Sunday, June 26, 2016

The Five Percent in Health

The Wealth and Health Divide
The Growing Gap in the United States
Between the healthy and the sick



We have all heard about the one percent that have 95% of the assets in America.  The middle class is 'dead'.  

The same is true of the understanding of health financing in America. Only about one percent of patients (and providers) have the time or in following the endless changes in this area.

 Now that I am retired I find it a rewarding activity during my day. Health IT and reform have stimulated a new interest for me.

The remainder of my professional life is now dedicated to health information technology and health reform. These are my missions in my blogs.  Health Train Express is available for general knowledge about breaking news in health research and public health.

Digital Health Space encapsulates knowledge about health information technology for patients and providers. It is essential that both sides of our equation are equal in order to maximize the tremendous potential of information technology and the use of the internet to disseminate and acquire knowledge as well as accessing personal health records.

My efforts are self-funded...a truly non-profit activity in which I invest time and some money. I am beholden to no-one, no foundations, pundits, experts, nor authority. At times I quote others or just curate content without modification. Some source articulate issues much better than I do. My linguistic style is not as erudite or polished as some. More important should be my ideas...serious with much sarcasm and some humor.

How long will this continue ?


The Event Horizon


Friday, June 24, 2016

The Affordable Care Act, Accountable Care Organization and the Election

Better Together Health 2016 Event - Better Together     Are we really

The Affordable Care Act has stimulated many changes in health care. What is  considered good or bad depends upon the viewpoint of the provider and/or patient.

We have not yet seen the details of the Republican plan so Health Train Express will not offer our evaluation. Decisions based upon political rhetoric are at the least foolish, and at the worst dangerous.

It is doubtful if the ACA will be repealed entirely. Significant amendments ill be made. Other than some displeasure in the provider and health insurance industry patients who are able to access care are at less risk of not getting urgent care.  Even that presents problems in terms of provider accesss and the high deductible and premium expence for most receiving a partial subsidy. For those who are indigent, they have not expenses.

The progress of the organization being promoted by Medicare and some private insurers is the Accountable Care Organization (ACO).  The progress of developing this organization is fraught with many barriers. The ACO is an HMO on steroids.

Perhaps the closest organization to an ACO is the Kaiser Permanente model. The Counsel of Associated Physicians Group recently held a symposium, Better Together Health 2016 Event - Better Together.

The speakers represent a broad spectrum of the view on Accountable Care Organizations.

ROBERT PEARL, MD   CHAIR, COUNCIL OF ACCOUNTABLE PHYSICIAN PRACTICES
Robert Pearl, MD, is Executive Director and CEO of The Permanente Medical Group and President and CEO of the Mid-Atlantic Permanente Medical Group. Dr. Pearl serves on the faculties of the Stanford University School of Medicine and Graduate School of Business. Dr. Pearl is a frequent lecturer on the opportunities to use 21st century tools and technology to improve both the quality and cost of health care, while simultaneously making care more convenient and personalized.

SENATOR JOHNNY ISAKSON    (R-GA), CO-CHAIR, SENATE FINANCE COMMITTEE CHRONIC CARE WORKING GROUP

Senator John Hardy Isakson (R-GA) is serving his second term in the U.S. Senate, and was recently tapped to lead the Senate Finance Committee’s Chronic Care Solutions working group with Senator Mark Warner (D-VA). The work of the bipartisan committee is to begin exploring solutions that will improve outcomes for Medicare patients requiring chronic care. Isakson is the first Georgian since the 1800s to have served in the state House, state Senate, U.S. House of Representatives and U.S. Senate. He also serves on the Senate HELP Committee, Senate Finance Committee, the Senate Foreign Relations Committee, the Senate Ethics Committee, and the Senate Veterans’ Affairs Committee.

TIM GRONNIGEr    DEPUTY CHIEF OF STAFF, DIRECTOR OF DELIVERY SYSTEM REFORM AT CMS
Tim Gronniger is the deputy chief of staff and director of delivery system reform at CMS. He was formerly a senior adviser for healthcare policy at the White House Domestic Policy Council (DPC), where he was responsible for coordinating administration activities in healthcare delivery system reform. Before joining DPC he was a senior professional staff member for Ranking Member Henry Waxman at the House Committee on Energy and Commerce, responsible for drafting and collaborating to develop elements of the Affordable Care Act. Before joining the Committee staff, Tim spent over four years at the Congressional Budget Office.

