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We Love to Talk About Our Lives. What About Our Deaths?

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By Alexandra Drane, Leigh Calabrese-Eck & Matthew Holt

Most of us find ourselves pretty fascinating… flipping through photos and slowing down for the ones where we’re included, tweeting our favorite tidbits of information, facebook-ing progress on this or that…

We find other people captivating as well. In fact, there’s a meme going around on facebook where people share a handful of things that most people don’t know about them – and there’s a great joy in learning these tidbits about the friends and family we think we know so well.

This Thanksgiving, we’re asking our friends and family to try this exercise, but with a twist – we want to know how they’d answer just five questions on their end-of-life preferences.

What? Are you CRAZY? Talk about how you’d want to die over Thanksgiving? Yup – that’s exactly what we’re suggesting. You know why? Because this is a conversation you absolutely want to have exactly when you DON’T need to have it… and it’s a conversation you need to have with your loved ones. Our hope for you this Thanksgiving is that you’ll have the luxury of checking both those boxes.

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Come to the Health 2.0 session at the 2013 mHealth Summit

Join Health 2.0 for an afternoon at the mHealthSummit – Dec 9th near Washington DC, at the Gaylord Convention Center!

 

First, we reveal the first ever Health 2.0 Annual Report – an insider’s guide to the 7th Annual Fall Conference, our biggest event yet. With company profiles that detail products, services, and why each presenter was selected for our stage, the Report captures all the trends and analysis you may have missed. Pre-order your copy of the report by emailing Kim Krueger. Available December 10th.

While the government is scrambling to get their exchange up and running smoothly, other tools are popping up everywhere for consumers to make smarter decisions about their insurance coverage. Jane Sarasohn-Kahn and Matthew Holt take the stage in The New Marketplace to review companies making waves in health care insurance.

Don’t miss Future of Self-Tracking and Personalized Medicine and Clinical and Population Data for Transforming Care which will cover the latest consumer quantifying tools, and how health care professionals are aggregating millions of these patient data points to streamline and provide better care.

Unmentionables is back!  Leigh Calabrese-Eck of Eliza moderates this session about life’s buffers and magnifiers.

We’ll wrap the afternoon by revealing the new Health 2.0 Database, a go-to aggregated source for all players in the industry today.

LIVE demos from:  GetInsured – WebMD – ConnectedHealth – Intuit – Ok Copay – Pokitdok – Azumio – BetterFit Technology – Withings – Aetna CarePass – Humetrix – Alere – Elation EMR – athenahealth – ManTherapy – MeQuillibrium – UT MD Anderson – Sexual Health Innovations – and more!

You can register for this session as a stand-alone or in addition to the whole event.

Healthcare.Gov and the Gulf Between Planning and Reality

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By Clay Shirky

Back in the mid-1990s, I did a lot of web work for traditional media. That often meant figuring out what the client was already doing on the web, and how it was going, so I’d find the techies in the company, and ask them what they were doing, and how it was going. Then I’d tell management what I’d learned. This always struck me as a waste of my time and their money; I was like an overpaid bike messenger, moving information from one part of the firm to another. I didn’t understand the job I was doing until one meeting at a magazine company.

The thing that made this meeting unusual was that one of their programmers had been invited to attend, so management could outline their web strategy to him. After the executives thanked me for explaining what I’d learned from log files given me by their own employees just days before, the programmer leaned forward and said “You know, we have all that information downstairs, but nobody’s ever asked us for it.”

I remember thinking “Oh, finally!” I figured the executives would be relieved this information was in-house, delighted that their own people were on it, maybe even mad at me for charging an exorbitant markup on local knowledge. Then I saw the look on their faces as they considered the programmer’s offer. The look wasn’t delight, or even relief, but contempt. The situation suddenly came clear: I was getting paid to save management from the distasteful act of listening to their own employees.

