Mobile Strategies 360 : Healthcare - Doctors put health apps under a microscope

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Mobile Strategies 360 : Healthcare - Doctors put health apps under a microscope

Mobile Strategies 360 : Healthcare - Doctors put health apps under a microscope

Mobile Strategies 360 : Healthcare - Doctors put health apps under a microscope

Donald Trump Releases Details Of Health Care Plan : NPR

What does  "The Donald" recommend for health reform ? It is all rather vague.....like the Affordable Care Act.  You won't know what is in it until it is passed.


Donald Trump released details of his health plan. No surprise - he wants to repeal Obamacare. NPR's Alison Kodjak reports that the other proposals on Trump's website include many Republican favorites and some that both liberals and conservatives find troubling.

ALISON KODJAK, BYLINE: When Trump was asked about his health care proposal in the debate last week broadcast on CNN, this is mostly what he talked about.

(SOUNDBITE OF ARCHIVED RECORDING)

DONALD TRUMP: We have to get rid of the lines around the states so that there's serious, serious competition.

UNIDENTIFIED MODERATOR: But Mr...

KODJAK: What he meant was that he wants to allow insurance companies to sell policies across state lines. It's a popular idea among Republicans, but beyond that, Trump was criticized because he had little more to offer. Now that's changed. The Trump campaign has posted a seven-point health plan on his website. It includes getting rid of those lines around the states, and it adds a handful of other provisions that are mainstays in conservative health care circles. Joe Antos is a scholar at the right-leaning American Enterprise Institute.

JOE ANTOS: He mentions things that, depending on how you interpret them, could really fit well within traditional Republican views.

KODJAK: Among those items, Trump calls for people to deduct their health insurance premiums from their taxes and use tax-free health savings accounts to pay for out-of-pocket costs. He proposes changes to Medicaid, the government health insurance for the poor and disabled. He'd give a fixed amount of money to each state rather than using today's cost-sharing formulas. Trump's plan leaves a lot up to interpretation. Antos likes the tax provision because he's assuming Trump would ensure they be structured to benefit low-income people, but other conservatives see it differently. Jeffrey Anderson is a senior fellow at the Hudson Institute. He looks at the proposals for deducting premiums and health savings accounts and sees a huge giveaway.

JEFFREY ANDERSON: It creates a new tax loophole by providing an open-ended tax break on the individual side.

KODJAK: Anderson agrees with Trump's goal to repeal the Affordable Care Act, but her worries about Medicaid. Trump's plan says, quote, "we must review basic options for Medicaid and work with the states to ensure that those who want health care coverage can have it." Anderson says that sounds to him like a huge Medicaid expansion. That's the conservative discussion. Liberals are interpreting Trump in yet another way. Igor Volsky is deputy director of the American Progress Action Fund. He says Trump wants to simply ditch Obamacare.

IGOR VOLSKY: It gets rid of Obamacare but doesn't talk about coverage expansion, doesn't talk about cost controls. And so we're left in the world where a lot of people are losing the coverage they currently have under Obamacare and they don't actually get anything in return.

KODJAK: We asked the Trump campaign to clarify some of these provisions. A spokeswoman said via email, quote, "the plan speaks for itself." Alison Kodjak, NPR News.

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Like most of the campaign rhetoric this year the discusisons disguise  real issues, creating angst for most people, and not being able to filter the important goals of elections.

Donald Trump Releases Details Of Health Care Plan

YaleNews | New technology will allow patients to become partners in research

“In the future we want to conduct research in partnership with people — not as subjects, but as our partners,” said Joanne Waldstreicher, MD, Chief Medical Officer of Johnson & Johnson. “Hugo holds the promise to empower people with their data and will create innumerable opportunities for them to participate in programs and projects that are customized to their interests and needs — and provides opportunities to be part of communities that contribute to knowledge that will help us all.”

The benefits of enabling data to flow more easily extend beyond research. Patients face the same hurdles as researchers in accessing their health information from different health systems. Hugo is designed to enable patients to acquire their data in a single platform for their own use, for example when seeking a second opinion, and increase transparency in health care. It will also allow them to be the carriers of their longitudinal health records.

Researchers at the Yale School of Medicine are launching a novel approach to research that engages people as true partners in science. Using an innovative health information technology platform called Hugo, which was developed in partnership with Yale New Haven Health System, people will be able to acquire their health-related data and use it to participate in studies.

Hugo is a highly secure cloud-based personal health platform that enables people to access their electronic health records (EHRs) from multiple health care systems and synchronize them with a research database. Designed to be user-friendly, it also allows people to contribute information from wearable devices and questionnaires.