CECI CONNOLLY    PRESIDENT AND CEO, ALLIANCE OF COMMUNITY HEALTH PLANS

Ceci Connolly became president and CEO of the Alliance of Community Health Plans in January 2016. In her role, she works with some of the most innovative executives in the health sector to provide high-quality, evidence-based, affordable care. Connolly has spent more than a decade in health care, first as a national correspondent for The Washington Post and then in thought leadership roles at two international consulting firms. She is a leading thinker in the disruptive forces shaping the health industry and has been a trusted adviser to C-suite executives who share her commitment to equitable, patient-centered care.

KAREN CABELL, DO    CHIEF OF QUALITY AND PATIENT SAFETY, BILLINGS CLINIC

Dr. Karen Cabell is the chief of quality and patient safety and a practicing internal medicine physician at Billings Clinic, an integrated medical foundation healthcare organization, located in Billings, Montana. Dr. Cabell has implemented diabetes, heart failure and HTN disease management registries along with point-of-care tools for patients and clinicians to better manage chronic disease. She was involved with Billings’ rollout and adoption of an electronic health record implementation since 2004 including all clinic sites and regional partners to include 15 other hospitals with clinics across a 500-mile radius. Dr. Cabell has been instrumental in gaining alignment between the EHR, quality and patient safety as well as strategic planning to support Billings Clinic’s organizational goals of clinical excellence, operational efficiency, market growth and development, and financial strength.

REGINA HOLLIDAY    PATIENT RIGHTS ACTIVIST, ARTIST, AUTHOR

Artist Regina Holliday is a patient advocate known for her series of murals depicting the need for clarity and transparency in medical records, and for founding the Walking Gallery movement. The Walking Gallery consists of more than 350 volunteer members who make statements about the lapses in health care at public meetings by wearing business suits or blazers painted with patient stories. Holliday’s experiences during her husband’s illness and subsequent death inspired her to use painting as a catalyst for change. Backed by her own patient and caregiving experiences, she travels the globe heralding her message of patient empowerment and inclusion in healthcare decision making. Holliday’s mission is to demand a thoughtful dialog with officials and practitioners on the role patients play in their own healthcare.

MARC KLAU, MD

ASSISTANT REGIONAL MEDICAL DIRECTOR, SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Dr. Marc Klau has been with the Southern California Permanente Medical Group for 31 years. He is currently the regional chief of Head and Neck Surgery, providing leadership for 100 surgeons.  He is also the Assistant Regional Medical Director for Education, Learning and Leadership. He now oversees the new KP School of Medicine and all of the Southern California Kaiser Permanente residencies, as well as continuing medical education and leadership.

JANET MARCHIBRODA

Artist Regina Holliday is a patient advocate known for her series of murals depicting the need for clarity and transparency in medical records, and for founding the Walking Gallery movement. The Walking Gallery consists of more than 350 volunteer members who make statements about the lapses in health care at public meetings by wearing business suits or blazers painted with patient stories. Holliday’s experiences during her husband’s illness and subsequent death inspired her to use painting as a catalyst for change. Backed by her own patient and caregiving experiences, she travels the globe heralding her message of patient empowerment and inclusion in healthcare decision making. Holliday’s mission is to demand a thoughtful dialog with officials and practitioners on the role patients play in their own healthcare.

DIRECTOR, HEALTH INNOVATION INITIATIVE, BIPARTISAN POLICY CENTER
Janet Marchibroda is the director of the Bipartisan Policy Center’s Health Innovation Initiative in Washington, DC. She has been recognized as one of the Top 25 Women in Healthcare by Modern Healthcare and is a nationally recognized expert on the use of health IT to improve healthcare quality.

LEANA WEN, MD  HEALTH COMMISSIONER, BALTIMORE CITY

Since taking the reins of America’s oldest health department in Baltimore, Dr. Leana Wen has been reimagining the role of public health including in violence prevention, addiction treatment, and urban revitalization. Under Dr. Wen’s leadership, the Baltimore City Health Department has launched an ambitious overdose prevention program that is training every resident to save lives, as well as a citywide youth health and wellness plan. She is the author of the book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, and is regularly featured on National Public Radio, CNN, New York Times, and Washington Post. Her talk on TED.com on transparency in medicine has been viewed nearly 1.5 million times.




Better Together Health 2016 Event - Better Together

Saturday, June 11, 2016

76th Scientific Sessions | American Diabetes Association


June 10th-14th is the 76th Scientific Sessions | American Diabetes Association meeting in New Orleans, LA.



Our Mission:  To prevent and cure diabetes and to improve the lives of all people affected by diabetes.


