The Health Care Blog – Page 523 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Making Health Addictive

Oct 26, 2013• 3

By Joseph Kvedar, MD

I first posed the question, “Could Mobile Health Become Addictive?” on August 20^th. Since then I’ve done more thinking and I’m warming to the concept.

To start with, addiction is a word laden with negative meaning. When we hear the word, we think of opiates, street drugs, cigarettes, or possibly gambling. In fact, Wikipedia defines addiction as, “the continued repetition of a behavior despite adverse consequences.” So, with that definition as backdrop, is there any way health can really be addictive? Probably not.

What I’m really talking about is the juxtaposition of motivational health messaging with some other addictive behavior, specifically checking your smartphone.

New evidence shows that people are in love with these devices, checking them more than 100 times per day! I’ve heard people are tapping in 110, even 150 times a day. Of course this varies, but let’s face it, we check our smartphones a lot and it’s hard to stop. A somewhat disturbing video makes the case well. It’s easy to build a case that smartphones are addictive.

Recent research shows that checking your phone results in a small release of the neurochemical dopamine. Dopamine release has long been associated with ingestion of addictive substances such as heroin and tobacco. In fact, once the pattern of ingestion and dopamine release is established, even thinking about the ingestion triggers the dopamine release, the biochemical explanation for cravings.

For this post and a series to follow, I choose not to question whether this compulsive relationship with smartphones is good or bad, but simply to acknowledge that it is common, almost universal among smartphone users and to ask if we can exploit it as tool to improve your health.

What’s Next for Healthcare.gov?

Oct 25, 2013• 12

By Aneesh Chopra

The launch of HealthCare.gov certainly didn’t go as planned. Due to technical errors, millions of Americans were sent to the functional equivalent of a waiting room before they could enter the shopping portion of the site.

Historically, projects of such complexity and demand have encountered early problems yet still often achieve great success. While much of the commentary has focused on coding problems, the site still has the potential to spur innovation — be it public or private — that will result in quality improvement and lower costs.

For context, the HealthCare.gov site is merely the front door to an incredibly complex technological undertaking tasked with organizing insurance plans, assessing program eligibility, facilitating consumer enrollment, managing financial services, and providing all of the associated customer support.

An estimated 19 million people visited the site through Sunday, and many did so at the same time; at peak periods, there were five times as many simultaneous visitors as had been expected. In rapid response to that surge, the HealthCare.gov team tried to restrict the number of visitors to the area of the site where they could establish accounts and begin shopping.

Naturally, this was not ideal, but it was preferable to the alternative.

When Internet entrepreneurs prepare to launch a new service, they tend to anticipate two scenarios. The first, and worst, is that nobody visits. The other is that too many people do.

Rise of a new platform

Drawing from my experience as CTO in President Barack Obama’s first term, we overcame initial technical challenges in popular programs such as “Cash for Clunkers” or the Post-9/11 GI Bill of Rights for veterans through an analysis of the root cause problems — and a systematic plan to address them.

I’m confident that the HealthCare.gov team will similarly fix the technology with the help of experienced technical talent – in and out of government – to work through its punch list. The site should continue to improve in the weeks ahead, building toward Dec. 15.

But the real story, likely to play out over the coming months, will be its rise as a new platform for innovation – one that will lead to the creation of new private sector services to improve our nation’s health.

* Patients Not Included

Oct 25, 2013• 22

By LESLIE KERNISAN, MD

A few weeks ago, I went for the first time to Stanford’s Medicine X conference. It’s billed as a conference that brings a “broad, academic approach to understanding emerging technologies with the potential to improve health and advance the practice of medicine.”

Well, I went, I saw, and I even briefly presented (in a workshop on using patient-generated data).

And I am now writing to tell you about the most important innovations that I learned about at Medicine X (MedX).

They were not the new digital health technologies, even though we heard about many interesting new tools, systems, and apps at the conference, and I do believe that leveraging technology will result in remarkable changes in healthcare.

Nor were they related to social media, ehealth, or telehealth, even though all of these are rapidly growing and evolving, and will surely play important roles in the healthcare landscape of the future.

No. The most remarkable innovations at MedX related to the conference itself, which was unlike any other academic conference I’ve been to. Specifically, the most important innovations were:

Patients present to tell their stories, both on stage and in more casual conversational settings such as meals.
Patient participation in brainstorming healthcare solutions and in presenting new technologies. MedX also has an ePatient Advisors group to help with the overall conference planning.

