HEALTH TRAIN EXPRESS
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Health insurance companies are signaling huge health insurance premium increases ahead of the 2016 open enrollment period. This is due to the droves of older and sicker consumers who signed up for coverage on the ObamaCare Exchanges, according to a report from The New York Times.
Typically, state insurance regulators negotiate with insurers to bring down the requested rate increases. But with ObamaCare's requirement that 80 percent of premiums paid go to the healthcare of the insured, insurers, particularly those that have seen losses due to the higher utilization of care, may not have much of a choice other than to raise premiums to keep their reserves stable. It may not be ideal for consumers, who may have to change plans and risk losing their doctor because of premium increases, but this is the new normal under ObamaCare.
Novartis' new heart failure medicine LCZ696, now called Entresto(TM), approved by FDA to reduce risk of cardiovascular death and heart failure hospitalization
A new drug for congestive heart failure was fast-tracked by the Food and Drug Administration because it works so well. The results of Phase III Clinical trials prompted officials to give approval for marketing Entresto.
Cardiophysiology of Congestive Heart Failure
What Is Heart Failure?
Heart failure does not mean the heart has stopped working. Rather, it means that the heart's pumping power is weaker than normal. With heart failure, blood moves through the heart and body at a slower rate, and pressure in the heart increases. As a result, the heart cannot pump enough oxygen and nutrients to meet the body's needs. The chambers of the heart may respond by stretching to hold more blood to pump through the body or by becoming stiff and thickened. This helps to keep the blood moving, but the heart muscle walls may eventually weaken and become unable to pump as efficiently. As a result, the kidneys may respond by causing the body to retain fluid (water) and salt. If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested, and congestive heart failure is the term used to describe the condition.
What Causes Heart Failure?
Heart failure is caused by many conditions that damage the heart muscle, including:
Coronary artery disease.Coronary artery disease (CAD), a disease of the arteries that supply blood and oxygen to the heart, causes decreased blood flow to the heart muscle. If the arteries become blocked or severely narrowed, the heart becomes starved for oxygen and nutrients.
Heart attack. A heart attack occurs when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle. A heart attack damages the heart muscle, resulting in a scarred area that does not function properly.
Cardiomyopathy.Damage to the heart muscle from causes other than artery or blood flow problems, such as from infections or alcohol or drug abuse.
You may not have any symptoms of heart failure, or the symptoms may be mild to severe. Symptoms can be constant or can come and go. The symptoms can include:
Congested lungs. Fluid backup in the lungs can cause shortness of breath with exercise or difficulty breathing at rest or when lying flat in bed. Lung congestion can also cause a dry, hacking coughor wheezing.
Fluid and water retention. Less blood to your kidneys causes fluid and water retention, resulting in swollen ankles, legs,abdomen (called edema), andweight gain. Symptoms may cause an increased need to urinate during the night. Bloatingin your stomach may cause a loss of appetite or nausea.
Dizziness, fatigue, andweakness. Less blood to your major organs and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion.
Rapid or irregular heartbeats.The heart beats faster to pump enough blood to the body. This can cause a rapid or irregular heartbeat.
What Are the Types of Heart Failure?
Systolic dysfunction (or systolic heart failure) occurs when the heart muscle doesn't contract with enough force, so there is less oxygen-rich blood that is pumped throughout the body.
Diastolic dysfunction (or diastolic heart failure) occurs when the heart contracts normally, but the ventricles do not relax properly or are stiff, and less blood enters the heart during normal filling.
A calculation done during an echocardiogram, called the ejection fraction (EF), is used to measure how well your heart pumps with each beat to help determine if systolic or diastolic dysfunction is present. Your doctor can discuss which condition you have.
How Is Heart Failure Diagnosed?
Your doctor will listen to your heart and look for signs of heart failure as well as other illnesses that may have caused your heart muscle to weaken or stiffen.
Your doctor may also order other tests to determine the cause and severity of your heart failure. These include:
Blood tests. Blood tests are used to evaluate kidney and thyroidfunction as well as to checkcholesterol levels and the presence of anemia. Anemia is a blood condition that occurs when there is not enoughhemoglobin (the substance in red blood cells that enables the blood to transport oxygen through the body) in a person's blood.
B-type Natriuretic Peptide (BNP) blood test. BNP is a substance secreted from the heart in response to changes inblood pressure that occur when heart failure develops or worsens. BNP blood levels increase when heart failure symptoms worsen, and decrease when the heart failure condition is stable. The BNP level in a person with heart failure -- even someone whose condition is stable -- is higher than in a person with normal heart function. BNP levels do not necessarily correlate with the severity of heart failure.
