Tag Archives: Health Policy

States that resisted the ACA face the biggest hurdles in 2017

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http://www.fiercehealthcare.com/payer/states-resisted-aca-face-biggest-hurdles-2017?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWmpJMlpEZzFZbVV3WXpSaSIsInQiOiI0dCs1NW9kd0ord0VnTUpDWkgzcUp6VmpOV09JNUpldnBqcTh3eUJNTithQUs5QWc0N1JBbjJRYWZmRVJRN216MjNHQ2tFNGhrQWNON2NwR0dLSkdiVTZTSGxDVEZkNVwvejNoRitlVFpGblU9In0%3D

Document titled "Patient Protection and Affordable Care Act"Document titled "Patient Protection and Affordable Care Act"

States that are set to experience reduced competition in their health insurance exchanges also appear to be the ones that were unwilling to lay the groundwork to create a robust marketplace.

The issues that many states are now facing regarding consumer choice and premium pricingwere predicated by resistance from Republican politicians, who failed to expand Medicaid or conduct the necessary outreach to enroll healthy individuals into marketplace plans, according to the Los Angeles Times. In fact, eight of the nine states that have the fewest plan options next year refused to expand Medicaid and failed to engage in outreach.

“It’s the same basic lesson I tell my kids,” Joel Ario, a former insurance commissioner in Oregon and Pennsylvania, told the newspaper. “If you put the work into something, you will get results. If you just sit on the sidelines and complain, you shouldn’t be surprised if things don’t work out.”

Uncovered California: Why Millions Have Fallen Into Health Care Gaps

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Uncovered California: Why Millions Have Fallen Into Health Care Gaps

stork

“Right now, I have a medicine sitting at Wal-Mart pharmacy that I can’t purchase till payday,” Jacqueline, a 55-year-old San Diegan told me during a telephone interview in mid-April. She asked that her last name not be used for this story. “I’ll go without, eight or nine days till payday. It’s for my high cholesterol.”

Five years after the Affordable Care Act became law, and more than three years after California began moving aggressively to implement its provisions, upwards of three million Californians remain without health care coverage; and millions more, like Jacqueline, have basic coverage but continue to be grievously under-insured.This is the story of how so many Californians continue to fall through the ACA’s cracks.

“Uncovered California” is a three-part series of stories and videos examining how the Golden State is trying to fill holes in its health care coverage. Sasha Abramsky’s articles look at working people who are falling through coverage cracks, and at what’s being done to help community college students gain access to mental health services. Debra Varnado reports on efforts to expand the role of nurse practitioners to increase medical services for low-income Californians.

Uncovered California: What’s Holding Back Nurse Practitioners?

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Uncovered California: What’s Holding Back Nurse Practitioners?

NPnurses4

Nurse practitioners, or NPs, are registered nurses with “advanced clinical training at the master’s and doctoral levels, providingprimary, acute and specialty health care services,” according to the American Association of Nurse Practitioners. Most NPs (55 percent) specialize in family care and in adult gerontology (nearly 21 percent). A significant number provide acute, pediatric, neonatal, women’s and psychiatric health care services.

According to a 2014 study published in Nursing Outlook, nurse practitioners are significantly more likely than primary care physicians to “practice in urban and rural areas, provide care in a wider range of community settings and treat Medicaid recipients and other vulnerable populations.”

“Uncovered California”is a three-part series of stories and videos examining how the Golden State is trying to fill holes in its health care coverage. Sasha Abramsky’s articles look at working people who are falling through coverage cracks, and at what’s being done to help community college students gain access to mental health services. Debra Varnado reports on efforts to expand the role of nurse practitioners to increase medical services for low-income Californians.

