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May 7, 2013
One of the great promises of healthcare reform is that it will improve care for the nation’s citizens while lowering costs in the long run.
According to a recent New York Times article, a study conducted on Oregon’s Medicaid program found that found that individuals who gained Medicaid coverage spent more on health care and made more visits to doctors and trips to the hospital.
According to the article
But the study suggests that Medicaid coverage did not make those adults much healthier, at least within the two-year time frame of the research, judging by their blood pressure, blood sugar and other measures. It did, however, substantially reduce the incidence of depression, and it made them vastly more financially secure.
“There was this view that Medicaid coverage would not do much for the low-income uninsured, either because they had access to charity care or because Medicaid is not good insurance,” said Amy Finkelstein of the Massachusetts Institute of Technology. “This rejects that notion entirely.”
Where Medicaid seemed to have the strongest measured impact was on depression. Getting Medicaid coverage reduced the probability of a positive screening by more than 30 percent.
“The authors are almost tilting the spin on the story to be a little more pessimistic than I would have been,” said John Holahan of the Urban Institute, responding to the new findings.
“There are some positive effects on health,” he said, calling the effect on depression “especially strong.”
Confirming previous findings released by the researchers, the new round of results found that adults covered by Medicaid increased their use of a broad number of health services, like mammograms and cholesterol tests. That increased their medical spending by about 35 percent, compared to adults who did not win Medicaid coverage in the lottery.
Depression is closely linked to anxiety, so if you step back and think about it, it should not come as a surprise that individuals who suddenly found themselves with health coverage achieved lower rates of depression.
April 20, 2013
“Well here is another fine mess you’ve gotten us into,” was the classic punch line from many of Laurel and Hardy’s great movies.
With troubles mounting for the administration’s administration of the Affordable Care Act, the line is one HHS Secretary Kathleen Sibelius might well be saying to the congressional authors of the law. So far, the ACA is running low on both care and affordability.
Last week, six Republican senators released a 28-page white paper, “REBOOT: Re-examining the Strategies Needed to Successfully Adopt Health IT” which enumerated their concerns about the ACA and other aspects of federal health IT policy.
In their report, the lawmakers acknowledged that the meaningful use program aims to improve health care quality and reduce costs.
According to the report
“Nearly four years after the enactment … we see evidence that the program is at risk of not achieving its goals and that $35 billion in taxpayer money is being spent ineffectively in the process.”
The report went on to list these specific concerns:
- The use of health IT systems “may have actually accelerated the ordering of unnecessary care, as well as increased billing for the same procedures”;
- The federal government has not required different EHR systems to be able to exchange medical information;
- There are few protections in place to prevent fraud and abuse in the meaningful use program;
- Processes to protect patient privacy are “lax and may jeopardize sensitive patient data”; and
- It is unclear whether health care providers who have received meaningful use incentive payments will be able to maintain their EHR systems without continued federal funding.
If that wasn’t bad enough, Sibelius took heat from Democratic Senator Max Baucus. He gave the “a failing grade” for its efforts to educate the public and small employers about sweeping changes due to take effect in eight months.
According to Insurance Journal,
“I just see a huge train wreck,” Senator Max Baucus of Montana told Secretary Sibelius at a hearing of the Senate Finance Committee.
“I’m very concerned that not enough is being done so far. Very concerned,” said Baucus, citing examples of perplexed small business owners and polling data showing that most Americans either do not know much about the coming changes or have false information about what to expect.
“The administration’s public information campaign on the benefits of the Affordable Care Act, I think, deserves a failing grade. You need to fix it,” he said.
A main concern is the creation of state online marketplaces where consumers will be able to buy private health insurance at subsidized rates intended to make the coverage affordable for those with family incomes of up to $90,000 a year.
Those exchanges are due to start enrolling beneficiaries on Oct. 1 and are open to individuals and businesses with fewer than 100 employees. Full operations are scheduled for Jan. 1.
Another classic movie punch line, one used in many thrillers is “When this is all over, we’re going to look back on this moment and laugh.”
Let’s hope when the ACA is completely implemented in three, four or five years from now, we will be able to look back on this challenging time and laugh – or at least not grit our teeth.
April 6, 2013
When and how should personal health information be shared?
Sharing information about cancer patients that has been de-identified is apparently OK.
According to a story in the iHealthbeat newsletter, the American Society of Clinical Oncology (ASCO), has completed a prototype of a cancer care database that leverages health IT to improve care.
The new system is designed to be able to collect patient data such as laboratory tests, genomic profiles and physician notes in any standard directly from any electronic health record system.
The prototype, named “CancerLinQ,” has four core functions:
- Real-time data collection;
- Clinical decision support;
- Data mining and visualization; and
- Quality feedback.
According to the article
Sandra Swain — medical director of the Washington Cancer Institute at Medstar Washington Hospital Center, a professor at Georgetown University and ASCO president — noted that only 3% of cancer patients participate in clinical trials and that older patients in particular are left out of such research.
Swain said that CancerLinQ will “help us unlock that 97% of data that’s beyond our reach,” adding that the “result will be higher quality, higher value care and better outcomes for patients.”
John Sharp, manager of Research Informatics at the Cleveland Clinic, called CancerLinQ “an ambitious attempt to achieve a piece of the learning health care system,” adding, “Rather than developing treatment guidelines over years of clinical trials, the learning health care system proposes a more rapid cycle of analyzing real-time data and incorporating this into evidence-based guidelines.”
