage at Healthcare.gov several times without success.  (I got a combination of the weird glitches and other symptoms other readers have reported. ) After the last fail, I decided to hold off on any further attempts on the theory that things are bound to get better.

Based on the news reports I’m seeing, that may or may not be happening. I’m starting to worry that if I wait too long I may get caught up in the mad rush as people scramble to beat the deadline.  Given what’s happened so far, I’m not highly confident that  Healthcare.gov will be working.

So here’s my question: am I better off waiting or should I try to push my application through the system now?”

Eight Bright New Ideas From Behavioral Economists That Could Help You Get Healthy.

• 5

By Deborah Bae

Through a series of small grants, we’re is exploring the utility of applying behavioral economic principles to perplexing health and health care problems—everything from getting seniors to walk more to forgoing low-value health care.

At a recent meeting in Philadelphia we challenged grantees to compete in an Innovation Tournament. The goal was to identify testable ideas that leverage behavioral economic principles to help make people healthier by working with commercial entities. Participants were assigned to groups and made their best pitches to their colleagues. And of course we used a behavioral economics principle (financial incentives) to increase participation: Each member of the first, second and third place teams received Amazon gift cards.

Eight teams made the finals:

1.     Love Lock: This team addressed the issue of driving and texting by proposing an app that could be installed on your cell phone that would send reminders not to text while driving. This team would work with car insurance and mobile phone carrier companies and provide discounts to those who get it installed. The behavioral economics principles being tested are default choice and opt-out.

2.     McQuick & Fit: Too many people eat unhealthy food. This team’s idea was to have a rewards card that can only be used to purchase healthy food. With each purchase, the customer would earn points toward free, healthy foods. Online orders would be placed through a website that would feature salient labeling and allow for defaults to order healthy meals. The behavioral economics principles at play include pre-commitment, default choice, labeling, and incentives.

3.     Just Bring Me Water: The problem tackled by this team is “regrettable” calories—mindlessly consuming whatever is put in front of you, such as free bread at a restaurant, or soda on a plane. The innovation: when booking a table online or calling for a reservation, you could ask to “opt-out” of the complimentary bread or chips that are offered. This would reduce the consumption of regrettable calories.

4.     Lunch Club: This group looked at addressing gluttony through a partnership with a chain restaurant. When going out for a meal, portions are typically bigger and diners consume more. But what if you had the option of doggy-bagging one third of the meal for another meal—framed as “buy dinner and get lunch free”? And, if you took this option, you would get a scratch off as an enhanced incentive and immediate reward. The behavioral economic principles being tested here include loss aversion, active choice, and incentives.

5.     Snooze, But Don’t Lose: People don’t get enough good sleep, which leads to poor executive functioning and safety issues. To increase safety, productivity, and efficiency, this group proposed using a Fitbit to build in reminders to go to bed earlier and provide feedback on good sleep. The behavioral economic principles at play are pre-commitment and loss aversion.

Continue reading…

Healthism: The New Puritanism

• 6

By Saurabh Jha, MD

Here is a thought experiment. Assume that every hour you run you extend your life by an hour.

I have chosen a one-to-one ratio between the increase in longevity from running and the time running because higher ratios lead to the immortality paradox. Lazarus aside, the all-cause mortality for Homo sapiens is 100 % and will remain so for the foreseeable future.

This arithmetic means that at one point you will literally be running for your life: your life being extended precisely by the time spent running. But ignore this logical fallacy.

You run an hour every day for 40 years. Your life is extended by 1.67 years. Your costs are a new pair of running shoes every three months, which might even be covered at zero co-payment by insurance if USPSTF gave running a grade A or B recommendation.

A back of the envelope calculation, assuming the shoes cost $ 80, yields cost per life year of roughly $7664. There is, of course, more nuance. I am not including injuries that may result from running. I am not discounting time: I am assuming we value an hour now the same as an hour 40 years from now.

I am also not factoring the costs avoided of treating late stage cardiovascular disease, which must be balanced against the additional social security checks that the individual will draw because of living longer, not to mention the costs of treating diseases of extended longevity such as cognitive impairment, Alzheimer’s disease, recurrent falls.

But please continue to indulge my approximation. The point is not precision of economic calculations but a principle.

$7664 for an additional life year. Compared to the benchmark of $50, 000 per quality-adjusted life year that’s a bargain!

Was it worth it then?

Continue reading…

What Public Insurance Exchanges Will Look Like 5 Years From Now

• 1

By Rich Gallun

When envisioning what public insurance exchanges of the future can and should look like when it comes to technology and structure, one only needs to look at the successful private exchanges that have paved the way over the past several years.

This experience has taught those who administer private exchanges that open enrollment—the phase that the federal government’s Health Insurance Marketplace is struggling through currently—is only the beginning. Public exchanges could benefit from lessons already mastered by private exchanges—starting with open enrollment but extending to even more complex technology-based transactions.
There are 10 scenarios that vendors must be able to handle.

1. Life Events. In today’s individual Health Insurance marketplace, consumers can generally add or drop coverage for themselves or their dependents anytime they want. In other words, it’s a relatively “rule-free world.” In January 2014, that world changes to look more like the current group health marketplace in which many rules are defined by the federal government’s existing tax code (e.g., Section 125) and HIPAA requirements, and consumers must select and “lock in” their coverage once a year for the following 12 months, unless they experience a qualified life event.

As a result, each qualified life event – e.g., marriage, divorce, birth of a child, loss of spouse’s coverage and many more – must be configurable within the Exchange technology to enforce the appropriate rules. For example, if a person gets married, is that person allowed to drop coverage or change plans and carriers? How about with the birth of a child? Or with a loss of spouse’s coverage? For a truly scalable Exchange technology, thousands of scenarios must be configured in advance to enable consumers to make enrollment choices online without administrator involvement.

Continue reading…

assetto corsa mods