 

Uncovered California: Community College Students’ Quest for Mental Health Services

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Uncovered California: Community College Students’ Quest for Mental Health Services

Mental Health infographic

On April 19, 35-year-old Sacramento City College student Rachel Wilson testified before the state Assembly’s higher education committee. A survivor of sexual assault and multiple suicide attempts, she described the lack of mental health support services available to her at school. Wilson was followed by an American River College professor, whose own son had killed himself while studying at a community college. The professor talked about three students who had recently committed suicide at her school, and of the lack of mental health services to help troubled individuals. When faculty members saw someone in crisis, she said, they were instructed to call campus police and have them take the student away.

“Mental illness is not a crime,” she told legislators. Then she repeated it: “Mental illness is not a crime.”

 Both women wanted the legislators to support Kevin McCarty’s (D-Sacramento) Assembly Bill 2017, which would significantly expand mental health services across California’s vast community college system.

Roughly two million Californians attend classes in one or another of the 113 community campuses dotted around the state. Surveys suggest that somewhere in the region of one in four of these students will experience a diagnosable mental health problem at some point, but approximately 40 percent of them won’t seek timely help. And too often, the institutions at which they study won’t be proactive in linking them up with vital services. As a result, they go untreated.

“Uncovered California” is a three-part series of stories and videos examining how the Golden State is trying to fill holes in its health care coverage. Sasha Abramsky’s articles look at working people who are falling through coverage cracks, and at what’s being done to help community college students gain access to mental health services. Debra Varnado reports on efforts to expand the role of nurse practitioners to increase medical services for low-income Californians.

Mylan’s CEO A Villain? Depends On Your Preferred Brand Of Capitalism

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http://healthaffairs.org/blog/2016/09/06/mylans-ceo-a-villain-depends-on-your-preferred-brand-of-capitalism/

Image result for capitalism

Different Flavors Of Capitalism

As usual, the answer is a clear “No” and “Yes,” and resolving the question raises much deeper issues than one executive’s personal culpability. The answer depends on what definition of capitalism one deems appropriate. As the European economist André Sapir has noted, there are actually four distinct brands of capitalism in the Western economy, of which the version practiced in the United States and some other Anglo-Saxon countries—sometimes also referred to as “savage capitalism”—is but one.

The clearest version of raw Anglo Saxon capitalism, and one quoted widely to this day, was offered by the late Nobel Laureate economist Milton Friedman in his classic book “Capitalism and Freedom.” There he proposed that the one and only social obligation to society that the CEO of an investor-owned, for-profit company is “to maximize its profits while engaging in ‘open and free competition without deception and fraud.’” (Quoted in Thomas Carson’s “Friedman’s Theory of Corporate Social Responsibility.”) On that view, any corporate action that is legal is ipso facto ethical.

Ms. Bresch can argue that with her aggressive pricing policy on EpiPen she was merely owning up to this doctrine of Anglo-Saxon capitalism. Her board of directors may or may not have known about that policy with regard to this particular product, one of many the company sells. Here Ms. Bresch also can point out that she is in good company in the drug industry. Many drug companies beyond the poster-boys for what is now decried as “price gouging”—Valeant Pharmaceuticals International and Turing Pharmaceuticals—have adopted raw Anglo-Saxon capitalism as the intellectual foundation for their pricing policies by steadily raising prices on long existing drugs, year after year, or even quarter after quarter.

High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care?

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http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps1

A Population-Based Comparison of Demographics, Health Care Use, and Expenditures

Abstract

Issue: Finding ways to improve outcomes and reduce spending for patients with complex and costly care needs requires an understanding of their unique needs and characteristics.

Goal: Examine demographics and health care spending and use of services among adults with high needs, defined as people who have three or more chronic diseases and a functional limitation in their ability to care for themselves or perform routine daily tasks.

Methods:Analysis of data from the 2009–2011 Medical Expenditure Panel Survey.

Key findings: High-need adults differed notably from adults with multiple chronic diseases but no functional limitations. They had annual health care expenditures that were nearly three times higher—and which were more likely to remain high over two years of observation—and out-of-pocket expenses that were more than a third higher, despite their lower incomes. On average, rates of hospital use for high-need adults were more than twice those for adults with multiple chronic conditions only; high-need adults also visited the doctor more frequently and used more home health care.

