Health Information Exchange and Accountable Care

 

 

 

Are HIEs Ready for Accountable Care?

This is a very interesting question.  HIEs were originally proposed long before the Affordable Care Act was law.  Their concept was to allow for  interoperability by harmonization and standardization of disparate EMR vendors.

The Accountable Care Organization is conceived to improve reimbursement paradigms, improve outcomes and to coordinate care among providers.

EMR and HIE came along long before the ACO was a concept.  The ACO in fact is not a reality in many places. Development costs, organization and implementation are a complex process.

I have not seen a concept of how HIEs would interact with ACOs. Technically all things are possible.

One of the centerpieces of the effort was support for the development of Health Information Exchanges. The government threw $564 million into the effort to create statewide HIEs, and some states followed suit with their own financial support.

But the big question facing the industry is what role, if any, HIEs can and will play in supporting the newest federal idea: accountable care organizations. As of February 2013, there were more than 250 Medicare ACOs, according to the Centers for Medicare and Medicaid Services; in a Health Affairs article published in February, David Muhlestein, an analyst at research/consulting firm Leavitt Partners, pegged the total number of ACOs at 428.

ACOs are credited as booming, and as of right now, there seems to be enough HIEs to support them. However, the future of HIEs is extremely murky due to the problem that has plagued the information exchanges since their conception-financial sustainability.

Most of the ACO effort has not been in terms of management, but the complexity of formation.   There are few operating Accountable Care Organizations working. Some that have been formed and operating are large health systems already operating as a single business entity.

The vast majority of medical practitioners and small hospitals function independently and have no contractual agreements with each other, a fundamental requirement for operating an ACO, to manage reimbursement, measure outcomes, and plan.

Stakeholder advocacy group eHealth Initiative assessed the state of HIEs in the United States in 2012 and identified 222 public and private HIEs, down from 255 in 2011.

A total of 161 HIEs responded to the organization's annual survey, the results of which highlight a big problem: Only 29 HIEs reported themselves as being financially self-sustaining. Ninety-three HIEs in 2012 said they were "highly likely" to be in business in three years, and 64 of those believe they will be financially sustainable within the next three years.

However, nearly half of those optimists currently depend on federal funds as their primary revenue source. And the $564 million in federal funding awarded to state HIEs under the HITECH Act stops in October 2013, with currently budgeted state funding sources expected to dry up by March 2014.

Very few HIEs are ready. The  eHealth Initiative survey also indicates that ACOs likely won't find the kind of data networks they could pay to piggyback on: Only 24 HIEs in 2012 reported being able to offer value-added services such as advanced data analytics, quality reporting, clinical decision support, and PACS reporting, all of which are services needed just as much by value-based programs as the actual exchange of data.

But too many HIEs are little more than a fax machine, sending a PDF-based Continuity of Care Document or medical image to a fax or into an EHR, and a surgeon can't operate the clinical decision support functionality of an EHR on information in a PDF.

Health Data Management also discusses further unknowns regarding the relationshiop between an ACO and a HIE.

Smoke and mirrors, cannot substitute for building ACOs on top of already inadequate Health Information Exchanges.

 

Technorati Tags: hie,aco,health informaiton exchange,accountable care,emr,interoperable,data,data analytics,affordable care act,aca,ehealth,hitech,outcomes

Reversal of HHS policy has Positive Outcome

 

Dying child was on life support when new lungs became available

Ten-year-old Sarah Murnaghan, who has cystic fibrosis, is receiving a lung transplant, at this moment.

The previous policy regarding the prohibition of children less than 12 years old with cystic fibrosis  receiving an adult lung transplant was reversed several weeks ago by the Dept of HHS in response to a public outcry  regarding the policy.  The policy was the result of obsolete statistics regarding survival statistics of children with the fatal genetic disease, cystic fibrosis which affect the lungs.  Previously adult lungs were also avoided due to size discrepancy between adult lungs and those of children.  The availability of adult lungs is much greater than children.

HHS Secretary Sibelius approves recommendations for lung transplant in child.

 

The criteria for lung transplantation in children with cystic fibrosis has been expanded .

 

 

Technorati Tags: lung transplants,cystic fibrosis foundation,children,rejection,survival rates,sarah murnaghan,life support

Health Train Express on Pause

 

Health Train Express will not publish for the remainder of June 2013

We are focused on publishing important status reports on the topic of Accountable Care Organizations in an effort to educate those assigned to develop these new entities.

Numerous topics will be addressed, including:

What health IT is necessary to support accountable care?

