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How Reform Law Funds Itself, Strengthens Medicare, and Cuts the Deficit: Part 1

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By MAGGIE MAHAR

The Mainstream Media Rarely Tries to Explain the Congressional Budget Office’s nearly unbelievable claims that the Patient Protect and Affordable Care Act can:

1)  Pay for itself

2)  Provide coverage for 32 million uninsured Americans

3) Trim this nation’s deficit by some $143 billion over the next ten years

And, that’s not all. Medicare’s Trustees say that the reform legislation puts Medicare on the road to financial solvency–while limiting co-pays and beefing up benefits.

You might well ask: How can this be? How can we provide insurance for an additional 32 million people, improve Medicare, and simultaneously save money?

The media has not been a great help in answering these questions. This is, in large part, because the good news lies in the details—dozens and dozens of details. Fleshing out the myriad ways that the ACA generates new revenues while reining in health care spending would take up far too much time on a cable television show—and way too much space in most newspapers.

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NCI’s Abdul Shaikh on Challenge for Enabling Community Use of Data for Cancer Prevention and Control

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Indu Subaiya, Director of the Health 2.0 Developer Challenge interviews Abdul Shaikh, Program Director for National Cancer Institute's Health Communication and Informatics Research Branch at NIH about the National Cancer Institute's inspiration in putting together the Enabling Community of Data for Cancer Prevention and Control challenge. Abdul talks about NCI's support of data mash-ups and visualizations related to cancer prevention and the need to create tools for both consumers and policy makers to utilize their data to drive behavior change, and draws inspiration from Hans Rosling's TED talk in 2006. 

 

Interview with Abdul Shaikh

 

How Health Services Researchers Can Harness Data : Discussion at Health Innovation Week, SF

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By TED EYTAN, MD Ted Eytan

Last week’s Health Innovation Week in San Francisco started for me with a day entitled “From Data to Information, to Knowledge to Application: How Health Services Research Can Harness Data to Help Support a More Rapid Learning Cycle,” at @KPGarfield in Oakland, California.  I was asked to present an example from clinical practice on “Novel Means of Data Generation.”

Kind of a lot to get my head around as since I am not a health services researcher.

I knew that I would be co presenting with Gilles Frydman ( @gfry ) and as I have always learned, even if you don’t know what to do, take a good history, so I went.

The second in my slide is maybe a small reflection of my anxiety over Twitter, thanks to the audience for letting me express it.

Speaking of social media, I really liked the stated approach for the day, “share whatever you like, just don’t attribute it to people.” For me that sets a great tone, so kudos to the organizers for discussing this proactively rather than waiting for someone to ask. With that in mind, I will attribute things to myself only, since they’re my things to attribute…

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The Politics of Health Reform

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By JOHN GOODMAN, PhD

There will be two national elections before the new health overhaul is substantially implemented (in 2014) and a third election the year it is supposed to be implemented.

Question: Will the voters reward office holders who supported the Affordable Care Act (ACA), or will they vote for their opponents? In thinking about this question, forget all the public opinion polls. Can you predict the outcome based on what you know about political science alone?

My prediction:  Supporters of the new law are going to get creamed. As I explained at my own blog the other day, there are four reasons: The law violates two bedrock principles of coalition politics that have been successful for the past 80 years; it abandons core Democratic constituencies; and it ignores the fundamentals of the politics of the health care sector.

Franklin Roosevelt’s First Principle of Successful Coalition Politics: Create benefits for people who are concentrated and organized, paid for by people who are disbursed and disorganized.

The ACA  violates this principle in spades. The main beneficiaries are many (but not all) of the new law are 32 million to 34 million newly insured people who otherwise would have been uninsured. Far from being organized and focused, most people in this group do not even know who they are. Indeed, it is probably fair to say that never in American history have so many benefits been conferred on so many people who never even asked for them!

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Medicare Costs Rise, Health Outcomes Suffer When Seniors Are Over-Medicated

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By NAOMI FREUNDLICH

The problem of elderly people taking too many medications is not new, but continues to pose a serious risk to health as well as contribute significantly to rising Medicare costs. The fact is that nearly 20% of adults aged 65 years and older who are not hospitalized take 10 or more medications daily. This number is not the result of shoddy care, but rather achieved when doctors simply follow practice guidelines for several common, co-existing conditions like diabetes, high blood pressure and depression, for example. If you look at all seniors (those both in and out of the hospital) the American Society of Consultant Pharmacists reports that the average 65-69 year old takes nearly 14 prescriptions per year; by ages 80-84 that number averages an astounding 18 prescription drugs per year.

What’s troubling is that instead of improving the health of seniors, evidence is growing that the more medications an elderly person takes, the more likely he is to experience falls, cognitive decline, loss of mobility, depression and even cardiac problems. These adverse drug effects may be mistaken for Alzheimer’s disease or other dementias too. The bottom line: Experts estimate that up to one-third of the elderly in our communities may be over-medicated and some 20% of their hospital admissions are due to adverse drug events. The costs related to over-medication in the elderly are thought to exceed $80 billion each year.

Although the problem of so-called “polypharmacy” among seniors results in significant economic and public health costs, little has been done to remedy the problem. In fact, in a recent commentary in the Journal of the American Medical Association, Jerry Avorn, associate professor of medicine at Harvard Medical School and author of the book “Powerful Medicines,” says that “many aspects of the US health care system act to discourage optimal prescribing” for the elderly.

For example, elderly Americans are highly underrepresented in the clinical trials for many of the drugs that doctors commonly prescribe for them. Seniors may metabolize these medications differently and they are often more sensitive to side effects and counter-indications with other drugs than younger people. They also take many more drugs (often all at the same time) than any subjects who take part in controlled clinical trials. Disturbingly, doctors sometimes end up prescribing a new medication to treat the adverse effects of a pill the elderly patient has been taking for years.