These innovations, along with frequent use of storytelling techniques, video, and music, packed a powerful punch. It all kept me feeling engaged and inspired during the event, and left me wishing that more academic conferences were like this.

These innovations point the way to much better academic conferences. Here’s why:

The power of patient presence

I wasn’t surprised to see lots of patients at Medicine X, because I knew that the conference has an e-patient scholars program, and that many patients would be presenting. I also knew that the director of MedX, Dr. Larry Chu, is a member of the Society of Participatory Medicine. (Disclosure: I’ve been a member of SPM since last December.)

I was, on the other hand, surprised by how powerful it was to have patients on stage telling their stories.

How could it make such a difference? I am, after all, a practicing physician who spends a lot of time thinking about the healthcare experience of older adults and their caregivers.

But it did make a difference. I found myself feeling more empathetic, and focused on the patient and family perspective. And I felt more inspired to do better as a physician and as a healthcare problem-solver.

In short, having patients tell their stories helped me engage with the conference presentations in a more attentive and meaningful way.

Now, some will surely be tempted to wave this off as a gauzy touchy-feely experience that is peculiar to the fruit-cakes of the Bay Area; a nice conference touch that isn’t materially important to the purpose of an academic conference.

Sorry. Saturated Fat is Bad For You. Or More Accurately — It’s Complicated. Let’s Review the Evidence…

Oct 25, 2013• 8

By David Katz, MD

A commentary in the current issue of the British Medical Journal (BMJ) suggests that saturated fat is not really so bad after all. The article has the media buzzing, with headlines exonerating saturated fat sprouting like mushrooms throughout cyberspace and print media alike. My most recent Google search of “saturated fat” limited to news retrieved 20,000 sites.

Since the new paper is just a commentary — one doc’s opinion — and not a new study, and since this opinion has been asserted many times already, I’m not sure I really get the reaction. But hey, I just work here. Let’s deal with it.

Is it, in fact, time to absolve saturated fat? No, it’s not. But then again, it was never time to demonize it in the first place. I will lay out my case that we are ill-served to think of saturated fat as either scapegoat or martyred saint.

1) Ancel Keys was never really wrong.

The case against saturated fat, its implication in the development of atherosclerosis, inflammation, and chronic diseases, notably heart disease, involves a vast expanse of research over many years by thousands of researchers around the world. But dealing with all of that in this column would be a terrible bother, so let’s just blame it all on Ancel Keys. Keys was certainly among the first to emphasize the association between saturated fat intake and heart disease.

The temptation to absolve saturated fat comes along with a temptation to indict Dr. Keys of crimes against dinner. But, Ancel Keys, while perhaps not quite right, was never really wrong.

Keys looked at rates of disease around the world and correctly noted that heart disease was more common in societies that ate more meat and dairy. His mistake may have been to look past that dietary pattern for the “active ingredient” in it, which led to the convictions of dietary cholesterol, saturated fat, and to a lesser extent overall dietary fat.

There’s much that could be said about this. Whole columns could be written about dietary cholesterol, dietary fat, and saturated fat and ways we went wrong. In fact, I — along with innumerable others — have written just such columns. Simply click the inserted links.

The 834 Problem

Oct 25, 2013• 12

By Robert Laszewski

You have probably already heard that Obamacare has as many backroom problems as problems with the front end consumer web enrollment portal.

Insurance companies participating in the new health insurance exchanges are receiving detailed enrollment information for each of the very few people who have successfully enrolled through the 36 federally run health insurance exchanges.

But the problem is that this enrollment is coming from the government with a very high rate of errors––way beyond anything they can handle manually once the real enrollment volume comes in.

So long as each insurance company is receiving only 10 or 20 enrollments a day––that is what they are receiving now––the high error rate enrollments can be fixed with lots of hands-on effort. If the Obama administration fixes the consumer portal before fixing the 834 problem, the insurance companies could begin receiving thousands of enrollments with high error rates every day.

That would bring the insurance company information technology departments to their knees. It would mean lots of new policyholders could have problems getting their bank accounts properly debited, their claims held up, or health care providers refusing to treat them because they aren’t on the list of covered people.

So this is a very big deal.

An 834 transaction is a technical term for exactly how enrollment information is exchanged, in this case, between the federal government and the health insurance companies.

The 834 transaction represents a computer “benefit enrollment and maintenance document.” It is commonly used by employers, unions, government plan sponsors (Medicare Part D, for example), and insurance marketing organizations to enroll members in a health benefit plan. This current version developed out of the 1996 Health Insurance Portability and Accountability Act (HIPAA). So, it has been around for many years.

