A curable condition that causes blindness - Andrew Bastawrous

Health Insurance Private Exchanges: Are They Making the Cut? - TalentCulture

Health Insurance Private Exchanges: Are They Making the Cut? - TalentCulture

It wasn’t long ago that the Affordable Care Act (Obamacare) swept over the American healthcare landscape, bringing with it a real focus on private exchanges. Consultants, brokers—and anyone with products to sell—were all focusing on these exchanges, which had a dramatic impact on both individuals, and businesses of all sizes, concerning the health care benefits afforded employees.

Fast forward to today.

Have Private Health Exchanges Lived Up To The Hype? 

With the cost of healthcare on the rise, many companies in the United States have been trying to figure out how to cut those hefty employee insurance premiums. Businesses have responded in different ways, with some organizations eliminating coverage altogether.

Of course, that’s only an option for the smallest of businesses due to the Affordable Care Act (ACA) employer mandate and penalty, which go into effect this year.

Another response has been for companies to increase the deductible their employees must pay before employer-sponsored coverage kicks in. Still other organizations have turned to private health insurance exchanges, which emerged in the wake of the ACA as an insurance marketplace for employers.

Private health exchanges allow companies to control contributions while giving employees the ability to choose from different plans and find a policy that best fits their needs. The use of Private health exchanges is an approach to employee benefits which has been thriving over the past few years.

In 2014, the private health exchange market included 2.5 million users. Last year, that number doubled. Industry analysts, such as consulting firms Accenture and Oliver Wyman, expect the market to grow to as many as 40 million users by 2018.

Private health exchanges offer a chance for employers to manage their costs and risks while giving employees control over their health coverage. But exchanges aren’t a revolutionary cure-all, either. To be the solution they could be, there’s still a lot of work to be done.

According to a survey by the Deloitte Center for Health Solutions, most employers who’ve made the switch from traditional benefit models to private health exchanges are happy with the result; just eight percent of those surveyed said they were dissatisfied with their experience. The majority of them saw their costs drop and say they now play a less active role in providing benefits that are comparable, if not of higher quality, to what employees had before.

On the whole, however, private health exchanges are a good option with a lot of advantages. The ones who succeed will have some, if not all, of the following attributes:

• A forward-looking approach to the ACA. The ACA changes that will take effect this year are only the tip of the iceberg. Many employers are concerned about 2018 when a 40 percent tax—commonly referred to as the “Cadillac tax”—will be applied to what employers and employees jointly pay for coverage above a certain amount. Staying on top of these changes and offering compliance-driven products will set platforms above their competitors.

• A strong focus on technology. Multiple technological failures set the ACA program back when it launched in 2013. Our expectations as users are high; if a platform doesn’t work well, it won’t last. Exchanges with platforms that aren’t consistent, easy-to-use, and high-functioning will be passed over for more user-friendly options.

• Demonstrated compensation transparency. For the private exchange system to thrive, all stakeholders need to receive some value, and transparency of data and benefit will play a fundamental role in current and future success. Employers who want to stay on top of costs will gravitate toward providers who offer clear fee schedules and compensation information.

• Demonstrated administrator experience. Inexperience has been a stumbling block for private exchanges so far. Both benefits and exchange administrators may not have the industry experience or training needed to manage day-to-day operations of the exchange setup effectively. Better training and communication will drive successful relationships between employers and exchange providers in the years to come.

Right now, the private health exchange market is growing and becoming increasingly successful—but not as quickly as experts predicted five years ago. Of course, this doesn’t mean private health exchanges aren’t a solid option; it only means the industry needs more time to evaluate how the new model measures up.

The Federal government stepped in several years ago with a government website. Many states decided to build their own.  Health.gov is a prime example how not to roll out a not for prime time sofrware platfrom.  The Health.gov web site singlehandely almost destroyed the Affordable Care Act.

Private exchanges can ill afford repeating that scenario, and at this time have avoided that minefield.

