First down the chimney is David Williams at Health Business Blog. Let’s see what he is pulling out of his sack…hmmmm, this look like an interesting package. Partners HealthCare is the 800-pound gorilla in the Massachusetts healthcare market and as such gets a lot of scrutiny. So, Partners is excited that a 700-pound gorilla —in the form of BI-Lahey— has arrived on the scene to take away some of the focus. That’s enabling Partners to move forward with a plan to open lucrative outpatient centers. By the way, David is quoted on the topic in the Boston Globe.

Next out of the bag is a post from Tom Lynch at Workers’ Comp Insider about the prohibitive cost of pharmaceuticals and what hangs in the balance when patients can’t pony up. Tom Lynch asks What Price Life?  He talks about a chronic disease requiring medication, which, if not taken every day, guarantees death within two weeks.  But the problem is that over the past 20 years prices for that medication have risen anywhere between 800% and 1,175%.

With prices skyrocketing, Hank Stern at InsureBlog talks about a solution to copays, deductibles and coinsurance that can make health insurance unaffordable, even when the premiums are paid. Henry Stern introduces us to The Zero Card, whereby all deductibles, co-pays and co-insurance are waived – and this is available for at least a fraction of the market. Read the blog for the details and fine print.

More good news in health insurance. Louise Norris at Colorado Health Insurance Insider is here with a gift for people who think they earn too much to qualify for ACA subsidies. She says, ” We talk a lot around here about the subsidies provided by the ACA.  In Colorado, people with household incomes up to 138% of poverty (133% plus the built-in 5% income disregard) are eligible for Medicaid.  If your household income is between 138% and 400% of poverty, you most likely qualify for a subsidy to help cover the cost of a private plan purchased through the exchange; a family of four can earn more than $100,000 in 2019 and still be eligible for premium subsidies!”

On the other hand, you might want to look that ACA gift horse in the mouth. Andrew Sprung at XPostFactoid says that some of the protections of the ACA may be going away. In Will your state waive goodbye to ACA’s protections? Andrew looks at how ACA innovation proposals that conform to the “waiver concepts” recently issued by CMS might affect people with pre-existing conditions as well as low income and older marketplace enrollees. It also questions whether proposals conforming to the “concepts” could survive legal challenge.

Joe Paduda at Health Care Matters believes he has found the root of the healthcare problem and is recommending coal for Capitalism’s stocking. “Capitalism will not solve Healthcare because Capitalism is the problem with healthcare,” he says. And he backs up his opinion with lots of examples. “California’s dialysis mess, pharmacy pricing, and pretty much every other sub-sector of healthcare provides ample evidence of why the free market is the driver of our lousy and wildly expensive healthcare.”

Meanwhile, Jessica Williams, PhD MA at The Medical Care Blog sheds light on ways people are trying to control the cost of  care and improve outcomes, in this case through obesity and diabetes research. This post explores the questions: What research questions in obesity and diabetes should be prioritized? Which topics matter most to people with those conditions? Recent research from the Patient-Centered Outcomes Research Institute (PCORI), published in Medical Care’s October supplement, revealed 8 important topics for research from the perspective of researchers, clinicians, and people with diabetes and/or obesity – two of the largest drivers of healthcare expenditures.

Ah, but the 2018 holiday season does not end the 2016 political season. Roy Poses tackles a thorny issue with From Russia with Money – Harvard Medical School Accepts $200 Million from Russian Emigre with Ties to Russian Oligarchs and Putin, and Who Is Under Investigation for US Election Meddling. The details are riveting, and I encourage you to spend time looking at all the angles that Roy presents in this post at HC Renewal.

Let’s wrap up this holiday edition with a big red bow. Here’s the CareTalk Podcast, #CareTalk: Bipartisan Breakthroughs on Health Policy with hosts John Driscoll (CEO of CareCentrix) and David Williams (President, Health Business Group). In this month’s episode of #CareTalk youtube.com, David Williams (Health Business Group) and John Driscoll (CareCentrix) discuss how the outcome of the 2018 mid-term elections will impact healthcare moving forward. This is always an enjoyable presentation of serious material. During these 12 minutes, you get to see a Red Sox World Series Championship cap and hear what I thought may have been a suggestion for Alex Cora to manage the healthcare system.

Dash away, dash away, dash away, all!

Thank you, Lisa, for your work and contribution to keeping the wonkery alive!

About 8 years ago, I started Health System Ed as an educational portal about the value of health information technology. It started with a blog called “Imagine” that described the dream of having all relevant patient information, all the time, in real time, to make good decisions about the patient in front of you based on best practices that had been determined by measuring what treatments worked in which patients.