Conclusion: Wide variation in costs and use of services within the high-need group suggests that interventions should be targeted and tailored to those individuals most likely to benefit.

The Promise and Pitfalls of Bundled Payments

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http://www.commonwealthfund.org/publications/blog/2016/sep/bundled-payments?omnicid=EALERT1095386&mid=henrykotula@yahoo.com

Why Bundled Payments?

Under bundled payments, a single payment is made for all of the services associated with an episode of care, such as a hip or knee replacement or cardiac surgery. Services might include all inpatient, outpatient, and rehabilitation care associated with the procedure.

There are a number of potential advantages to this payment approach. Bundled payments give providers strong incentives to keep their costs down, including by preventing avoidable complications. Bundled payments also can encourage collaboration across diverse providers and institutions, as well as the development and implementation of care pathways that follow evidence-based guidelines. In addition, bundles target the work of specialists, who have been less likely up to now than primary care physicians to participate in value-based payment arrangements.

More conceptually, health care economists are drawn to bundled payments because a bundle of care constitutes a clinically and intuitively meaningful “product” — in this case, the clinical episode. Defining clear products in health care helps create markets in which providers directly compete on quality and price. One barrier to effective health care markets has been that prices, when available, tend to relate to inputs into clinical care — such as pills, bandages, bed days, or X-rays — that are not meaningful to consumers of care and that don’t necessarily predict the total costs of care. For example, a health system that charges a lot for X-rays may still be more efficient because it uses fewer of them or saves money on other inputs. Bundles bring all these inputs together into a single price for a single basket of services.

Malcolm Gladwell on Fixing the US Healthcare Mess

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http://www.medscape.com/viewarticle/847495#vp_1

Image result for Malcolm Gladwell on Fixing the US Healthcare Mess

In this edition of One-on-One, Medscape Editor-in-Chief Eric J. Topol, MD, sits down with best-selling author and journalist Malcolm Gladwell, who shares his unique perspective on healthcare and the practice of medicine. Mr. Gladwell believes that reform in healthcare might begin if, at its most basic level, the practice functions as a cash economy. He also notes the frustration clinicians feel after being saddled with technology that has become more of a hindrance than a help, and believes that ultimately providers need to be allowed more time to spend with patients, and fewer mandates, if healthcare is to prosper.

Medicine’s Future, From a Leader in Genome Editing and Stem Cells

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http://www.medscape.com/viewarticle/862921

Image result for Medicine's Future, From a Leader in Genome Editing and Stem Cells

Hello. I’m Eric Topol, editor-in-chief of Medscape. Welcome to One-on-One. We’re thrilled to have Chad Cowan, an associate professor at Harvard University who is at the Harvard Stem Cell Institute. Chad and I have both been principal investigators on the induced pluripotent stem cell (IPSC) grant. I have looked to Chad as a leader in this field and he has been prolific in recent years.

Without Medicaid expansion, Texas hospitals left holding the bag

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http://www.fiercehealthcare.com/finance/without-medicaid-expansion-texas-hospitals-left-holding-bag

AustinAustin

Should Texas ever decide to expand Medicaid eligibility under the Affordable Care Act, its hospitals would be spared about $358 million a year in costs tied to uncompensated care, a new study has found.

The research was conducted by the Florida-based consulting firm Health Management Associates on behalf of the Texas Health and Human Services Commission, The Dallas Morning News has reported. The report was not immediately available online.

If Medicaid were expanded, about 9 percent of the approximately $4 billion a year Texas’ hospitals spend on uncompensated care could be saved, the newspaper reported. Health Management Associates (HMA) predicted about 668,000 Texans out of the 1.1 million eligible for Medicaid coverage would enroll if eligibility were expanded.

But, quoting the report, the newspaper said that Texas lawmakers are not inclined to expand Medicaid anytime soon.