Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday July 13 at 1pm PST 4pm EST are Queen of employer benefits Jennifer Benz (@Jenbenz); radiologist Saurabh Jha (@RogueRad), and policy expert consultant/author Rosemarie Day (@Rosemarie_Day1).
You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.
BY DAVID INTROCASO
In May the Centers for Medicare and Medicaid Services (CMS) simultaneously published two proposed Medicaid rules (here and here) intended to improve moreover access and quality. Both discussed at length the agency’s commitment to “addressing health equity.” The first sentence in both identified health equity as a Medicaid program priority. The proposed “ensuring access” rule stated CMS “takes a comprehensive approach to . . . better addressing health equity issues in the Medicaid program.” CMS went on to state “we are working to advance health equity by designing, implementing, and operationalizing policies and programs” by “eliminating avoidable differences in health and quality of life outcomes experienced by people who are disadvantaged or underserved.”
Nevertheless, CMS’ interest in health equity is entirely performative. It is impossible to believe the agency is legitimately interested in “eliminating avoidable differences” because leadership is well aware the greatest health equity threat to Medicaid – and Medicare – beneficiaries is the climate crisis. This is because the most climate vulnerable Americans are Medicaid and Medicare populations. Yet, the climate crisis is never addressed much less mentioned in either proposed Medicaid rule. The word “climate” never appears in 291 Federal Register pages.
This is explained by the fact that despite the Biden administration’s “government-wide approach” approach to “tackle” the climate crisis, HHS has refused to address the threat the climate crisis poses by regulating the healthcare industry’s massive carbon footprint.
Children, 36 percent of whom are Medicaid beneficiaries, are uniquely vulnerable. Fine respirable particles resulting from fossil fuel combustion are particularly harmful because children breathe more air than adults relative to their body weight. Research published last year concluded the health effects to the fetus, infant and child include preterm and low-weight birth, infant death, hypertension, kidney and lung disease, immune-system dysregulation, structural and functional changes to the brain and a constellation of behavioral health diagnoses.
Medicare beneficiaries, already compromised due to higher incidence rates of co-morbidities, are at even greater risk related to arthropod-borne, food-borne and water-borne diseases because the climate crisis can increase the severity of over half of known human pathogenic diseases. Extreme heat episodes are particularly deadly. Over the past 20 years heat-related mortality among seniors has increased 54%.
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BY KIM BELLARD
Attention must be paid: the world is now hotter than it has been in 125,000 years.
A week ago, we broke the record for average global temperature. That record was broken the next day. Later in the week it was broken yet again. Yeah, I know; weather records are broken all the time, so what’s the big deal?
Well, it is a big deal, and we should all be worried. “It’s not a record to celebrate and it won’t be a record for long,” Friederike Otto, senior lecturer in climate science at the Grantham Institute for Climate Change and the Environment, told CNN.
Bill Maguire, a professor at University College London, tweeted: “The global temperature record smashed again yesterday. The first four days of the week were the hottest recorded for Planet Earth. I would say welcome to the future – except the future will be much hotter.”
“Expect many more hottest days in the future,” agrees Saleemul Huq, director of Bangladesh’s International Centre for Climate Change and Development.
Continue reading…BY MICHAEL MILLENSON
In 1767, as American colonists’ protestations against “taxation without representation” intensified, a Boston publisher reprinted a book by a British doctor seemingly tailor-made for the growing spirit of independence.
Talk about “democratization of health care information,” “participatory medicine” and “health citizens”! Every Man His Own Physician, by Dr. John Theobald, bore an impressive subtitle: Being a complete collection of efficacious and approved remedies for every disease incident to the human body. With plain instructions for their common use. Necessary to be had in all families, particularly those residing in the country.
Theobald’s fellow physicians no doubt winced at the quotation from the 2nd-century Greek philosopher Celsus featured prominently on the book’s cover page.
“Diseases are cured, not by eloquence,” the quote read, “but by remedies, so that if a person without any learning be well acquainted with those remedies that have been discovered by practice, he will be a much greater physician than one who has cultivated his talent in speaking without experience.”
Translation: You’re better off reading my book than consulting inferior doctors.
To celebrate Americans’ independent spirit, I decided to compare a few of Dr. Theobald’s recommendations to those of his 21st-century equivalent, “Dr. Google.” Like Dr. Google, which receives a mind-boggling 70,000 health care search queries every minute, Dr. Theobald also provides citations for his advice which, he assures readers, is based on “the writings of the most eminent physicians.”
At times, the two advice-givers sync across the centuries. “Colds may be cured by lying much in bed, by drinking plentifully of warm sack whey, with a few drops of spirits of hartshorn in it,” writes Dr. Theobald, citing a “Dr. Cheyne.” Dr. Google’s expert, the Mayo Clinic Staff, proffers much the same prescription: Stay hydrated, perhaps using warm lemon water with honey in it, and try to rest. Personally, I think “sack whey” – sherry plus weak milk and sugar – sounds like more fun.