The CCHIT ACO HIT Framework is a guide
to developing a technology roadmap   HIT framework is an essential enabler for ACO’s.

The market for these products will be considerable, and it is still in the development phase.  As yet the role of health information exchanges is not clear, however some are looking to HIE’s as a component for their ACO HIT infrastructure.

Follow the links to Digital Health Space for daily updates.

 

Technorati Tags: aco,accountable care organization,cchit,healthtrain express,digitall health

The Achilles Heel(s) of The Affordable Care Act

 

Some Youths Unlikely to pay for Obama Care

President Obama had focused his long term objective as being the President that brought universal health care to America. Despite it’s passage unilaterally with only Democratic votes the law is unpopular and each day new challenges arise as to the fiscal integrity of the law, as much of it appears to be wishful thinking based on  the desire to see every citizen have health insurance without concern for affordability, it’s impact on businesses, and rough autocratic mandates the law gives to the Head of the Department of Health and Human Services, Kathleen Sebelius.

 

Health Train will continue to bring to you thoughts, observations and opinions from many respected health consultant and experts:

*********************************************************************************

By Grace-Marie Turner
Orange County Register, June 5, 2013

Virtually all Americans will be required to have health insurance under the Affordable Care Act (caution---this document is about 900 pages-- starting in 2014, and President Barack Obama especially wants young, healthy people to sign up.

About two-thirds of the uninsured are younger than 40. They use fewer health services, and their premiums are needed to help keep insurance costs down for everyone else.

Yet the incentive structures in the law work at cross-purposes with this goal and could well undermine its success. It will all come down to costs.

Four out of 5 people younger than 30 will face higher premiums than without the Affordable Care Act even with the subsidies many can receive.

The law requires young people to pay more for their health coverage so older people can pay less. A study published this year by the American Academy of Actuaries’ Contingencies magazine found that because of this provision, “premiums for younger, healthier individuals could increase by more than 40 percent.” Young men will pay even more than young women.

A former director of the Congressional Budget Office, Douglas Holtz-Eakin, conducted a survey that showed fewer than half of young people will sign up for insurance if premiums rise by 30 percent.

Young people also face a daunting approval process in applying for coverage. Applicants must divulge their income, family status and information about their employers, details on any insurance offered at work and their health habits — just to find out if they are eligible for subsidies.

Ezekiel Emanuel, a key architect of the president’s health plan, says he is worried that young people will be “bewildered,” and they may “forgo purchasing health insurance and opt to pay a penalty instead.”

That certainly will be an attractive option for many since the penalty starts at just $95 the first year.

And there is yet another disincentive for young people to enroll in coverage: They can wait to sign up for coverage until after they get sick or injured. The law requires health insurance companies to sell insurance to anyone who applies.

         

But if young people don’t sign up, the insurance pools are likely to be composed primarily of people who have high health costs. This could cause a “death spiral” where many more older — and sicker — people are enrolled, causing health insurance premiums to rise to cover their medical costs, thereby driving even more young people out of the market.

The White House believes that it will be able to persuade young people, who overwhelmingly supported the president, to enroll out of loyalty.

“The president connects with young people, too, so he needs to use that bond and get out there to convince them to sign up for health insurance to help this central part of his legacy,” said Emanuel, a health care expert at the University of Pennsylvania.

But young people may find that zeal may be severely tested when it comes down to paying thousands of dollars for health insurance that they may not want or need.

Consider, for example, a 27-year-old earning about $34,000 a year. He now could buy health insurance for about $200 a month. However, the new rules and more generous benefits required under the health law mean he would have to pay about $300 a month instead. He could get a subsidy of about $20 a month but, even with that, he still would be paying nearly $1,000 a year more for health insurance than without the law.

The White House is expected to mount a massive advertising campaign this summer to encourage people to enroll.

This will severely test his young supporters, who are having the hardest time finding jobs in our economy. Forcing them to also purchase health insurance — and pay more for it — may cool their enthusiasm to help the president fulfill his legacy.

http://www.galen.org/topics/some-youths-unlikely-to-pay-for-obamacare-coverage/

 

Technorati Tags: ezekiel emanuel,aca,obamacare,white house,university of pennsylvania,elderlly,young people,hhs,sebelius

Obamacare in California: Health Benefit Exchange

 

Executive Director:  Peter Lee

 

Health Train Express did some deep dyving into the Covered California Plan. California is the first State to embark on the Affordable Care Acts option for states to plan their own Insurance Exchange.

This information is taken from the Covered California web site. Readers must realize that this plan will not be operational until January 2014, and that most figures are subject to revision.

