Tuesday, April 26, 2016

Health Reform Troubles and the Affordable Care Act

We are now several years into the Affordable Care Act.  There are now facts and figures which reveal troubling tremors in the financial underpinning of health insurance for all patients. No one will be exempt from these market forces.

Some politicians and President Obama (for whom the ACA was renamed "Obamacare") insist on how many millions of Americans are now insured. Yes,  they carry a card, either a blue one with a stripe (Medi-caid) or a private plan.  What many of these newly insured do not know is the card they carry from the ACA is not the same that fully paying patients have in their wallets.  The term "What' in your wallet" may be applied to health insurance cards as it has been to certain credit cards.  The similarities are frightening.

These subsidized plans required providers to sign new contracts with less reimbursement eliminating any incentive to be credentialed for the affordable care act. It required providers to re-program their practises management software to bill different amounts for the ACA and to accept a lower reimbursement for each procedure code.

In some Western states the impact of undocumented workers remains largely unknown. However there are those who want to include the  segment of our population.  I think these immigrants do need to be protected, and not be excluded from the American health system. We have always been a country that welcomes immigrants and usually assimilate them fairly quickly.

Here is what is building.

ACA News

Will Covered California Sell Health Coverage To The Undocumented?
ObamaCare premiums expected to rise sharply amid insurer losses
United’s Departure From Marketplaces Could Impact Consumers’ Costs, Access

United HealthCare has absorbed multiple other companies during the past two years, to insulate itself from competition and have full reign over the market for insurance plans.  These mergers include or  will include the following competitors.

Wikinvest lists these UHG mergers and acquisitions and divestitures in the past ten years

                 This includes former independent health insurers, Oxford, Pacificare,Mid Atlantic Medical                            Services Inc.,Definity Health Corporation (Definity).Uniprise USS, Exante

                 United Health Group has several other companies in their sights Humana and Aetna. Anthem also
                 has eyes on Humana  and Aetna  is bidding on Cigna. As the old  baseball adage goes (So who's                  on first?) 

                 Readers can see more..........


The changes will impact consumers in  different states, according  to market share and other factor such as the amount of care to patients with long standing expensive chronic disease, more advanced because of neglect in the group of the uninsurables. The impact of lifestyle becomes a significant issue for some states where poor nutritional habits affect health and the development of chronic illness, diabetes, obesity, hypertension, the effects of depression, unemployment, environmental hazards.  Social change and erosion of the middle class will impact health as well. 

The longstanding organization of employee based health care is disappearing, and group policies are re-organizing.

Wall Street is ablaze with speculation and the huge increase in share value for many of these companies.

Fortune's headline proclaims,

UnitedHealth-Aetna colossus would overtake Apple on the Fortune 500.
As things develop eventually there may only be several players in the health insurance
market....."too big to fail".  Uncle Sam steps in when all is lost.......and there you have it "UNIVERSAL PAYER"  Who wudda thot ?
So where do patients and providers fit in?
Parts of this article are from Fortune, and reporting from the California Medical Association.

Sunday, April 24, 2016

F.A.S.T. Are you at Risk for a Stroke

I have had many illnesses, including heart disease and a mild stroke.  I went through open heart surgery and several angioplasties for heart disease.

On a scale of dread, heart disease was about a 2 on a scale of 1 to 5.  The idea of a stroke was a 6 in my mind, and when it happened quite suddenly, while I was asleep i had an  acute anxiety attack.

When I awoke I realized there was something amiss in my non-dominant right hand, it was numb. In the past I would at times awaken and have one of  my hands tingling or numb which I attributed to a cervical disk problem.(one of my cervical disks bulges,and I have had a surgery on my lower back for a ruptured intervertebral disk)  However this did not go away even with stretching my neck. Try as I might my right arm and hand refused to obey my commands.

I am fortunate. The symptoms and signs diminished quickly over a period of two weeks.  I was left with some residual balance and gait disorder, for which I have learned to compensate.

The best way to treat a stroke is to not have one. I ignored a serious and common factor for stroke risk.  Snoring and sleep apnea, both of which are successfully treated. It is  listed as a risk factor, but is overshadowed by cholesterol issues, hypertension, and diabetes.  I ignored my spouses warnings about my snoring and periods of sleep apnea. Sleep apnea occurs when there is total airway obstruction from snoring.  Patients are unaware of these episodes but whoever sleeps with or near them will hear a gasp and see the victim roll over or moan.

Sleep apnea or severe snoring should be characterized as an urgent medical problem. There are tests to easily diagnose the problems, and even an at home testing device, which screens for sleep apnea. A formal sleep apnea test in a sleep lab is still necessary. It's a small price to pay, sleeping away from home for a night, however it is a small price as compared to paralysis

I share this as an admonition for this month' preventive measure as well as weight reduction, a healthy diet, and exercise.