Brown Nearing MCO Tax Deal With Health Plans - capradio.org

The unforseen effects of the Affordable 

Care Act

California lawmakers could vote this week on a proposal to restructure a tax on health care plans in order to avert a potential $1 billion state budget hole.

This “managed care organization” (MCO) tax brings in federal funds for Medi-Cal, California’s health care program for the poor. The federal government say the state’s current structure is no longer acceptable – and must be fixed by the end of June for the state to keep getting the money.

So Gov. Jerry Brown and health plans have been negotiating for months – and now talks are in the final stages.

Any deal would require Republican votes to pass the Legislature. There are signs that the votes could be there for the right deal as long as it's “revenue neutral“ – that is, the federal funds offset any tax liability to the health plans so the insurance companies don’t pass costs on to the rest of us.

A deal would also likely include funding increases for in-home care for the elderly and disabled (known as in-home supportive services or IHSS), and programs that benefit people with developmental disabilities.

Brown Nearing MCO Tax Deal With Health Plans - capradio.org

The Silence Around Stillbirth is Unspeakable

7,200 lives are lost every day to stillbirths. Imagine if we could reduce that number and stop this epidemic 
Almost 2·6 million babies are stillborn worldwide every year. That’s roughly the population of Rome, wiped out. Yet we still don’t talk openly about stillbirth. Vulnerable girls and women are often left to suffer in silence. It only perpetuates the stigma when they have little to no information on the topic. More must be done to cut through the sociocultural, religious, and health barriers that inhibit open dialogue.

A healthy pregnancy should be a universal right. Millions of women worldwide are still denied access to basic education about pregnancy and stillbirth. Education must include information about sexual health, birth control and treatable diseases, as well as the risks associated with smoking, obesity, and pregnancy in later life.

Skilled health professionals matter. Their care is vital for all expectant mothers. Yet they are in short supply. We must value health workers, including skilled birth attendants, in order to succeed–boost their numbers, increase access to quality training, give them a visible community presence, and remove the barriers to access.  

 1·3 million of the 2·6 million stillborn babies started labour alive

The Lancet | The Best Science for Better Lives

Where the Leading Presidential Candidates Stand on Healthcare

Much of the presidential candidates’ discussions of healthcare center on Obamacare, but there are other key issues affecting the health of the country.

Ballotpedia is a one stop source for the 2016 candidate's position on health care and the affordable care act.

                                                  The Candidates:  Democratic

Not only are most people confused  about what the Affordable Care has done to the health system, another challenge is to understand and differentiate what the 2016 Presidential candidate's platform say about further health reform.  Bear in mind, positions will change, and  be subject to congressional actions.

                                                  The Candidates:Republican

This Health  Train Express post hopes to offer some framework for their stances. The myriad proposals and the short term effects of the Affordable Care Act add to the confusion.

Voters have many interests, besides health reform, terrorism, immigration, economy, police abuse, gun control all of which are considerable.



Where the Leading Presidential Candidates Stand on Healthcare

'Landmark' Study Identifies Genetic Link to Schizophrenia Nancy A. Melville

In what some are calling the strongest evidence to date of a genetic link to the development of schizophrenia, researchers have identified a gene that shows a significant association with the mental disorder that may explain its characteristic brain volume reductions and onset during adolescence.

For many years research scientists suspected a genetic component to schizophrenia. "This represents a landmark study which certifies more definitively than in previous studies the specific genetic contribution that causes schizophrenia," 

Jeffrey A. Lieberman, MD, the Lawrence C. Kolb Professor and chairman of the Department of Psychiatry at Columbia University College of Physicians and Surgeons, in New York City, agreed that the study's implications are important and may help guide treatment as well as diagnosis in schizophrenia.

Excessive Synaptic Pruning

Imaging studies of patients with schizophrenia exhibit a shrinkage in gray matter. The gene appears to control a complement component C4 which controls synaptic pruning..the decrease in the number of synapses seen in the aging process.  As we age, old connections are deleted through a process called synaptic pruning.