On the surface it appears reasonable to assure all are covered.  If your income is below the 400 % of the Federal Poverty Level (subject to the size of your family) you will be eligible for the subsidized tax credit.  The Covered California web site provides a simple calculator to get an estimate of your premiums.  The web site also provides a benefit table, co-pays, deductibles, maximum out of pocket expenses and a range of plans, Bronze,Gold, Silver, Platinum.

The ACA  Changes that occur in January 2014

Calculating Potential Insurance Cost in 2014

Coverage Basics

For Individuals and Families

Getting Financial Help

Calculating Potential Insurance Cost in 2014

Frequently Asked Questions

If you need coverage before 2014

The Fine Details (Not for the faint of heart)---written by attornies and passed into law by the California State Legislature and signed by Governor Jerry Brown

Legislative Bills

AB 792

AB 1766

AB 1926

SB 961

 

Technorati Tags: PPACA,AB 792,AB1766,AB1926,AB 961,AFFORDABLE care act,health insurance exchange,health benefits exchange,federal poverty level

A Blogger’s Paradise

 

If you are an avid blogger your presence is most likely known to the Department of Homeland Security.

I came upon this little tidbit of information released as a result of a FOIA (Freedom of Information Act) query

Analyst Desktop Binder_REDACTED by Andrea Stone

It professes to know what ‘keywords” the D.H.S. searches for when scanning social media for ‘suspicious’ material.

Judging from the list there is little to fear….this has to be some kind of joke, sort of like the Affordable Care Act.  It would be funny but it is not…these are the people we elect to run our lives.

So here goes my test:

This material has been released under the Freedom of Information Act and is in the public domain.

Technorati Tags: terror,homeland security,keywords,social media,blogger,foia,freedom of information

THE WALKING GALLERY A SOCIAL EVENT

 

Just a reminder,  today is another episode of The Walking Gallery, a regularly occuring event, which thus far has only been held in Washington, D.C.  This unique event was founded by Regina Holliday. This year it will be held:

The Walking Gallery 3 will be held in St. Paul’s Lutheran Church in Northwest DC one block from the Mural 73 Cents.

The event has been quite successful growing in numbers each year. For the past two years The Walking Gallery gathered in the Kaiser Permanente Center for Total Health.  It was a great venue for the first two years.  Thank you Kaiser Permanente for your gracious support!  The first year we had 54 Walkers wearing their jackets.  The second year we had over 80.  

The “glue” that is the centerpiece for the event is the creative paintings which Regina Holliday has painted on the back of jackets which the attendees wear. These are pictorials of people in medical situations depicting different events.  Regina travels the country visiting many medical conferences and is inspired by these events. Many of the attendees are well known in social media and are prominent thought leaders.

Regina Holliday also blogs at “Regina Holliday’s Advocacy Blog”  this week’s edition is entitled “Stair Steps”

Accompanying each of these paintings Regina also utilizes her amazing story telling talent as a postscript for the artwork. The stories themselve are an art form and a novelette. They are also based upon real life situations. The stories always grab me, there is humor, happiness, sadness and tragedies….many of which are precipitated by our broken health care system.

If you are a provider, patient or an advocate it gives you much thought and should stimulate thought and illuminate just where things have gone “wrong’ Regina along with other prominent patient advocates, such as ePatientDave are already making a difference.

The event came to my attention rather late. So if you miss it plan for next year.

My only complaint is that the event has not taken place on the West Coast or in the midwest.

Regina, you have many fans here on the ‘Left Coast”.  How about a Walking Gallery in Los Angeles, San Diego, or in San Francisco ?

 

San Diego Convention Center                   San Francisco Cable Car Turnaround

One other suggestion is to also carry the event as a live stream on Google Hangouts on Air, to share it with the rest of the world.

 

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Does Patient Engagement lead to Higher Bills?

 

From Science Roll

“Patients who helped with medical choices had higher bills: Let’s Analyze This!

by Dr. Bertalan Meskó on June 1, 2013

As a huge fan and supporter of e-patients who want to use digital technologies and the information they find online in their health management, I don’t like news articles speaking against them without explanations and data.

The healthcare social media community has been discussing a study that concluded patients who wanted to participate in medical decision making had higher bills. It might predict that e-patients will have higher bills as well. Let’s take a look at it:

Analyzing the data, the researchers found that nearly all — 96.3% — wanted to receive information about their illnesses and treatment options, but that only 28.9% said they had a strong preference for making their own decisions about their care.