This process is where the federal government’s backroom has come off the rails and is in need of an urgent fix.

Round One of the Obamacare Exchange Hearings. Angry Republicans 6 Contractors 0.

Oct 24, 2013• 7

By Charles Ornstein

Today’s House Energy and Commerce Committee hearing/grilling of the contractors behind Healthcare.gov brought a lot of defenses and fingerpointing, but little clarity of when the website will be fixed.

Still, here are some of the more-memorable quotes. The sources are below each.

“I will not yield to this monkey court,” Rep. Frank Pallone (D-N.J.) said when Republican lawmakers tried to talk about online privacy fears. -Politico

“This is not about blame. It’s about accountability,” said Rep. Fred Upton (R., Mich.), chairman of the House Energy and Commerce Committee. “We still don’t know the real picture, as the administration appears allergic to transparency.” – WSJ.com

“CMS [the Centers for Medicare and Medicaid Services] had the ultimate decision to go live or not go live,” said Cheryl Campbell, senior vice president of CGI Federal, the lead federal contractor on the project. “At CGI we were not in position to make that decision. We were there to support the client. It’s not our position to tell clients whether to go live or not go live.” — Washington Post

“Amazon and eBay don’t crash the week before Christmas,” said Rep. Anna Eshoo of California, a Democrat. “ProFlowers doesn’t crash on Valentine’s Day.” – NBC News

“Three weeks after the Web site went live, we are still hearing reports of significant problems. These problems need to be fixed, and they need to be fixed fast,” said Representative Diana DeGette, Democrat of Colorado. -New York Times

“We understand the frustration many people have felt since healthcare.gov was launched. We have been and remain accountable for the performance of our tools and our work product,” said Andrew Slavitt, the group executive vice president for Optum/QSSI, a contractor on the project. – ABC News

Meanwhile, HHS officials may be regretting their decision to give Healthcare.gov visitors the ability to post comments to the site. ProPublica reporters reviewed over 500 comments posted at https://www.healthcare.gov/connect/.

A sampling:

Wrongly Listed As Jailed

“Website said my wife and I were ineligible due to current incarceration. We have never been arrested in our lives, both 63!!!!!!!!!!!!!!!!!!!!!!!,” Fred wrote on Oct. 21.

Health Problems Made Worse

“I have a pre-existing condition …. a-fib…..and actually had an attack after getting frustrated with this confusing mess,” Bill wrote on Oct. 22. (A-fib refers to atrial fibrillation, an abnormal heartbeat.)

Daughter is Not a Daughter Anymore

“I am having difficulty with my account,” Joanna wrote on Oct. 22. “It appears that my daughter was added twice so that I now have two daughters with the same name and social security number. I am unable to delete one of them. Also, the drop down menu that relates to what relationship someone is to another is faulty. I choose that my husband is the father of our daughter and that my daughter is a dependant [sic] to me and my husband. What it actually shows though is that my daughter is a stepdaughter to her father and that my daughter is now both my husband and I’s parent. “

The Sequestration Cuts That Are Harming Health Care

Oct 24, 2013• 2

By John E. McDonough

Between October 1 and 17, the federal government ceased all nonessential operations because of a partisan stalemate over Obamacare. Although it is premature to declare this the greatest example of misgovernance in modern U.S. Congressional history, this impasse ranks highly.

One casualty of the showdown was any consideration of changes to lessen the impact of the across-the-board sequestration cuts that began on March 1. The cuts have caused economic and other distress across the nation, including serious impacts within the health care sector. Nearly eight months into sequestration, we can move beyond predictions and begin to quantify these effects.

Consider the following impacts of sequestration on Federal health agencies and activities:

NATIONAL INSTITUTES OF HEALTH

Cuts to the FY13 budget: $1.71 billion or 5.5%

This includes:

A 5.8% cut to the National Cancer Institute, including 6% to ongoing grants, 6.5% to cancer centers, and 8.5% to existing contracts

A 5.0% cut to National Institute of General Medical Sciences, and a 21.6% drop in new grant awards

Among the effects:

703 fewer new and competing research projects
1,357 fewer research grants in total
750 or 7% fewer patients admitted to NIH Clinical Center
$3 billion in lost economic activity and 20,500 lost jobs
Estimated lost medical and scientific funding in California, Massachusetts, and New York alone of $180, $128, and $104 million respectively.