"If we have a suspicion of schizophrenia, we could examine through imaging or another means the trajectory of their brain's change or growth, so it offers an opportunity to help with diagnostic assessment," he said.

"It could also help guide how we treat the disease. For instance, instead of looking downstream, trying to block dopamine, we can look to factors that preserve or slow synaptic elimination.

In the future it may be possible to forecast who is at risk of developing schizophrenia. 

This news was published in Nature Magazine

RunawayRx_Costs While_You_Were_Out_

There appears to be significant profiteering by some unscrupulous investors. One particularly egregious event was an enormous increase in the cost of some drugs (5,000%) by Turing Pharmaceuticals. Turing Pharmaceuticals acquired the rights to Daraprim in August. 

The drug treats toxoplasmosis, a parasitic affliction that affects people with compromised immune systems.

After Turing's acquisition, a dose of Daraprim in the US increased from $13.50 (£8.70) to $750.The pill costs about $1 to produce, but Mr Shkreli, a former hedge fund manager, said that does not include other costs like marketing and distribution, which have increased dramatically in recent years. Mr Shrell, it should be noted has been indicted for security fraud in an unrelated situation.

Martin Shkreli Arrested on Securities Fraud Charges   

This indictment had nothing to do with the pharmaceutical furor. and 

revolved around a different alleged incident ( Ponzi Scheme.)

While the specifics of this case are unique and skewed significantly, 

other Pharma companies are increasing prices to offset hard bargaining

by health plans and CMS in the wake of the Affordable Care Act.

Health financing, like other industries has it's "bad boys" and it deserves 

careful scrutiny to guard against rampant raping of the federal and state 

treasuries.

Despite over-regulation and micro management of changes fostered by 

the affordable care act, profiteers and adventurers find ways to bilk the 

system.

“Some of these companies seem to act more like hedge funds than traditional pharmaceutical companies”

Meanwhile:The California Legislature has passed AB 463,

Pharmaceutical Cost Transparency Act of 2015 2016

127675.

 The Legislature finds and declares all of the following:

(a) It is the intent of the Legislature to make information available to the public about the cost of ultra-high-priced pharmaceuticals, in order to make pharmaceutical pricing as transparent as the pricing in other sectors of the health care industry.

(b) To fulfill this goal, the Legislature finds that there should be annual cost reporting on the most expensive drugs that would be of use by policymakers, government agencies, and others to understand costs for these important products.

127676.

 (a) Each manufacturer of a prescription drug, made available in California, that has a wholesale acquisition cost (WAC) of ten thousand dollars ($10,000) or more annually or per course of treatment, shall file a report pursuant to this section on the costs for each qualifying drug.  Further details here

Runaway Prescription Costs

Today is Cystic Fibrosis Awarenes day in the U.S.

While there have been great advances in survival there is still no cure. This leads to a longer life of suffering. Please donate generously to the Cystic Fibrosis Foundation.  www.cff.org

@kidsCFawareness May is CF awareness month pls share this pic help spread awareness

Is There a Doctor in the Marriage? - The New York Times

Women who are not married to a doctor often equate being a physician with other professionals. Marriage is one of those things.

Having a spouse as a physician requires a mate who can be largely independent with short periods of intimacy and companionship.  While there are some specialties that insulate  physician marriages from clinical demands, such as pathology, dermatology  and a few others, most doctors become focused on patient care either by an innate sense of duty, moral standards, or the induced habit by repetition of answering all calls during training.

Fortunately for many, actual independent clinical practice is not usually as demanding, although the stress level rises substantially when the final decision rests upon them.  It is also the time when physicians begin to pay their own medical malpractice premiums...a certain indicator of medical liability.

Is There a Doctor in the Marriage?

Six weeks after our wedding, my husband and I were flying back to New

Orleans, where we live. As soon as we reached cruising altitude, his
head tilted forward in sleep.