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Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday July 6 at 1pm PST 4pm EST were futurist Ian Morrison (@seccurve); writer Kim Bellard (@kimbbellard); health economist Jane Sarasohn-Kahn (@healthythinker); & patient advocate Robin Farmanfarmaian (@Robinff3);
Two special guests joined us today, Bob Rebitzer, these days at Manatt Health & brother Jim Rebitzer Professor at Boston University’s Questrom School of Business. We discussed their new book “Why Not Better & Cheaper“
The video is below. If you’d rather listen to the episode, the audio is preserved from Friday as a weekly podcast available on our iTunes & Spotify channels
By RICHARD FRANK
By relying on virtual cardiometabolic solutions for continuous care, Medicare Advantage can produce better outcomes, curb costs, enhance member satisfaction — and improve Star ratings in the process.
Medicare Advantage is a hot market. Enrollment is steadily climbing and Medicare Advantage (MA) members now make up half the Medicare population. Though members keep rolling in, competition among MA plans is tight and turnover remains high. Nearly 16% of MA members switch plans at least once during their first year, while over a third end up switching by year three. Higher-need Medicare members tend to disenroll altogether, impacting Stars ratings.
On top of fierce competition for members, MA plans struggle with ballooning costs as rates of cardiometabolic conditions like diabetes, obesity, and hypertension persistently rise. It’s hard to overstate what a toll cardiometabolic conditions take on our nation’s seniors — especially since those conditions tend to co-occur and compound with age. We’re long overdue for more innovative solutions.
Poorly managed cardiometabolic conditions are significant drivers of MA medical expense trend and spend, member dissatisfaction, and, by extension, poor Star performance. But increasingly, virtual care companies are starting to turn some of those trends around. MA plans should take note.
Virtual care provides value-based pricing and cost-saving interventions
Continue reading…BY KIM BELLARD
I was at the barbershop the other day and overheard one barber talking with his senior citizen customer about when – not if – robot AIs would become barbers. I kid you not.
Now, I don’t usually expect to heard conversations about technology at the barber, but it illustrates that I think we are at the point with AI that we were with the Internet in the late ‘90’s/early ‘00s: people’s lives were just starting to change because of it, new companies were jumping in with ideas about how to use it, and existing companies knew they were going to have to figure out ways to incorporate it if they wanted to survive. Lots of missteps and false starts, but clearly a tidal wave that could only be ignored at one’s own risk. So now it is with AI.
I’ve been pleased that healthcare has been paying attention, probably sooner than it acknowledged the Internet. Every day, it seems, there are new developments about how various kinds of AI are showing usefulness/potential usefulness in healthcare, in a wide variety of ways. There’s lots of informed discussions about how it will be best used and where the limits will be, but as a long-time observer of our healthcare system, I think we’re not talking enough about two crucial questions. Namely:
Now, let me clarify that these are less unclear in some cases than others. e.g., when AI assists in drug discovery, pharma can produce more drugs and make more money; when it assists health insurers with claims processing or prior authorizations, that results in administrative savings that go straight to the bottom line. No, the tricky part is using AI in actual health care delivery, such as in a doctor’s office or a hospital.
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BY MIKE MAGEE
If there is a silver lining to the Trump assault on decency and civility, it is our majority response to this “stress test” of our Democracy, and the sturdiness (thus far) of our Founders’ vision.
It was, after all, a long shot when Alexander Hamilton, under the pen name Publius, published Federalist No. 1 on October 27, 1787, writing: “It has been frequently remarked that it seems to have been reserved to the people of this country, by their conduct and example, to decide the important question, whether societies of men are really capable or not of establishing good government from reflection and choice, or whether they are forever destined to depend for their political constitutions on accident and force.”
Two weeks before the Iowa caucus in 2016, Trump himself sided with “force” and signaled a rocky road ahead when he stated in Sioux City, Iowa, that “I could stand in the middle of Fifth Avenue and shoot somebody, and I wouldn’t lose any voters, OK? It’s, like, incredible.”
In so doing, he was taking on medieval jurist, Henry de Bracton, who wrote in On the Laws and Customs of England in 1260 that “The king should be under no man, but under God and the law.”
Of course, Trump, while representing our Executive branch, was not acting alone. He was supported by members of our Legislative branch as they successfully stacked the Judicial branch with religious conservatives. The net impact was this past year’s overturning of Roe v. Wade, and a Christian Evangelical legislative windfall (and subsequent political backlash) in multiple Red States across the union.
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Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday June 29 at 1PM PT 4PM ET are futurist Jeff Goldsmith: medical historian Mike Magee (@drmikemagee); and patient safety expert and all around wit Michael Millenson (@mlmillenson).
You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.
BY HAYWARD ZWERLING
Synopsis:
I retired early from the profession that I loved because the devolution of the healthcare system had made it impossible for me to provide care to my patients in a manner which met my own standards. The resultant “moral injury” left me leary of again becoming involved with our healthcare system in the near future.
My Early Career
Although I had originally planned a career as a physician-scientist, it became apparent toward the end of my training that this was not the best career path for me and I choose to pursue a career in private practice.
My first post-training job was as a physician working in a clinic owned by Blue Cross and Blue Shield (1989-1991.) After two years in this relatively low stress environment it became clear that taking care of young, healthy patients was not much fun nor interesting.
I then joined Dr. LP’s private medical practice where I learned how to run a private practice. It was in this setting that I began to create an electronic medical record program for my practice, ComChart EMR. ComChart evolved into a minor commercial endeavor, it was a hobby that earned me some money, and it connected me to many interesting physicians around the US, some of whom I continue to hear from to this day.
After a couple of years practicing alongside Dr. LP I decided it was time to strike out on my own. I built out a new office and soon thereafter added a nurse practitioner.
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