Gun violence survivors and witnesses could face lifetime of trauma and bad health

http://www.modernhealthcare.com/article/20161105/MAGAZINE/311059989

Gun violence survivors

Chicago has been pummeled with near constant gun violence this year. An estimated 3,600 shootings have taken place, on average—that’s about 10 shootings a day.

During the recent Halloween weekend alone, 17 people died and 41 were wounded.

And while politicians and policy makers struggle to find ways to create policies to address America’s violence, another related crisis is slowing growing.

Most of the shootings are concentrated in impoverished communities. The virtual war zones are home to people who suffer from poor health and lower rates of insurance coverage, leaving them at a disadvantage when they are injured, either physically or tangentially, by gun violence. And oftentimes, the most vulnerable victims are young people who have a lifetime ahead.

f you grow up in a world where you’re not feeling safe, then you feel as though you’re under attack whether or not you actually are,” said Dr. David Soglin, chief medical officer at La Rabida Children’s Hospital, an acute-care pediatric center on Chicago’s South Side that specializes in treating children who have been victims of abuse and trauma. “For some kids in our communities, they really are under attack.”

The trauma surrounding exposure to gun violence is not disputed, especially among children. In 1995, the Centers of Disease Control and Prevention reported that children who had four or more adverse childhood experiences, such as experiencing or witnessing a shooting, were more likely to smoke, drink, abuse drugs and engage in unsafe sex. Those behaviors often lead to chronic conditions such as cancer, heart disease, stroke, liver disease, diabetes and sexually transmitted diseases.

The growing number of people who survive living in the country’s most violent neighborhoods is causing public health officials to respond by creating comprehensive violence prevention efforts.

Clinton vs. Trump: 5 critical election issues

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/hillary-vs-trump-5-critical-election-issues?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=25102016

While Hillary Clinton vows to forge ahead with Obamacare if she is elected president, Donald Trump would scrap it altogether. The end results would be two very different forms of healthcare, and industry leaders have much to consider.

Brill“Many different factors are weighing on managed care executives such as the costs of pharmaceuticals, diagnostics and devices; the impact of consolidation amongst hospitals, physicians, health plans; and the losses in the exchange marketplace,” says Managed Healthcare Executive editorial advisor Joel V. Brill, MD, chief medical officer, Predictive Health, LLC, which partners with stakeholders to improve coverage of value-driven care. “With each of these factors, plans can, at least at a high level, make some educated guesses about the relative risk of each factor and impact to the bottom line.”

The election results, however, are much less certain, which from a risk perspective, weighs heavily on the minds of healthcare executives, Brill says. “How can you plan for business knowing that whatever you are doing currently could be upended in the beginning of November?”

To help provide some clarity, Managed Healthcare Executive identified five of the top industry issues, reviewed the candidates’ platforms for each, and asked industry experts to weigh in.

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

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.

This Nurse Leader Cut LOS by 40% in the Emergency Department

http://www.healthleadersmedia.com/nurse-leaders/nurse-leader-cut-los-40-emergency-department-0?spMailingID=9348186&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=980998666&spReportId=OTgwOTk4NjY2S0#

Around 2012, Ajimol Lukose, DNP, RN-BC, nursing director at Swedish Covenant Hospital in Chicago, noticed a trend—more patients with behavioral health issues were seeking treatment in the emergency department. This development came on the heels of the state cutting $113.7 million in general funds from its mental health budget, and Chicago closing of six of its 12 city-run mental health clinics.

“There was a reduction in mental health clinics, so the follow-up or outpatient programs were limited. That resulted in patients showing up in the emergency department,” Lukose told me.

On any given day, there could be as many as six or seven behavioral health patients in the ED.

“Our emergency department was struggling with patients with mental health issues staying there for three and four days and waiting for state transfer, especially unfunded patients,” she said.

At the same time, Lukose needed to implement a project for the doctorate of nursing practice degree she was working toward. She has a background in psychiatric nursing and thought she could help address some of the issues around caring for this patient population by developing a safe care delivery model to improve care quality and reduce length of stay in the ED.

Her results were even better than expected.

Saving Lives And Saving Money

http://www.healthleadersmedia.com/finance/saving-lives-and-saving-money

As health care costs continue to rise, attention has turned to a tiny number of super-utilizers. A program that started in California has taken a different approach to treating these high-cost patients: Over the past two years, it has tracked them, healed them and saved a ton of money.

Medicaid plans can now pay mental health institutions. Most won’t until 2017

http://www.modernhealthcare.com/article/20160705/NEWS/160639991

A policy that lifts a 50-year ban on Medicaid pay for mental health institutions kicked in Tuesday, but it may be months before many enrollees can take advantage of the new coverage

Since the creation of Medicaid in 1965, the program has excluded payment for institutions of mental disease (IMDs) for beneficiaries 21 and over. Most residential treatment facilities for mental health and substance-use disorders with more than 16 beds did not qualify for Medicaid reimbursement.

Providence St. Joseph Health System Merger Creates $100 Million Mental Health Initiative

Providence St. Joseph Health System Merger Creates $100 Million Mental Health Initiative

Concussions

4 forces that will influence medical cost trends in 2017

http://www.healthcaredive.com/news/4-forces-that-will-influence-medical-cost-trends-in-2017/421162/

Binoculars

The healthcare industry is in a transformational period. The rising use of retail clinics, MACRA, population health efforts and the Medicare Part B demonstration are but a few examples of disruptive conversations being had in board rooms. Yet, all of these discussions are underscored by the one topic underlying most business conversations: the almighty dollar.

There’s a push and pull between healthcare services utilization and narrow networks focusing on value that could shift the medical cost growth rate in future years. “When medical growth outpaces general inflation, a flat trend is not good enough,” the report states.

“As a result, 2017 will be a tough balancing act for the health industry,” the report states, adding, “Healthcare organizations must simultaneously increase access to consumer friendly services while decreasing unit cost. Employers, worried that this current trend is at an inflection point that could turn back up, will demand more value from the health industry.”

Congress Should Act on Mental Health

https://morningconsult.com/opinions/congress-act-mental-health/

mental-health

Conventional wisdom says that Congress generally won’t achieve much in a Presidential election year as issues begin to get mired in partisan posturing.  But 2016 has been anything but a conventional election year, and this Congress has the opportunity to pass two important bipartisan health bills this year.

We’re talking about the mental health bills before the House and the Senate as well as the Medicare chronic care legislation under development by the Senate Finance Committee.  These bipartisan proposals could improve the lives of millions of Americans and move our health care system in the direction of better integrated and higher value care. It’s time that Congress act on them.

Chronic disease already accounts for the vast majority of health care costs in Medicare and our health care system in general.   Without action, the problem will only get worse.

Largest Share of Health Spending is on Mental Disorders

http://www.healthleadersmedia.com/finance/largest-share-health-spending-mental-disorders?spMailingID=9084486&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=941950601&spReportId=OTQxOTUwNjAxS0

Mental Illness Awareness

Reductions in deaths from cardiovascular and cerebrovascular disease are likely to drive spending on mental disorders even higher, as more people survive to older ages when mental disorders become more prevalent.