Chest X-ray.A chest X-ray shows the size of your heart and whether there is fluid build-up around the heart and lungs.
Echocardiogram.This test is an ultrasound which shows the heart's movement, structure, and function.
The Ejection Fraction (EF) is used to measure how well your heart pumps with each beat to determine if systolic dysfunction or heart failure with preserved left ventricular function is present. Your doctor can discuss which condition is present in your heart.
Cardiac catheterization. This invasive procedure helps determine whether coronary artery disease is a cause of congestive heart failure.
Stress Test. Noninvasive stress tests provide information about the likelihood of coronary artery disease.
Is There a Treatment for Heart Failure?
There are more treatment options available for heart failure than ever before. Tight control over your medications and lifestyle, coupled with careful monitoring, are the first steps. As the condition progresses, doctors specializing in the treatment of heart failure can offer more advanced treatment options.
The goals of treating heart failureare primarily to decrease the likelihood of disease progression (thereby decreasing the risk of death and the need for hospitalization), to lessen symptoms, and to improve quality of life.
Together, you and your doctor can determine the best course of treatment for you.
Treatment can begin with simple health and wellness advice.
Stage
Definition of Stage
Usual Treatments
Stage A
People at high risk of developing heart failure (pre-heart failure), including people with:
An angiotensin converting enzyme inhibitor (ACE inhibitor) or an angiotensin II receptor blocker (ARB) is prescribed if you have coronary artery disease, diabetes, high blood pressure, or other vascular or cardiac conditions.
Beta blockers may be prescribed if you have high blood pressure or if you've had a previous heart attack.
Stage B
People diagnosed with systolic left ventricular dysfunction but who have never had symptoms of heart failure (pre-heart failure), including people with:
Prior heart attack
Valve disease
Cardiomyopathy
The diagnosis is usually made when an ejection fraction of less than 40% is found during an echocardiogram test.
Treatment methods above for Stage A apply
All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitors) or angiotensin II receptor blocker (ARB)
All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitors) and beta-blockers
African-American patients may be prescribed a hydralazine/nitrate combination if symptoms persist
Diuretics (water pills) and digoxin may be prescribed if symptoms persist
An aldosterone inhibitor may be prescribed when symptoms remain severe with other therapies
Restrict dietary sodium (salt)
Monitor weight
Restrict fluids (as appropriate)
Drugs that worsen the condition should be discontinued
As appropriate, cardiac resynchronization therapy (bi ventricular pacemaker) may be recommended
An implantable cardiac defibrillator (ICD) may be recommended
Stage D
Patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care.
Treatment methods for Stages A, B & C apply
Patient should be evaluated to determine if the following treatments are available options:heart transplant, ventricular assist devices, surgery options, research therapies, continuous infusion of intravenous inotropic drugs and end-of-life (palliative or hospice) care
Signs and symptoms of heart failure due to structural problems such as aortic stenosis, insufficiency, mitral valve disease may be treated surgically early on. Cardiac arrhythmia's should be corrected.
Treatment is progressive and adjusted accordingly. Heart failure is chronic and may be progressive. It can present abruptly from an acute coronary obstruction, or insidiously with aging.
ENTRESTO is not a first line drug and is intended for refractory CHF. It is very expensive.
Could remote monitoring help Novartis persuade payers to reimburse for new heart drug?
“If you had a remote patient-monitoring device that the patient could use in their home together with Entresto, we could make an even more serious dent in hospitalization.”Beyond the Pill is a growing trend among pharma companies looking for ways to add more value to their medication with digital services aimed at improving medication compliance but also helping their physicians monitor their health between appointments. He added:
“We’re going to have to get smarter about services around the pill…and move into some areas that are different from just discovery of the drug…
The addition of wearables, remote monitoring and new mHealth devices could make a major impact in reducing hospitalizations, by detecting symptoms early and identifying activities that cause CHF.
This report courtesy of WebMD. It is not intended as any recomendation for treatment. Always consult with your physician for treatment.
About 25% of the surgical procedures in the U.S. will be affected, and the agency hopes to save up to $150 million under the program, Bloomberg reported. If approved, the program would begin Jan.
"Hospitals and physicians would have an incentive to work together to deliver more effective and efficient care," Sylvia Matthews Burwell, the Secretary of Health and Human Services, said on a conference call with reporters.
Medicare shelled out about $586 billion in 2013 to cover more than 50 million elderly and disabled people in the country, the news service said. Reducing those costs has been a major goal under the Obama administration, which introduced the Affordable Care Act.
The test program will be mandatory for more than 800 U.S. hospitals covering 75 regions and should provide CMS with improved data on the effectiveness of the initiative. Stryker ($SYK), Zimmer Biomet ($ZMH) and Johnson & Johnson ($JNJ) are among the top medical device producers of artificial knees and hips.