“This could be a game changer. Hugo harnesses the very latest in digital health technology and puts patients in the center, making them true research partners,” said Dr. Harlan Krumholz, the Harold H. Hines Jr. Professor of Medicine, director of the Center for Outcomes Research and Evaluation (CORE) at Yale-New Haven Hospital, and a developer of Hugo.

source: Yale News






YaleNews | New technology will allow patients to become partners in research

Sandeep Kishore at TEDMED 2012

Medical Costs Vary Wildly Around The Country : Shots - Health News

Medical Costs Vary Wildly Around The Country : Shots - Health News : NPR

The Dangerous Patient Safety Delusions of Evidence-Based Medicine

Is common sense being overruled by Evidence Based Medicine ?  That is the core argument in this article in The Health Care Blog written by  clinicians, they can lead to clinical errors.  MICHAEL L. MILLENSON  summons Nortin M, Handler M.D. as his muse, stating  the renowned neurologist, Martin Samuels, paid homage to the degree to which uncertainties create more than just anxious rors. 

No slouch at his own erudite ambivalence about edicts from the National Academy of Medicine,  Millenson comes out as highly suspicious and pessimistic about the evidence based medicine cult which appears to have the  upper hand, becoming embedded in institutional cement.  Some of his reticence results from the seemingly lack  of effect  of evidence based medicine in parts of North Carolina Perhaps this is a local cultural resistance to centralized federal government edicts and perhaps the exception that proves the rule.  The United States is such a large country and has a heterogeneous diverse population both genetically, in socioeconomic strata as well as culturally that one should not be surprised by regional variations.


“The current medical culture is obsessed with perfect replication and avoidance of error. This stemmed from the 1999 alarmist report of the National Academy of Medicine [formerly the Institute of Medicine], entitled “To Err is Human,” in which the absurd conclusion was propagated that more patients died from medical errors than from breast cancer, heart disease and stroke combined; now updated by The National Academy of Medicine’s (formerly the IOM) new white paper on the epidemic of diagnostic error.

Not long after the National Academies published “To Err is Human. Building a safer health system”, a study from the US Veteran’s Administration demonstrated that the preventable hospital deaths due to medical errors was very much “in the eye of the reviewer.”[1] 



In a recent post, the renowned neurologist, Martin Samuels, paid homage to the degree to which uncertainties create more than just anxious clinicians, they can lead to clinical errors. That post was followed by another  by Paul Levy, a former CEO of a Boston hospital,arguing that the errors can be diminished and the anxieties assuaged if institutions adhered to an efficient, salutary systems approach. Both Dr. Samuels and Mr. Levy anchor their perspective in the 1999 report of Institute of Medicine Report, 


Dr. Samuel's post on THCB is similarly worthy for championing the role of the physician in confronting the challenge of doing well by one patient at a time. Mr. Levy and his fellow travelers are convinced they can create settings and algorithms that compensate for the idiosyncrasies of clinical care. I will argue that there is nobility in Dr. Samuels’ quest for clinical excellence. I will further argue that Mr Levy is misled by systems theories that are more appropriate for rendering manufacturing industries profitable than for rendering patient care effective.

Physicians must not be coerced by government guidelines. These metrics are ruled by the least common denominator, and filtered by ta hierarchy of committees.

America has made a tremendous investment in intensive care units. We have many times the ICU beds per capita as any other resource advantaged country, 25 per 100,000 people as compared to 5 per 100,000 in the United Kingdom. Not surprisingly, when we build them we also build the demand, so-called demand elasticity.[2] The indications for admission in America result in a very different case-mix than anywhere else. We need ICU beds for patients with acute or potentially reversible conditions, but do we need them for the frail elderly or the terminally ill? Maybe the error is not so much in their medical treatments as in the lack of appreciation of their humanity.

Credits:

Nortin M. Handler, Michael Millenson, 









The Dangerous Patient Safety Delusions of Eminence-Based Medicine | THCB

Better Aging Through Practice, Practice, Practice - The New York Times

Better Aging Through Practice, Practice, Practice - The New York Times

Can Certain Allergy Meds Worsen Restless Legs Syndrome? - US News

Can Certain Allergy Meds Worsen Restless Legs Syndrome? - US News

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.

United HealthCare and Humana to Merge - PR Newswire

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.

Planning for the Next Generation of Health Care Delivery: Designing for Telemedicine Spaces – Telehealth and Medicine Today ™

Planning for the Next Generation of Health Care Delivery: Designing for Telemedicine Spaces – Telehealth and Medicine Today ™

Five Things ACA Supporters Don't Want You To Know About UnitedHealth's Withdrawal From Obamacare - Forbes

Five Things ACA Supporters Don't Want You To Know About UnitedHealth's Withdrawal From Obamacare - Forbes

Medical school has killed my soul. What can I do? | Pamela Wible MD

It is not hopeless. the problem and the solution lies within.





Medical school has killed my soul. What can I do? | Pamela Wible MD