Those patients had longer hospital stays, by about a quarter of a day on average, than patients who preferred let their doctors take the lead. They also had greater hospital costs ($865 more, on average.)  By and large, people who were more likely to participate in medical decisions were better educated, and more likely to have private insurance coverage, than the rest of the patients who were surveyed.

You see? It says patients who had a strong preference for making their own decisions about their care. E-patients are partners with their doctors, not making medical decisions themselves alone. That’s the difference.”

This makes sense and should not be surprising. Discussion of the medical issues is patient engagement and leads to patients and physicians reinforcing decisions. Physicians are much less reticent to investigate further after discussing issues with the patient rather than just ordering tests without the patient’s understanding.

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Why Kids go to the E.R.

 

Huffington Post:

 

Sneezing, runny nose and other cold-like symptoms are the top reason kids are brought to the emergency room, according to a new government report on the state of Americans' health that includes a special section on emergency care.

The data show cold symptoms accounted for 27 percent of kids' ER visits in 2009 and 2010, and 14 percent of adults' ER visits.

The report also showed that Medicaid recipients were more likely to go to the ER at least once in a year, compared with people without health insurance or people with private insurance.

The use of advanced imaging (such as CT scans or MRIs) during ER visits has also increased, going from being used in 5 percent of visits in 2000 to 17 percent of visits in 2010.

More highlights from the report:

- About one in five people visited an emergency room in the last year, while 7 percent of people visited an emergency room two or more times in the last year.

- Falls were the No. 1 injury-related cause of an ER visit from 2008 to 2010.

- Life expectancy has increased slightly for men and women between 2000 and 2010, going up from 74.1 years for men in 2000 to 76.2 years in 2010, and 79.3 years for women in 2000 to 81 years in 2010.

- Deaths from heart disease decreased by 30 percent from 2000 to 2010.

- Deaths from cancer decreased by 13 percent from 2000 to 2010.

Nineteen percent of Americans smoked cigarettes in 2011.

- The number of U.S. adults ages 20 and older with a body mass index between 30 and 34.9 was 20 percent from 2007 to 2010, up from 14 percent during 1988 to 1994.

- Fewer U.S. adults had uncontrolled high blood pressure in 2007-2010: 49 percent, versus 74 percent in 1988-1994.

- Fewer U.S. adults had high cholesterol in 2007-2010: 14 percent, versus 20 percent in 1988-1994.

- A little less than half of U.S. adults didn't meet federal exercise guidelines (at least 150 minutes of moderate to intense exercise each week).

- Slightly fewer young Americans are uninsured now: 34 percent of people ages 19 to 25 in 2010, down to 28 percent in 2011.

SUMMARY:  FEWER HEART DISEASE RELATED DEATHS: ELEVATED CHOLESTEROL LEVEL DECREASED: CANCER DEATHS DECREASED BY 13%

LIFE EXPECTANCY INCREASED FOR BOTH MEN AND WOMEN

MAJOR PROBLEMS:   OBESITY, SMOKING

Healthcare approaching a nexus of Star Trek: The Tricorder, Incentivizing mHealth Innovation

 

 

Qualcomm (San Diego, Ca) a company well known for development of cellular phone technology is sponsoring an  XPRISE competition for an award worth $10 million global in a competition developed to incentivize healthcare technology

innovation.  The goal is to develop a hand-held device that would allow a consumer to access the state of their own health anytime, anywhere.

The goal is to develop a hand-held device that would allow a consumer to access the state of their own health anytime, anywhere.  The device will be able to capture key health metrics and diagnose a set of 15 diseases.  These metrics could include blood pressure, respiratory rate and temperature.  The device would ultimately collect large volumes of data from ongoing monitoring.

So far, more than 250 teams from around the world have already filed Intent to Compete forms. Look at this map (from the website) to see where the teams come from:

 

HealthWorks Collective’s Joan Justice interviews Mark Winter, Senior Director, Qualcomm Tricorder XPrize, to get an update.

 

BOOTILICOUS----The formula for Beyonce’s Butt

 

Alternative title:   The Algo Conspiracy, or how a graph deceives us . What Beyonce can tell us about health statistics, or what are we measuring?

Huxters play on this….”The Million Man Match” “Hummers are more Green than Prius’  These are distortions to prove a pre-conceived goal.

Charles Seiffe explains:

Healthcare decisions, like those in other fields are based upon statistics, which measure disease, treatment, alternative treatments, outcomes, reimbursements, market share,,morbidity, mortality. Well to sum it up, watch the video. It tells it much more eloquently than I am able to.