The previous year had been the hardest stretch of his medical training. As a
third-year resident in internal medicine, he often worked 30-hour
shifts. When he came home, he’d still have notes to dictate. I’d
frequently find him snoozing in an armchair with the light still on. A
few hours later, he’d wake and go back to work.“I’m trying to survive,” he told me when I complained about how work consumed him. “I’m doing the best I can.”When we first met, I fell in love with his playfulness as much as his passion. He belonged to an improv comedy group and kept me up talking in

funny voices and telling me what he loved about medicine.

Our personal life is private, but his professional life is public

Modern Love
By ANYA GRONER DEC. 3, 2015

 

Is There a Doctor in the Marriage? - The New York Times

Health and the Weather

Mental health professionals have labelled some depressions as seasonal affective disorder (SAD), an appropriate acronym  for depression related to seasons. The term is most often linked to depression occuring in winer when days are short, thereby decreasing the amount of time when visible light and other components of the electro-magnetic spectrum are a low levels.

 However visible light is only one part of the electromagnetic spectrum which fall upon us.  Ranging from the  low infrared through the visible spectrum (R,G,B,V) and into the ultraviolet, radio frequency, x-ray and beyond, including cosmic rays (solar flares-coronal mass ejections). Some or all of these may effect our psyche.

        Solar X-rays

.

 

Coronal Mass Ejections 

A sense of wellness is often associated with being at the beach or in elevated topography, which is associated with + ions.

Magnetic forces which may alter our mental, physical health or spiritual well being is proposed for wearing magnetic bracelets, rings or necklaces.

NOAA has developed sensitive measuring equipment to monitor space weather.

Window to the Universe

Space weather can be found either at: http://www.noaa.gov/  or http://www.swpc.noaa.gov/

Turnaround for Riverside County's Financially Beleaguered Medical Center

The ACA and it's effects on the county public health hospitals....are they more than a safety-net?

by Lauren McSherry, California Healthline Regional Correspondent, California Healthline, Monday, January 11, 2016

Riverside County took drastic action in recent years to turn around its financially mired public hospital.

The county loaned the Riverside County Regional Medical Center $200 million, spent nearly $26 million on a contract with Huron Healthcare to turn the hospital toward profitability and this year, embarked on a rebranding effort. The hospital now is called Riverside University Health System Medical Center.
Hospital CEO Zareh Sarrafian, who took the reins a little over a year ago, has advocated for equipment and technology upgrades and a hospital expansion that he said are geared toward improving efficiency, quality of care and the hospital's financial health.
Sarrafian said the hospital has the financial means to support new investments, which include a new $53 million electronic health record system that will enable improved records sharing and data mining. Also in the works are a new catheterization lab and the purchase of new medical equipment.
"We wouldn't be making these investments if we didn't think they were vital to our existence and the future and quality of care," he said.
Another project on the horizon is a new medical office complex on undeveloped land neighboring the hospital. Through a public-private partnership, the hospital plans to build physician offices, an out-patient surgical center and a new mental health center.
Sarrafian, who previously worked for Kaiser Permanente and Loma Linda University Medical Center, said the investments are necessary to prevent the hospital from falling behind in its capital expenditures.
The hospital's overall strategy is to play a role in unifying the Inland Empire's somewhat fragmented marketplace, with the goal of "integrating vital parts of the continuum of care," including mental health, he said. The hospital also has been working to establish a system of providers, he said.
Jennifer Bayer, vice president of external affairs at the Hospital Association of Southern California, said the hospital's turnaround is a welcome change, but it's still early in the process to make a final call.
"They have put a tremendous amount of investment into the facility," she said. "They are certainly on the right track from what we are hearing."