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The FDA Ban on Trans Fat Should Be Just the Beginning

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By Deborah Cohen, MD

It’s been clear for more than a decade that trans fat is a dangerous substance that increases the risk of heart disease.  Denmark banned its use in 2003.  Several American cities and states have followed suit, but the use of trans fat is still widespread despite the availability of suitable substitutes.

Over the past 10 years, trans fat consumption is thought to have contributed to an estimated 70,000 needless American deaths. Given  that universal, voluntary cooperation to eliminate trans fat hasn’t happened, the Food and Drug Administration (FDA) is justifiably seeking to designate trans fats as unsafe.

A nationwide ban on artery-clogging artificial trans fat is a long-overdue first step toward improving American diets, fighting obesity and limiting the risk of chronic disease. But it is just the first step in what should be a far broader campaign to help consumers make healthier choices at mealtime.

Public lack of awareness of the impact of prepared foods on individual health is not limited to trans fat.   When dining out, even in establishments that avoid trans fats in preparing food, Americans face a range of health risks often without realizing it. People are routinely served far more calories than they can burn.

They are routinely served too many low nutrient foods and insufficient quantities of fruits, vegetables, and whole grains.  What should become routine instead is the availability of menu options that put people’s health first.

Hopefully, the FDA’s trans fat initiative will succeed – previous city/state bans and labeling improvements have already managed to cut daily consumption by Americans from 4.6 grams in 2006 to 1 gram in 2012 – and pave the way for the creation of other standards and regulations regarding the quantity and quality of food that is offered to diners in restaurants.

The lack of such standards makes it difficult, if not impossible, for most people to recognize when they are being put at risk for a chronic disease.   If people are served too much of something (like calories), they would have to compensate by eating less later; conversely, if they are served too little of something (like vegetables), they would have to eat more later to neutralize the risk of chronic disease.

But most people lack the information they need to judge or track the quantity and quality of the nutrients they consume.

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40M? 30M? 15M? How Many Uninsured Americans Are There? We’re About To Officially Find Out.

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By THCBist

THCB reader Ed Vandenberg writes in with this friendly little conversation starter:

The voluntary enrollment in Obamacare will provide an interesting perspective on the liberal ‘factoid’ that some 43M people are uninsured. The actual number of long-term uninsured, of course, is something like 15M (and even that number probably assumes some static population).

So essentially, enrollment in Obamacare will give lie to the story board of the uninsured. If the liberals are correct, and poor people simply can’t get insurance and it’s an intractable number, then something like 30M people should be signing up as soon as they are able to access it.

What actually will happen (my prognosis) is that even when made mandatory, the actual number of enrollees will be something less than 10M. Because the number of uninsured counted to justify this massive legislated solution far overstates the actual number of truly uninsurable people.

Many people, counted in the big number simply don’t insure and won’t even under ACA. Hopefully, we can start tackling the problem with the real numbers …

Have questions or comments about the Affordable Care Act? Send them to ed****@***************og.com. We’ll publish the good ones…

#Gchat Medicine?

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By JOYCE LEE, MD

Google just announced that they are piloting a specific health focused service for Helpouts which apparently is a fully HIPAA-compliant system that allows patients to receive telemedicine from clinical providers.  They are currently partnering with One Medical Group, an “experience-focused” medical practice, which allows patients to “request a Helpout, and typically speak with a physician within 20 minutes. It’s recommended for people with cold and flu symptoms, rashes, or simple infections.”

I love the idea of medicine finally moving away from the clinic and towards a digital future, and in our health system we are currently exploring ways that we can deliver telemedicine to our patients with diabetes.  But to do this effectively, we have to understand the elements needed for a health visit.

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Trying To Make Sense of the Covered California Numbers

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By Robert Laszewski

I’ve read a number of reports in recent days gushing over the progress Covered California is making leading the nation in signing up people for Obamacare.

But, I am having trouble understanding how the numbers should make anyone gush with enthusiasm.

Covered California, the state health insurance exchange, has a goal of enrolling 500,000 to 700,000 subsidy eligible Californians by March 31, 2014.