GURPREET DHALIWAL: Technology has much to offer doctors, but it is not the health-care technology agenda you hear about in the news. Big data, the electronic medical record, and the connected patient are frequently hyped as remedies to medicine’s ills. But improving and restoring health is a messy business that requires investment in human capital more than physical capital.
Here’s a modest technology agenda from the perspective of the front-line clinician who hopes to master their craft and continually improve the care they provide to their patients.
Big data. Correlations that massive data sets churn out seldom change practice. Those associations are no different than any preliminary research finding: not ready for prime time until they are confirmed, scrutinized and distilled for daily practice. Clinicians need constant exposure to the findings of high-quality studies and synopses that already meet those criteria. Twitter, for example, is a great way to do that. Spare me your big data, send me your good data.
Electronic medical record. The medical record has devolved into a forensic document and billing tool with a subordinate role as a communication tool, but it never has become a learning tool. Doctors only improve with feedback, but workloads make it impossible to quickly answer questions like, “Is that patient I saw last week OK?” or “What did that test result show?” Some electronic medical records allow doctors to create a list of patients to track or set up scheduled reminder emails. But it should be easier and better, such as, “Siri, send me a secure email when Ms. Jain sees her rheumatologist. I want the note and labs from that day.”
The connected patient. I want updates from my patients, but the outdated emphasis on face-to-face visits often makes this impossible. Text, email and videoconferencing should be commonplace for follow-up, even though regulations and reimbursements pose formidable barriers. Many doctors already communicate electronically because it is the right thing to do—and because we believe it is more important to be connected to your health-care provider than it is to be connected to your Fitbit.
Dr. Gurpreet Dhaliwal is a professor of medicine at the University of California, San Francisco and a staff physician at the San Francisco VA Medical Center.
Flip a coin or guess is as good as the online web diagnosis sites.. This study from the British Medical Journal.
Researchers entered symptoms for 45 patients into the checkers, sourced from standardized vignettes used in medical student training (WBUR/Kaiser Health News, 7/9). The patients' conditions included:
Acute liver failure;
Bee stings;
Meningitis; and
Mononucleosis ("Shots," NPR, 7/9).
Study Findings
Overall, the study found about:
One-third of the sites named the correct diagnosis as the patient's first option;
51% of the sites named the correct diagnosis in their top three options; and
58% of the sites named the correct diagnosis in their top 20 options (Semigran,BMJ, 7/9).
Overall, researchers said the checkers were about as accurate as diagnoses made through primary care physician phone services, which usually offer insight on whether patients should seek urgent care. Further, lead author Hannah Semigran, a research assistant at Harvard Medical School, said the online symptom checkers were "pretty good at effectively directing people with an (emergency) situation to seek some kind of appropriate care, and to do so quickly" (Mozes, HealthDay, 7/9).
Comments
Ateev Mehrotra, one of the study authors, said the findings show patients should use symptom checker sites with caution (WBUR/Kaiser Health News, 7/9). He said, "People who use these tools should be aware of their inaccuracy and not see them as gospel. They shouldn't think that whatever the symptom checker says is what they have" ("Shots," NPR, 7/9).
Mehrotra added, "These sites are not a replacement for going to the doctor and getting a full evaluation and diagnosis.
Conventional print magazines, newspapers have weathered a sea-change in their business model.
And so has medicine and health process.
Health care financing, and administration also are struggling to change even as our current medical system is overwhelmed with increased expenses. The similarity between magazine process and health process are remarkably alike.
Prominent news publishers, such as the Washington Post, New York Times and many others went out of business at the same time re-inventing their 'product' in a more efficient manner. In some cases ownership shifted quietly behind the scenes. There were major reductions in staff, overhead and outright elimination of tasks that served no purpose or had been replaced by digitalizing the industry.
Even as this is occurring health organizations are burdened with daily organizations while being mandated by government, CMS, the Affordable Care Act, Insurers, and expansion of new covered benefits such as remote monitoring, telehealth and mobile health care. The uptick in expenditures for health IT is overwhelming many, both large and small. There is no room for error. During the past five years some large institutions spent millions of dollars to purchase EHRs only to find they could not perform as advertised. Providers, and hospitals did not know or have experience in systems that were new and untested in a real world setting.
Health care operated mostly on a cash basis until the birth of managed care, capitation, and other obtuse forms of risk management. In health affairs risk management used to have to do with risk of disease and/or treatments. Insurance companies were required to have an actuarial basis for setting premium rates against history of their insured disease risks.