The program will begin on Friday, June 10 at 11:45 a.m. with our new Mini-Symposia sessions and conclude on Tuesday, June 14 at 12:15 p.m. following the ADA Presidents Oral Session.


The ADA maintains an archive of previous events, posters, abstracts and webinars:





Remember, good blood sugar controls lessens the risks for retinopathy, renal disease, heart disease, and neuropathy.  Diabetes effects the entire body, not just blood sugar levels.

Thursday, June 9, 2016

CURING CANCER




It’s far more important to know what person the disease has than what disease the person has.  – Hippocrates (460-370) B.C.






"Precision medicine" is not a new concept. It was a term coined by Eric Topol and then parroted by President Barak Obama  As early as 435 B.C.  Hippocrates gave us the quote noted above.

Hippocrates established this idea long before the science of biochemistry, genomics, proteomics and DNA sequencing. Since 400 B.C. we have managed to prove his hypothesis, expanding our understanding and developing nomenclature to connect the dots.

Physicians have studied diseases and pathology to understand their process better. Each person however reacts differently to the disease, and so too does the disease react differently to the patient.  It clearly defines to what the term 'patient-centered medicine' applies.

To say that the disease choses the person is to 'humanize' illness. Illness is what occurs when disease conquers human defense mechanisms. in truth, a constant battle is taking place in our bodies each day as bacteria, viruses, autoimmunity and uncontrolled cell multiplication takes place. Inherent in our bodies is a wide array of defense mechanisms. Cellular immunity, circulating antibodies, free radical scavenging biochemisty, enzymatic defense, inflammatory mechanisms, apoptosis and others.


Tuesday, June 7, 2016

Sleep is not an option. A behavior that is common to all of us

What do Arianna Huffington and Oncologist Dr Steven Eisenberg have in common ? Like us, they require sleep to allow our brains to recover, store energy, and allow our neural network to organize our thoughts and emotions.




Consequences of Insufficient Sleep
In the short term, a lack of adequate sleep can affect judgment, mood, ability to learn and retain information, and may increase the risk of serious accidents and injury. In the long term, chronic sleep deprivation may lead to a host of health problems including obesity, diabetes, cardiovascular disease, and even early mortality.

Sleep and Disease Risk

The price of insufficient sleep may be poor health. Study after study has revealed that people who sleep poorly are at greater risk for a number of diseases and health problems. And now the search is on to discover why this might be. more

Sleep, Performance, and Public Safety

Lack of sleep exacts a toll on perception and judgment. In the workplace, its effects can be seen in reduced efficiency and productivity, errors, and accidents. Sometimes the effects can even be deadly, as in the case of drowsy driving fatalities. more

At a Glance

  • The cost of poor sleep is much greater than many people think: it may have profound consequences for our long-term health.
  • Research has revealed that people who consistently fail to get enough sleep are at an increased risk of chronic disease, and scientists are now beginning to understand why.
Treating sleep as a priority, rather than a luxury, may be an important step in preventing a number of chronic medical conditions.

Sleep deprivation research 

Researching the Link Between Sleep Duration and Chronic Disease


There are three main types of study that help us understand the links between sleep habits and the risk of developing certain diseases. The first type (called sleep deprivation studies) involves depriving healthy research volunteers of sleep and examining any short-term physiological changes that could trigger disease. Such studies have revealed a variety of potentially harmful effects of sleep deprivation usually associated with increased stress, such as increased blood pressure, impaired control of blood glucose, and increased inflammation.

The second type of research (called cross-sectional epidemiological studies) involves examining questionnaires that provide information about habitual sleep duration and the existence of a particular disease or group of diseases in large populations at one point in time. For example, both reduced and increased sleep duration, as reported on questionnaires, are linked with hypertension, diabetes, and obesity. However, cross-sectional studies cannot explain how too little or too much sleep leads to disease because people may have a disease that affects sleep, rather than a sleep habit that causes a disease to occur or worsen.

The third and most convincing type of evidence that long-term sleep habits are associated with the development of numerous diseases comes from tracking the sleep habits and disease patterns over long periods of time in individuals who are initially healthy (i.e.,longitudinal epidemiological studies). We do not yet know whether adjusting one’s sleep can reduce the risk of eventually developing a disease or lessen the severity of an ongoing disease. However, the results from longitudinal epidemiological studies are now beginning to suggest that this is likely.

Getting the Sleep You Need



The Dr. Steven Show | Arianna Huffington - YouTube