Covered California just announced that it would proceed with its original plan to cancel 1.1 million existing individual policies (their estimate)––80% of them by December 31. Covered California also just said that 510,000 of them would qualify for a subsidy.

The only place a Californian can buy a policy with a subsidy is on the Covered California state exchange.

So, it would certainly seem that the only way those 510,000 people can continue their coverage and get a subsidy is to sign-up on the California health insurance exchange––80% of them by December 23.

So, if only the canceled policyholders who are subsidy eligible replace their canceled policies Covered California will make the lower end of its entire 2014 enrollment goal. Doesn’t sound like much of a stretch goal for them.

Besides the 1.1 million who have lost their policies because of cancellation, Covered California has estimated that 5.3 million Californians are uninsured and eligible to purchase coverage on the state exchange––about half with subsidies.

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How Will My Subsidy Be Paid?

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By THCBist

A THCB reader writes in:

“I understand that part of the population will qualify for subsidies and others will not.

What I do not understand, nor do I think that those getting subsidies understand, is how will the monthly cost be paid.

For example (this is made up), the insurance I am quoted costs $1,200 per month, however, I qualify for a $500 per month subsidy.  When I pay the bill each month do I pay $1,200 or $700.   My understanding is that the ACA is showing people the Net cost with the subsidy applied.   I would assume that one would pay the full amount and hope to get the subsidy as a refund when taxes are filed.

Unfortunately, I can not afford to pay $1,200 per month up front and am unable to wait to file taxes and hope to get the refund in a timely manner.  Those that get subsidies are most likely lower paid, already struggling to make ends meet, and will be unable to pay the up front value.  How does the ACA work regarding paying the monthly costs?  What happens if a person is audited?  Does it delay their subsidy?

What happens if refunds are late?  How are people supposed to pay their bills if they are counting on the subsidy in their refund?

If those that do receive subsidies have to pay the entire cost up front, then this will turn into a very big cash flow issue for them.   Is this how the program works?  If the ACA Website is showing the net cost with the subsidy applied, however, does not clearly state that you pay the full cost up front and receive the subsidy with your tax refund, then I find that to be very shady advertising.”

Is Opposition to Obamacare Racist?

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By PETER UBEL, MD

It is pretty easy to be against Obamacare these days.

The federal government can’t come up with a working website to help people buy health insurance. The President misled people about whether they could hold onto their old insurance plans. And come next tax day, the least popular provision of the Affordable Care Act – the individual mandate – will be implemented for the first time.

Lost amidst all this controversy is the very strong likelihood that once Obamacare is fully implemented, and the disastrous healthcare.gov website is functioning properly, the law will mean health insurance for millions of previously uninsured Americans.

And the people most likely to benefit from this law, according to a recent study, are blacks and Hispanics who not only have higher rates of uninsurance, but also frequently demonstrate greater need for medical care.

Which raises a question: is it racist to oppose the Obamacare efforts to increase health insurance in the United States?
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A Tale of Two IT Procurements

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By David Blumenthal, MD

Recently, the President of the United States, the most powerful person on earth, the man whose finger rests on the nuclear button, struck a bold blow for . . . procurement reform?

“There are a whole range of things that we’re going to need to do once we get [the Affordable Care Act (ACA) rollout] fixed—to talk about federal procurement when it comes to IT and how that’s organized,” the president said on November 4, speaking to a group of donors and supporters.

People are clamoring for heads to roll, and the president is talking about what just could be the geekiest, most obscure topic ever to clog a federal bureaucrat’s inbox. Procurement reform? Has he gone off the deep end?

Well, not really. Among the causes of healthcare.gov’s difficulties, the federal process for purchasing goods and services could rank right up there with toxic politics, lack of funding for ACA implementation, and management goofs. Let me explain why, from personal experience.

From 2009 to 2011, I served as National Coordinator for Health Information Technology. My job was to implement the HITECH ACT, which aims to create a nationwide, interoperable, private, and secure electronic health information system. As national coordinator I had to lead a lot of federal contracts.

This is how that went.

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