AUT researchers have developed an app to calculate stroke risk factors. Available on both iOS & Android platforms, the Stroke Riskometer App was selected by leading doctors as a top health app for 2014 from 100,000+ apps available. It is available on iTunes and Google Play Store.It is endorsed by the WSO (World Stroke Organization

Remember !

FFace Drooping – Does one side of the face droop or is it numb? Ask the person to
smile. Is the person's smile uneven?
AArm Weakness – Is one arm weak or numb? Ask the person to raise both arms.
Does one arm drift downward?
SSpeech Difficulty – Is speech slurred? Is the person unable to speak or hard
to understand? Ask the person to repeat a simple sentence, like "The sky is blue." I
s the sentence repeated correctly?
TTime to call 9-1-1 – If someone shows any of these symptoms, even if
the symptoms go away, call 9-1-1 and get the person to the hospital immediately.
Check the time so you'll know when the first symptoms appeared. This is critical for
medical personnel to know if blood thinners will be effective in treating the stroke.

Wednesday, April 20, 2016

Don Quixote and the Health Professional’s Endless Quest | THCB

Recently The Health Care Blog featured a post by Richard Gunderman M.D.

Don Quixote on his mount, Rocinate, with Sancho Panza

Are we as physicians destined to also flail at windmills?  In the modern era we face similar obstacles

"April 22 marks the 400th anniversary of the death of the greatest novelist who ever lived, Miguel de Cervantes. Though the day will pace unnoticed by most physicians, it is in fact one many should note. Why? Because both his life and work can serve as vital sources of inspiration and resilience for health professionals everywhere."

Cervantes faced numerous disappointments and setbacks in life – poverty, imprisonment, slavery, serious injury, and repeated rejection. Not unlike many contemporary health professionals, he had many reasons to become discouraged and give up. Yet he found the will to carry on. Where did he find such inspiration and resilience? I believe that he found them above all in his work – not the reactions of critics or the royalties he collected, but his deep belief in his life’s mission.
Though the novel is filled with battles of various kinds, Don Quixote reminds contemporary health professionals that the real battle takes place within.
"In giants we must kill pride and ignorance. But our greatest foes, and those we must chiefly combat, are within. Envy we must overcome by generosity and nobleness of spirit; anger, by a reposed and quiet mind; riot and drowsiness, by vigilance and temperance; lasciviousness, by our inviolable fidelity to the mistresses of our thoughts; and sloth, by our indefatigable peregrinations through the universe. . . . This, Sancho, is the road to lasting fame and good and honorable renown."
Richard Gunderman makes me realize it is time  to re-read Miguel de Cervantes.

Don Quixote and the Health Professional’s Endless Quest | THCB

Saturday, April 16, 2016

Social Media Marketing Leads to Reduce Stigma associated with Mental Illness

Social Media has already played a role in improving treatment of mental illness. The result is improved economic benefit to California's economy.

A statewide social marketing campaign to reduce the stigma associated with mental illness has brought economic benefit to California’s economy, a new study says.
How? By boosting the employability, productivity and incomes of people afflicted by psychiatric conditions, according to the study, published Thursday by the RAND Corporation, a Santa Monica-based policy think tank. 
The study showed that people in need of mental health treatment who were exposed to the anti-stigma message of the social marketing campaign were more likely to seek help. Those who get treatment have a significantly higher chance of finding good-paying jobs, thus contributing more tax dollars to state coffers, it said.
“This is an important finding,” said Alejandra Acuña, an assistant professor of social work at California State University, Northridge. “Social marketing campaigns have been used with great results to change behavior and address public health concerns like nutrition and HIV testing.”
Reducing stigma, especially in the minds of people who suffer from mental illness, was a key priority. Central to the effort was a multi-faceted social media campaign that delivered stigma-reducing messages in a variety of forms, including documentaries, public services announcements, online public forums and multimedia advertisements.
An important part of the media campaign was a documentary that recounts the stories of California residents who have suffered from mental illness and recovered. It was broadcast numerous times on public television stations, showed to community groups and other audiences and is posted on the CalMHSA-funded website, EachMindMatters.org.
“The goal is to change the conversation [about mental health] in our society by increasing knowledge and changing attitudes,” said Wayne Clark, executive director of CalMHSA. “The better mental health people have, the more productive citizens they will be.”
Scott Ashwood, lead author of the RAND study, said an estimated 121,000 people per year seek mental health treatment after being exposed to a social marketing campaign’s anti-stigma, anti-discrimination message.  
Discrimination against people with mental health illnesses continues to be a serious social problem, experts say, though many of them think society is headed in the right direction.
And stigma in the eyes of others isn’t the only problem.
“Part of it has to with a person’s own self-perception,” said Tom Loats, director of behavioral health at St. Joseph Hospital in Orange, Calif. “People believe they have to pull themselves up by their own bootstraps. That’s silly. You can’t do that for diabetes or heart disease.”
“If they recognize and accept their illness, they will seek treatment and function better,” Delacruz said. But they have to jump through the stigma barrier, she said, that’s where these social media campaign efforts can help.