 

del.icio.us Tags: algorithm,statistics,graphs

What I’ve learned from saving physicians from suicide

 

At one time or another we all face this demon, and develop the defensive adaptation to deal with it successfully.  However there are very many highly intelligent and responsible physicians who fall into the black hole of desperation. How do we help them?

I ask the group, “How many physicians have lost a colleague to suicide?” All hands are raised. “How many have considered suicide?” Except for one woman, all hands remain up—including mine.

 

From KevinMD by Pamela Wible MD

A psychiatrist in Seattle had picked out the bridge. At 3am he would swerve across his lane and plunge into the water. Everyone would assume he fell asleep.

A surgeon in Oregon was lying on the floor of her office with a scalpel. Nobody would find her until it was too late.

An internal medicine resident in Atlanta heard an anesthesiologist joking about the lethal dose of sodium thiopental. Alone in the call room, she would overdose that night.

Three planned suicides. All three physicians survived. Why?

Physicians have the highest suicide rate of any profession,” I explain. “In the United States we lose over 400 physicians per year to suicide. That’s the equivalent of an entire medical school. Even that’s an underestimate because many physician suicides are incorrectly identified as accidents.”

While preparing to overdose, the internist was interrupted by an endocrinologist calling to check on her. Before grabbing her scalpel, the surgeon called several physicians pleading for help—I responded immediately. Two days before he was to drive off the bridge, the psychiatrist spotted my ad for a physician retreat. He called me begging to attend.

It’s easier to say accident than suicide. Doctors can say gonorrhea and carcinoma. Why not suicide? Maybe we can’t face our own wounds.

Too many patients and not enough time sets us up for failure. Rather than kill myself, I invited my patients to help me design an ‘ideal clinic.’ It is possible to love medicine again.”

Here, physicians, nurses, and medical students share their wounds and their wisdom—in community. We share new practice models, communication techniques, and strategies to care for ourselves—so we can care for our patients.

Tonight we begin a retreat for doctors who yearn to love medicine again. Studies confirm most doctors are overworked, exhausted, or depressed. The tragedy: few seek help.

In four days, I witness more healing than in four years of med school. Once strangers, we’ve become family. Parting ways, the psychiatrist from Seattle thanks me again……..excerpts from the story

 

del.icio.us Tags: suicide,physician suicide,overdose,accidental overdose,scalpel,physician retreat,psychiatrist,anesthesiologist

Would Toys decrease the Cost of Health Care Devices?

 

What may be a new and disruptive technology in healthcare is being studied and developed at the MIT Little Devices Laboratory,, part of the International Innovations and Health Group.

Currently medical devices are very expensive for a variety of reasons, research and development, patent licenses, marketing cost, government regulations and more.  Our current development cycle does little to reduce the cost of such devices.

 

MIT sells a Medikit (MEDIKits (Medical Education Design Invention Kits) are Do-It-Yourself medical device kits designed to foster innovation and creativity with all the pieces to assemble a medical  device

The devices are assembled from a variety of Lego parts, the internal workings of other toys with electronic parts, LEDs,

By demystifying medical technology and providing appropriate tools and materials, MEDIKit enables healthcare professionals to develop their own solutions.

As an innovation in international health it affords affordable medical devices for patients who would otherwise have nothing.

Medical Devices are not Toying Around 

The term DIY Medical Device might conjure images of a FDA nightmare in the minds of most. But in a time when healthcare costs are increasing globally, Jose Gomez-Marquez, director of the Director of the IIH (Innovations in International Health) Lab at MIT, has embraced the idea by heading up MIT’s Little Devices group, dedicated to design, invention, and policy toward DIY health technologies.

 

Created with the healthcare needs of the developing world in mind, the MEDIKit (Medical Education Design and Invention Kit) allows medical professionals to design their own medical devices using easy-to-assemble modular components. The MEDIKit allows users to customize and quickly assemble medical devices that address the challenges of work environments in many developing nations.

Right now the MEDIKits span six areas: drug delivery, diagnostics, microfluidics, prosthetics, vital signs, and surgical devices. Each kit contains a platform with a combination of medical device parts that can be adapted and assembled into various functions like LEGOs. In fact, many of the Little Devices group’s many still developing projects revolve around reconfiguring and finding new uses for cheap, readily available products (like toys).

Watch the Video about fluidics, diagnostics and more using inexpensive materials such as paper to test for Anemia, Dengue, Protein Content, and routine laboratory testing.

 

del.icio.us Tags: medikits,leggo,diy,medical devices,medical technology,toys,mit little device lab