About health Insurance
“Medicare for all” has had a lot of different meanings depending on the candidate who is asked about it. Senator Sanders appeared at a Fox News-sponsored town hall meeting on Monday and gave his version. You can “cut to the chase” at 25:45. Basically he says: no premiums, no out of pocket expenses and complete freedom to choose providers. He admits taxes will need to be raised to fund the program, but claims the overall costs will be lower than they are now. The Urban Institute evaluated Sander’s original proposal and found expenses over a 10 year period would go up by about $5 Trillion.
In a related article in today’s Wall Street Journal, Harvard Business School Professor Regina Herzlinger and Fraser Institute’s Centre for Health Policy Studies Associate Director Bacchus Barua write about the Canadian system and caution about “single payer” government-sponsored schemes.
At a time when our country is moving more toward government funded care and demonizing the private sector, most other countries are looking to their private sectors to alleviate access problems and often improve quality of care.
Uninsured Adults in States that Did Not Expand Who Would Become Eligible for Medicaid under Expansion: This research by the Kaiser Family Foundation found that if the 14 states which do not currently participate in the ACA’s Medicaid expansion would join the program, 4.4 million more people would be eligible. The study details results by state.
Value-Based Care in America: State-by-State: A Change Healthcare study found that a total of 48 “states and territories” (including the District of Columbia and Puerto Rico) implemented government-sponsored, value-based reimbursement (VBR) programs in 2018. That compares with only 6 in 2013. Details vary state by state and the report has those individual differences.
Humana Launches Oncology Model of Care Program to Improve the Patient Experience and Health Outcomes in Cancer Care: In its fourth specialty-based value payment model, Humana announced provider partners who will furnish oncology services. Details about the arrangements are sparse.
Better quality, lower costs when providers and payers share risk: According to the Integrated Healthcare Association: “A capitation payment model results in better value and outcomes than a fee-for-service model.” For example, in California, “60,000 more women would have been screened for breast cancer and hundreds would have been treated for breast cancer earlier if all California providers shared risk with payers.” It’s a rediscovery of HMOs from 30 years ago!
About healthcare IT
WHO releases first guideline on digital health interventions: The WHO is recommending a number of digital interventions to improve healthcare. Among the recommendations that have already been successfully implemented are sending reminders to pregnant women to attend antenatal care appointments and having children return for vaccinations.
Read the announcement
Decision Support and Alerts of Apps for Self-management of Blood Glucose for Type 2 Diabetes: A number of apps are on the market to help diabetics control their blood sugars, many of which are not FDA approved. The question is how well they work. The answer is: not well. This research found that: “The majority of diabetes apps did not provide real-time decision support or situation-specific education on blood glucose self-management. Only 20.7% of apps with explicit alert messages for hypoglycemia and 15.3% for hyperglycemia also prompted an action. Of concern, in most apps, consecutive low or high blood glucose values did not trigger an escalation of alerts that could prevent severe hypoglycemia or hyperglycemia.” This case seems appropriate for FDA intervention.
Text Messages May Improve Adherence in Diabetes: On the other hand…simple reminders can help, according to this study,
Feds oppose white-coat kickbacks suit out of 'animus' against whistleblowers: judge: This is a new one. The Department of Justice recommended withdrawal of a whistleblower suit because of lack of evidence. However, the judge in the case said the government lawyers displayed “animus” against the plaintiff and that was the reason fo their wanting the action to go away. They must proceed.
About the public’s health
The fact that the opioid crisis needs a multi-pronged program to succeed is emphasized by two stories of failure in different parts of the healthcare system.
This morning, The Washington Post reported that 60 people ( including 31 doctors, seven pharmacists, eight nurse practitioners and seven other licensed medical professionals) were indicted for their involvement in 350,000 illegal prescriptions that accounted for 32 million pills. The alleged offenders were from Kentucky, Ohio, Tennessee, Alabama and West Virginia.
In the other story, CVS was fined $535K for filling forged Percocet prescriptions.
Effect of a Workplace Wellness Program on Employee Health and Economic OutcomesA Randomized Clinical Trial: Well-meaning employers often adopt programs they think will lower cost by improving employee health. This study found that: “Among employees of a large US warehouse retail company, a workplace wellness program resulted in significantly greater rates of some positive self-reported health behaviors among those exposed compared with employees who were not exposed, but there were no significant differences in clinical measures of health, health care spending and utilization, and employment outcomes after 18 months.” Note the discordance between self-reported health and actual clinical measures.
Republicans reject Democratic attempts to tighten vaccine laws: This article documents Republican efforts to block states from mandating vaccinations (or at least severely limiting opt out opportunities). GOP lawmakers claim the laws infringe on personal freedoms. I wonder how they feel about the rights of those who want to protect themselves from preventable infectious diseases.