State Economy Gains By Reducing the Stigma of Mental Illness, Study Says

Republican experts trash Trump's healthcare 'plan'

Donald Trump's objectively awful healthcare "plan" continues to baffle and "exasperate" Republican policy types who are going to have be responsible for defending it—and him—should he get the nomination. None of them seem to have any problem now, however, unloading about just how much of a mess it is.

“If you repeal the Affordable Care Act, you’ve got to have a serious way to expand coverage to replace what you have taken away,” said Gail R. Wilensky, who was the administrator of Medicare and Medicaid under President George Bush from 1990 to 1992. “There’s nothing I see in Trump’s plan that would do anything more than cover a couple million people.”
Robert Laszewski, a former insurance executive and frequent critic of the health law, called Mr. Trump’s health care proposals “a jumbled hodgepodge of old Republican ideas, randomly selected, that don’t fit together.” […]
James C. Capretta, a senior fellow at the Ethics and Public Policy Center, a conservative nonprofit group, said Mr. Trump underestimated how difficult it would be to uproot a law that was now embedded in the nation’s health care system. […] "I just don’t see that in Trump’s vague plans to repeal the law and replace it with something beautiful and great.” […]
Grace-Marie Turner, the president of the Galen Institute, a champion of free-market health policy, said Mr. Trump’s proposals were sketchy and inadequate.   All of which Trump's chief policy adviser, Sam Clovis, dismisses in a manner that's totally emblematic of the entire campaign. When it comes to policy, there just isn't any beyond a bunch of catch phrases and emphatic bluster from Trump.
Clovis says that his candidate is running against the political establishment, so these criticisms just don't matter because he's not relying on "traditional establishment Republican people" like them. Instead he has a half-dozen or so advisers who are "very prominent people," but who "are not ready to have their support of the Trump campaign known." 
Yeah, I bet they're not anxious to be known.

Republican experts trash Trump's healthcare 'plan'

Friday, April 8, 2016

Covered California Imposes New Quality, Cost Conditions On Plans | California Healthline

It's about time!

In the early days of Medicaid when it was formed it was considered a safety-net for those who were uinsured,  unemployed, and below a certain poverty line to become eligible for 'state aid'. In reality the federal government subsidizes the state-run medicaid system.

Even then the system was riddled with deficits in reimbursement to providers hospitals, and quality of care was an issue.  The system was burdened with bureaucracy and late payments with little response from state agencies about errors in reimbursement and little  chance of adjudication of denied claims that were denied.

While federal and state programs set goals for private insurers in term of quality assurance Medicaid was not required to meet to meet those standards, until very recently.  The Affordable Care Act has begun a slow process of improvement.

Moving into a realm usually reserved for health care regulators, Covered California Thursday unveiled sweeping reforms to its contracts with insurers, seeking to improve the quality of care, curb its cost and increase transparency for consumers.
Among the biggest changes: Health plans will be required to dock hospitals at least 6 percent of their payments if they do not meet certain quality standards, or give them bonuses of an equal amount if they exceed the standards.

The plan, to be implemented over seven years, is based on a similar strategy pursued by the federal agency that oversees the government-run Medicaid and Medicare health insurance programs.
Seven years is a prolonged adjustment period for new regulations to be implemented.
Covered California will also require health plans to identify hospitals and doctors that are performing poorly on a variety of quality metrics or charging too much for care. The plans must dump the providers from their networks as early as 2019 if they don’t mend their ways. The plans could choose not to cut the hospitals or doctors, but they would have to explain in writing why, and detail what the providers are doing to address their deficiencies.
Some doctors have noted that provider networks in many of the health plans sold by Covered California are already thin and warned that cutting the networks even more would only exacerbate the problem. And, they say, some hospitals and physicians might balk at the stringent new requirements and decline to participate in Covered California networks.
Among other elements of Covered California’s contract overhaul:
  • Health plans must assign a primary care doctor to enrollees within 30 days of coverage.
  • Health plans and doctors must share data to better track and treat patients with chronic conditions such as diabetes.
  • Plans are obliged to monitor and reduce health disparities among all their patients, starting with four major conditions: diabetes, hypertension, asthma and depression.
  • They also are required to better manage the price of high-end pharmaceuticals and aid consumers in reducing the cost of expensive drug treatments.
  • The health plans must help consumers better understand their diseases and treatment choices – and their share of the costs for those treatments.
While not dealing with problems, it is the first time Medicaid will be required to meet standards set for private insurers.

Perhaps some requirements of the Affordable Care Act will bear fruit.