Quality of Care

Hospital administrators said part of their strategy has been renewed focus on quality of care.
They point to a sharp decline in sepsis mortality, catheter infections, surgical site infections and ventilator-associated pneumonia in the Neonatal Intensive Care Unit.
Gary Thompson, the hospital's medical director for quality, said the attention to improved quality of care has resulted in cost savings due to decreased length of hospital stays. For example, the decline in sepsis mortality resulted in savings of more than $3 million and addressing diabetic hypoglycemic rates among patients resulted in more than $1 million saved per year, he said.
This month, the hospital received a "gold-plus" rating from the American Stroke Association and last September was selected as a national top performer on key quality measures by The Joint Commission, a not-for-profit hospital accrediting agency. The hospital also is pursuing becoming a Level 1 trauma center.
The focus on improved outcomes has been influenced by increased competition among medical providers following the rollout of the Affordable Care Act.
"How can you attract patients if you don't have quality care?" Thompson said.
Sarrafian said the hospital's role as a safety-net hospital means it needs to survive, even though it is no longer the only game in town. His aim has been to stabilize the hospital financially, while creating a delivery model that included coordination of care for the entire county.
Bayer said public hospitals across the state are giving attention toward how to attract patients and private insurers because they can no longer rely on a "shoo-in" Medi-Cal population. Medi-Cal is California's Medicaid program. Patients in the vast region encompassed by Riverside County can now opt to go to a medical center closer to home, particularly if they live far from the hospital's Moreno Valley campus.
"With Medi-Cal expansion and the ACA, many people have much more choice," she said. "It has caused many county facilities to rethink the way they deliver care so they can compete."
Due to health care reform, public hospitals are re-evaluating themselves from a competitive standpoint rather than a mandatory standpoint, Bayer said. And like RUHS Medical Center, they are considering new investments in technology, structural improvements and expansions, realigning general efficiencies and patient satisfaction, she said.
Some of the medical center's improvements, such as those related to patient infection rates, are related to new Medicare standards that can reduce hospitals' payments if they do not meet certain performance thresholds.
"You could lose 8% to 9% of your revenue based upon performance," said Craig Garner, a health care lawyer and former hospital CEO. "It's quite a challenge. They are trying to look at additional revenue streams to keep them afloat, and the question becomes, is that going to be enough?"

Building a New Image

With its rebranding, the hospital seems to be trying to tap into the prestige of other academically affiliated medical centers, such as Loma Linda, UCLA and UC-Irvine, Garner said.
The hospital's rebranding and expansion plans also appear to be part of a strategy to attract private insurers and a wider patient base.
"People want to go to the best facilities," Garner said. "It's hard to compete with other academic institutions or conglomerates."

Staying Afloat

Garner said the road ahead for public hospitals like RUHS Medical Center is not an easy one.
"They have to become very efficient. They have very little room for error," he said. "If people are being encouraged to utilize less, and providers are being paid less and they already had slim profit margins, something has to give. That's the burden of health care reform, to find a way to bridge that gap."
The hospital appears to be on better financial footing. It reported a $54 million profit in fiscal year 2015, compared with a $62 million loss in 2014. And the $200 loan from the county in the form of a line of credit is no longer on the books as the hospital has a positive cash flow, according to a statement from the hospital's spokesperson. Meanwhile, the hospital has 10 years to pay back its debt obligation to Huron Healthcare.
Sarrafian conceded that the ACA has required public hospitals to adapt in order to survive new competitive forces. He foresees more consolidation and said size is going to matter and some hospitals will need to become part of a larger network to survive.
"It's been very difficult for many organizations to anticipate the ramifications," he said. "Public hospitals have probably been the most adversely impacted."

Source: California Healthline, Monday, January 11, 2016

Andy Slavitt puts meaningful use on ice; Read his J.P. Morgan speech transcript | Healthcare IT News

Andy Slavitt puts meaningful use on ice; Read his J.P. Morgan speech transcript | Healthcare IT News



Another foolish CMS mandate results in a 15-20 billion dollar debacle.....Much time and effort and capital wasted for a meaningless mandate



MEANINGFUL USE IS DEAD !!

Individuals’ Right under HIPAA to Access their Health Information | HHS.gov

Individuals’ Right under HIPAA to Access their Health Information | HHS.gov