The article notes that the new system is based upon open-source software, but does not mention how it will be paid for. Presumably, physicians or hospitals will have to pay a fee to access the information. Nor does the article address the difficult topic of using private health information of individuals for research purposes. For example, would this data base be made available to pharmaceutical companies that could use the information to develop drugs which they might eventually patent and sell for profit?
In the bestselling book The Immortal Life of Henrietta Lacks, author Rebecca Skloot documents how cancer cells, later turned into a cell line used for hundreds of medical experiments, were taken without the knowledge or permission of a poor black woman. Her family never gave permission, nor were they compensated.
The ASCO data base project will not use human tissue, of course, but it does raise the issue of health care organizations benefitting from the illness of individuals and the use of private health information without permission.
March 29, 2013
Love me, love me not.
Employers are blowing hot and cold on Obamacare’s coming requirement to provide health insurance for all workers.
Beginning in January 2014, the law requires businesses with more than 50 employees to offer health insurance to employees who work an average of at least 30 hours a week, or pay a fine. Many employers of 50-100 workers have been contemplating shrinking their full-time workforce to less than 50 to avoid the requirement.
I was in a meeting with a business owner last week who is already making plans to outsource a dozen janitorial and clerical jobs to reduce his workforce.
For those employers who will be impacted, just how great will the cost be? Keep in mind, the employer just has to offer a health insurance plan, he is not penalized if the worker decides not to join.
The Wall Street Journal reported today that one major restaurant chain has greatly reduced its cost estimate for compliance.
Wendy’s Co. initially estimated the health-care law would increase the cost of operating each of its 5,800 U.S. restaurants by $25,000 a year. But Chief Financial Officer Steve Hare told an investment conference on March 14 that executives have cut the estimate by 80%, to $5,000 a year, primarily because they expect many employees to decline the insurance offering.
AFC Enterprises, operator of the Popeye’s chain, is among the employers that has few takers for its current plan. Ralph Bower, Popeye’s president-U.S., said in an interview that fewer than 5% of employees have signed up for a plan that carries high deductibles and costs $2.50 a week. So he doesn’t expect many more employees to enroll next year, when employees likely will have to pay about $25 a week for a plan offering more coverage.
Instead of buying insurance, Mr. Bower expects many employees will choose to pay the $95-a-year fine for being uninsured. “Do you want to pay $100 a month for health care, or are you going to pay a $95 fine that comes out of your income-tax return at the end of the year?” he said.
Jack in the Box already offers health insurance to any employee who has worked at least three months, but only about 20% use it, [a spokesman] said. He said he doesn’t expect that number to change next year.
So the good news is that the new health reform law won’t “break the bank” for small employers. The bad news is that it will still leave many workers without health insurance.
March 24, 2013
Q. What does HIX stand for?
- the latest strain of the flu virus
- Health Information Exchange
- Health Insurance Exchange
- None of the above
You should know this, because you’re in the cotton-pickin business! It is 2. of course.
The fact is many people don’t know about the new health insurance exchanges, due to roll-out in less than a year. At this point 33 states have tossed the “hot potato” of HIX formation back to the federal government.
According to a recent article in Politico the Obama administration is struggling to get the exchanges up and running.
The federal role in building the health insurance exchanges is bigger than expected — and money wasn’t set aside. The Obama administration di
dn’t expect 33 states to refuse to build their own health insurance exchanges. When it asked Congress for another $1 billion. Without IT infrastructure to process enrollments and payments, verify eligibility and establish call centers, health insurance for millions of Americans could be further delayed.
In addition, the article adds
Obamacare won’t work if people don’t sign up for coverage. But they won’t sign up if they don’t know how to enroll, how it may help them or precisely what — after three years of fuss — they are signing up for.
The hardest piece is the cyber architecture connecting a slew of federal agencies to one another, the states and consumers…The idea is sort of like Travelocity — but health insurance, of course, is more complicated than plane tickets. The consumer provides basic information about age, location, family size and tobacco use, and the “hub” kicks in data about the applicant’s citizenship, income and employment. All of that is supposed to generate information about eligibility, subsidies and net costs for various health plan options.
The State of California embraced the concept early on and is farther along than the other states. According to an article in KQED’s The California Report
“We know buying insurance is really complicated. We want to make it as easy as buying a book on Amazon,” said Peter Lee, executive director of the California Health Benefit Exchange.
But as the state has worked to create the actual application for health insurance, the idea of a one-click purchase is far from the reality. …The contract for California’s application was awarded to Accenture last summer. While a draft of the federal application was just released, stakeholders have yet to see a version of California’s application, which, like the federal model is being based on the UX2014 work.
The new federal draft application is 15 pages long for a 3-person family. A single applicant is only required to fill out 6 pages. Meanwhile a YouTube video shows what to expect from the online federal version:
Karp (of the California Healthcare Foundation) says after early promises that this would be like buying an airline ticket online, it’s important to set the right expectations.
“The law says we should have a consumer friendly process … it should be better than what people are experiencing today and we should go to lots of lengths to make it easier for people,” Karp says.
The California Report article shows a screen shot of the first page of the form. Have you ever filled out a six-page form online?
It does not require a six-page form to buying an item from Amazon or book a flight at Travelocity. Perhaps companies like TurboTax will emerge that can capture an individual’s information and help them through the process.