Today this risk is carried not just by the insurance company, it has been shifted to hospitals and providers. Other calculations are being considered such as quality of outcomes, measured by re-admission rates to the hospital. The latest in the quirky world of health high finance is the 'accountable care organization. (ACO).
The name was coined by Elliott Fisher as a philosophical term during it's germination period. Theoretically the organization that saves the most gets a 'kickback' a larger reward incentive than the rest of the providers/hospitals.
The health care company of 2005 is gone. its processes, procedures and priorities would be nearly unrecognizable today. In fact, the medical practice that existed in 2010 is gone too. In a period of accelerated transformation, nothing is more striking than the scope—and pace—of change in the processes through which these companies engage their customers (patients) The very terms physician and patient devolved into provider and consumer. Physicians are no longer generalists or specialists they are primary care providers. It’s not just peripheral or incremental change, either. What the industry is going through in 2015 is a revolution in processes. In advertising, content creation, marketing, back-office functions and everything in between, what was done just a few years ago has been rendered obsolete, as new ways to interact with and serve stakeholders push the old ways into the trash bin. What’s changed is that technology is transforming every single phase of the business. It’s ubiquitous. It’s impacting the business on a wholesale level.” It’s a new world of “VUCA,” says Lenny Izzo, group president of legal media at ALM. “That’s an acronym for Volatility, Uncertainty, Complexity and Ambiguity. It’s an old military term Providers and hospitals have become 'punch-drunk' much like boxers and football players suffer from TBD or traumatic brain disorder.
Uncertainty comes in the form of new competitors. It comes with the decline in traditional branding-based display advertising, and the rise of new formats like cost-per-lead sales and programmatic advertising. Complexity comes in the form of tying together new expensive technologies that cross email, web, billing, production, ad-management, and content creation. Ambiguity comes in the form of not having the expertise to evaluate expensive new systems, and sometimes not knowing the right KPIs. Volatility? How about not knowing whether a new software system that cost $1 million will be relevant in 18 months?
This report is an on-the-ground look at process change in magazine media companies and how it’s affecting, well, nearly everything, from organizational structure and staffing needs, to assumptions about efficiency and newly essential skillsets. We’ll look at overall philosophies and approaches, and then explore, mainly through case studies, what publishing companies and executives are actually doing.
Radical changes in process are driven by several things, of course. But mostly, it’s a function of two things: emerging technologies that enable new methods of serving markets, and a quest within companies for efficiency driven by economic necessity.
The revolution in health is not just in health IT, it includes changes in medical group administration, payment reform, relationships between providers, hospitals and providers, referral patterns and a new dynamic between regulators, licensing boards and providers of health care.
Interestingly, for health provider and magazine publishers, there’s a significant paradox in process change. Because the business model is in a seemingly permanent state of flux, and because technologies become obsolete so quickly, both types of companies find themselves betting huge amounts of money on unproven ideas. “Maybe the paradox of process is that you’re forced to be hyper-efficient in the things you understand, to finance what you hope is our future,”
Note: Much of this article has been taken word for word from anaticle found on FOLIO an internet magazine about the publishing business. It was a simple task to substitute health for magazine or publishers.. A true example of 'convergence'
"Half of heart disease , for example, is preventable and related to five risk factors-f high cholesterol, hypertension, diabetes, obesity and smoking. Although the death toll has steadily declined over the past 30 years due to prevention and treatment measures, heart disease is still the leading cause of death in the U.S., causing one in every four deaths, or 610,000 deaths each year, according to the Centers for Disease Control and Prevention. Yet, about 80% of people reported exposure to at least one of the five risk factors. Getting them to change is a big challenge.
Research like this is giving us a better understanding of patient psychographics and what makes them tick, particulary when it comes to changing their behavior. Giving people data alone does not change behavior. For information to be effective , they need the tools to change and the motivation to do so. Until then, throwing data at doctors and patients might be an interesting way to try to make a few bucks, but it's unlikely to improve outcomes."
Sick care and disease prevention has become one big data management exercise. Patients are data sets and doctors are data managers. In addition, in the gap between the data and the doctor, are many others including data scientists, navigators, care coordinators, and, of course, the payers.intervention has to change but, in order for any of this to do any good, there needs to be an intervention based on identified risk factors and that behavior.
Reading information taken from data does not extrapolate to changes in behavior. It is that last mile that resists change.
If you took the time to take the test, you will get some understanding of why it's so hard to change human behavior and habits and why people don't. Simply put,we're all built differently, were brought up differently and have different approaches to changing our habits Gretchen Rubin is the author of several books, including the blockbusterNew York Timesbestsellers, Better Than Before, The Happiness Project and Happier at Home.