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San Francisco 2010: Qpid.me Demonstration

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By Bianca Grogan

At the Health 2.0 Fall Conference, October 7-8, 2010, in San Francisco, Ca, during the much talked about Behavior Change, Health 2.0 & The Unmentionables session, Ramin Bastani, Founder of Qpid.me spoke about one of the most difficult, but important, conversations you should have with your partner. Ramin drew from his past experiences while introducing a service which he called "a mordern, flirtatious, I'll show you mine, if you show me yours." Take a look at this demonstration and discover a new and easy way to mention one of the biggest unmentionables of them all.

PBM Industry Reforms can Reduce Wasteful Health Care Spending, Protect Patient Choice of Pharmacy

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By CSS

American businessman Victor Kiam best described the small business owners’ mindset by declaring, “An entrepreneur assumes the risk and is dedicated and committed to the success of whatever he or she undertakes.” However, external forces can occasionally constrain even the most astute entrepreneur, as is the case with independent community pharmacy owners. These same forces needlessly inflate prescription drug costs for employers and health plan sponsors, while undermining patient choice and health outcomes.

Pharmacy benefit managers (PBMs) are hired by employers, government agencies, health insurance plans and unions to administer prescription drug plans. They morphed over time from simple claim adjudicators to gigantic drug middlemen operating a byzantine drug delivery system that benefits them at the expense of others. They reap windfall profits simply for processing claims and operating mail order pharmacies. In 2009, the three largest PBMs – CVS Caremark (which includes the CVS pharmacy retail chain), Medco Health Solutions, and Express Scripts – made $6.4 billion, $1.1 billion and $776 million respectively in profits. By contrast, independent pharmacies operate off of slim profit margins that are driven by prescription drug reimbursement. Despite the rising cost of many medicines, these rates have been declining for years.

Local pharmacists have a Hobson’s choice: accept onerous, non-negotiable contract terms dictated by PBMs or lose access to both new and long-term patients. When the contracts are signed community pharmacies are dragged into a profit-draining, bureaucratic abyss. If they have the temerity to complain, PBMs can often freely void the contract. U.S. Representatives Anthony Weiner (D-NY) and Jerry Moran (R-KS) introduced H.R. 5234, the PBM Audit Reform and Transparency Act of 2010; a bipartisan-supported bill designed to tackle some of the most egregious practices of the PBM industry. Its passage is a must. 

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Doctors, Hospitals and the Yankees

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By ROB LAMBERTS, MD

Joe Boyd hated the Yankees.

“Those damn Yankees.  Why can’t we beat ‘em?”

Then he got the opportunity to save his beloved Washington Senators by making a deal with the devil – giving up his soul in exchange for being transformed into “Shoeless Joe” to propel his team to win the World Series.

Interesting.  I think a lot of doctors are making their deal with the devil.  They are looking for a small gain in comparison to a long-term of misery.  True, Joe Boyd made out in the end; but that will only happen if someone from Hollywood writes our script.

Here’s the problem: at the core of our problems with healthcare is the total lack of cohesive communication.  Doctors have no idea what other doctors have done with a patient.  Tests get ordered, medications get changed, procedures, hospitalizations, even surgeries are done without communication to other doctors who would benefit from this information.  The conduit of communication is this:

Doctor: “So, how have you been doing over the past few months?”

Patient: “Didn’t you get the notes from the hospital?  I was in for two weeks.  I had a heart attack and a stroke and now I am in rehab for both of these.”

Doctor: (checks chart uncomfortably) “No, I didn’t hear about it.  Why don’t you tell me about it….”

Situations like this happen daily at my office.  Patients are started on medications by specialists without my knowledge.  Lab tests are done that I have no access to.  Huge changes happen in the lives of the patients for whom I have cared for over a decade, and I get nothing.  Even consults I order are done without any communication back to me.  On the other side of things, my patients are hospitalized without any consideration of the care I have been giving over the past decade.  Patients are treated as if their care starts from scratch every time they enter a new venue.

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San Francisco 2010: Launch of ShareCare

By Bianca Grogan

 

WebMD founder Jeff Arnold launched ShareCare at this year’s Health 2.0.  ShareCare recruits industry experts to answer health and wellness questions, providing consumers with the necessary tools to make smart health choices and live healthier lives. ShareCare simplifies the search for health information, allows consumers to find high quality answers from multiple points of view, and drives healthcare to the local level by allowing consumers to hear from physicians close to home. With partners such as Sony, Harpo (Oprah’s production company), Discovery, Dr. Mehmet Oz, and multiple major content providers, the launch of ShareCare has been highly anticipated.

The Health Reform (Almost) Everyone Loves

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By MICHAEL MILLENSON Michael Millenson

Come with me to the land of happy health reform. It is a place where Republicans and Democrats find common ground, a place where physicians, hospitals and health insurers sit together as partners, a place where criticism is respectful, not rancorous. It is the world of Accountable Care Organizations (ACOs).

What are ACOs, and why have they escaped the general onslaught of opprobrium from Obamacare opponents?

The term Accountable Care Organization was originated by Elliott Fisher of the Dartmouth Center for the Evaluative Clinical Sciences, picked up by the Medicare Payment Advisory Commission and then enshrined in Section 3022 of the Patient Protection and Affordable Care Act (otherwise known as health care reform). The language is explicitly designed to use financial incentives to change the health care delivery system.

ACOs are defined less by form than by function. A group of physicians, possibly with a hospital, agrees to manage the full spectrum of care for a defined population of at least 5,000 Medicare beneficiaries for a minimum of three years. If the ACO meets certain targets for quality and cost-effectiveness, it gets to keep part of the savings.

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