Dr. Randy Schekman, whose first major grant was from the National Institutes of Health in 1978, said winning this year’s Nobel Prize for Medicine made him reflect on how his original proposal might have fared in today’s depressed funding climate. “It would have been much, much more difficult to get support,” he said. Congresswoman Zoe Lofgren (D-Calif.) noted the irony that because of sequester cuts, NIH funding was reduced for the research that resulted in Yale’s James Rothman sharing in the 2013 Nobel Prize for Medicine.

CIGNA and Me

Oct 24, 2013• 17

By Vik Khanna

I have a challenge for CIGNA CEO David Cordani. Sometime this week, pick up the phone and be a secret shopper. Call your customer service team and ask them the same thing I asked them on a Friday not long ago: does my plan cover and reimburse for flu shots, and at which participating providers in my area? This is managed care and wellness 101. Just not at CIGNA.

Customer service rep A says shots are covered and reimbursed, but she cannot confirm any place in St. Louis as a par provider that would bill the plan directly for payment. Her stubborn refusal to grasp the meaning of “par provider” was infuriating. She repeatedly reads a list of potential providers (all national companies, such as Walgreens) and then tells me I must call each location to discern its billing practices.

Wrong. Just plainly and simply wrong because they’re all signed to national contracts. Then, while both my German Shepherds headed for cover in another room, she hung up on me. (I was angry but never profane or malevolent.)

Undaunted and now even more frustrated, I call customer service again. Customer service rep B says: shots covered fully and each location noted previously is a par provider that will accept assignment. Done, right? Not yet. Customer service rep A calls me back.

She has not, however, learned anything in the intervening 15 minutes, as she returns to her home base of ignorance with the accuracy of a GPS. Finally, I demand a supervisor. With the supervisor comes enlightenment and lower blood pressure.

Is Healthcare.gov the Future? I Ask a Futurist

Oct 24, 2013• 8

By Charles Ornstein

Ian Morrison is a health care futurist. Companies, trade groups and nonprofits call on him to speak about trends in health care and offer prognostications of what the future brings. I’ve heard him speak a few times and his knowledge and sense of humor drew me in right away.

Last Friday, I tweeted a story written by Anna Gorman and Julie Appleby,friends at Kaiser Health News about hundreds of thousands of consumers receiving cancellation notices from their insurance companies on account of the Affordable Care Act. I was surprised to learn that Morrison was one of them.

I emailed him to find out more. This is what he told me: Until 2011, Morrison paid for his health coverage from a company on whose board of directors he served. The company was sold and he was insured through COBRA until this March. As he tells it, Blue Shield of California “didn’t want a badly behaved 60 year old Scotsman,” so he got coverage through a preferred-provider organization offered by the insurance company Health Net through a Farm Bureau program.

“No kidding,” he says, he’s no farmer.

Two weeks ago, he received a letter canceling that plan for reasons similar to those cited in the Kaiser story. He subsequently applied for coverage—not through Covered California, the state’s new health insurance marketplace, but directly through Blue Shield. Because of the Affordable Care Act’s ban on discriminating based on pre-existing conditions, the insurer must take him.

Here’s a Q&A I had with Morrison by email (edited for clarity with his approval).

.Gov Prices May Not Add Up

Oct 24, 2013• 5

By The THCBist

A THCB Reader in Michigan writes:

“The rates listed on the Healthcare.gov/Michigan site are inaccurate “estimates.” Being unable to apply on the website due to glitches, I simply go on the site to view plans for my husband and me. Based on our locality, “estimates” shown are about $250 – $600 for bronze and silver plans. We even see some gold plans for about $460.

But when I telephone the insurance companies (Aetna, Humana, BCBSM, HAP) for details and quotes, suddenly the costs of the same plans are $950 – $1750! Obviously, the “estimates” are disingenuous, probably reflecting prices that are available only to very young adults with no medical history.

An estimate is not an estimate unless it is close to what the final price is expected to be, not one-half or one-third the final price. Insurance companies need to list the estimates on the .gov website by range, rather than a single rate. For example, if a policy can be sold for as little as $250 or as much as $950 depending on the particulars of each insured, that policy estimate needs to read $250 – $950. Until insurance companies do this, they are, effectively using a bait-and-switch sales technique, which is illegal.”

If you’ve had a bad or good experience attempting to buy health insurance on the state or federal exchanges, we’d like to know about it. E-mail us at ed****@***************og.com.