Lately, as I write about genomics and sensored medical devices, it is clear that we are oh-so-close to the dream. In 2010, I didn’t have a clue how long it would take to achieve lift-off. Today, all the pieces are in place for people (masquerading as patients to the healthcare system) to know what is going on inside their bodies even before they manifest illness sometimes.

• Scientists and researchers can peer inside the genetic code to see what has gone awry, and they can snip, delete and replace poor genetic codes.
• Doctors can measure results by getting information about the patient in real time – whether it is a glucose reading to track the efficacy of your medication dosage, a heart rate monitor looking for signs of trouble, or a sensored knee brace telling your orthopedic surgeon whether you are doing your rehabilitative exercises
• Patients can know how they are doing and adjust their behaviors
• Payers know what works, what to pay for, and when to implement resource utilization strategies to encourage best practices

The electronic patient record systems are mostly in place now to capture information. They may need to be tweaked, upgraded, or replaced with the next generation of software, but the infrastructure is in place today. Next, we will build the analytics to turn data into usable information.

One of the most beneficial aspects of capturing patient data – everywhere, all the time – is that ultimately people will get the most effective treatment first which will drive down costs to the system and extend the healthy human life span. When we know what works in whom, it is a much shorter trip from disease to health.

It is nothing but exciting. We aren’t there yet. But we can see “there” from here.

Peggy is an author and writer who specializes in healthcare.

Happy Halloween!

By Joe Paduda

Okay, I’m a bit early on the pumpkin-and-costume thing, but time is going by so damn fast I want to be early for once.

It’s also open enrollment time! that joyful event where we all get completely confused, baffled beyond belief, our minds all-a-boggled by all the tiny print on the screen describing in excruciatingly minute detail really important nuances in health benefit design that, if we ignore, will cause us to go bankrupt and die. Fear Not – Louise is here in her SuperWoman costume, typing madly away to bring you all you need to know about individual market enrollment – and in English too!

There’s been a lot of chatter about simplifying all this stuff, with much of it about Medicare for All. My contribution this week unpacks the argument that MFA would somehow harm Medicare. Hint – MFA is not the boogyman it’s made out to be.

Andrew Sprung’s found out that Bob Hugin, Republican candidate for the Senate seat held by Bob Menendez in NJ may well be hiding his real views on healthcare – but no one is asking. Andrew’s not afraid to ask…What’s behind the curtain, Mr Hugin?

Hank Stern over at Insureblog.net doesn’t like the HMO-only plans offered to his clients in the Buckeye State; Hank sees the evil hand of Obamacare at work, limiting his clients’ choices.

Our favorite healthcare economist, Jason Shafrin, has been looking into the costs of mental health that go beyond medical care. He’s also done a lot of research into medication adherence. And I can’t find any meme that works for this entry…darn it.

If you don a nursing costume, you may need to add a back brace. Nursing assistants get more back injuries than any other occupation. That’s the scary news from Tom Lynch at Workers’ Comp Insider.

The estimable David Williams is on a search to uncover a deep mystery – what happened to “Consumer Directed Health Plans”??? Join David as  he finds this to be a conundrum wrapped in an enigma; were they ever REALLY “consumer” directed?

Leaving my poor attempts at humor behind, Ranit Mishori MD MHS asks some very pointed questions about political determinants of health, determinants such as the for-profit motive and prioritizing religious beliefs over science.

Out long-term colleague Roy Poses MD FACP has been focusing on this as long as HWR has been around (15 years and counting). Roy’s learned big health care corporations, particularly pharma, biotech, device, and health insurance companies, provide significant sources of funding to dark money organizations.  It appears nearly all such money from health care organizations supports right- wing/ Republican/ pro-President Trump activities.

What happened to putting patients above all?

Thanks for reading, and thanks for writing contributors!

Over at Health Wonk Review, the hits keep coming. This month, Julie Ferguson posts her compilation of health wonkery at her home blog turf Worker’s Comp Insider. Click to go there for the fun or check it out right here.

Through vacations, heat waves, and days on the beach, our health policy wonks are still on the job. As we eke out the remaining days of summer and slouch toward the interim election, they continue their relentless focus on opining about the issues of the day. Check our August edition entries.

• First up, Joe Paduda unpacks the generic term to uncover the varied approaches to universal coverage currently operating at far lower cost and far better outcomes than our “multi-payer” “system” in his post What exactly is single payer at Managed Care Matters.

• Louise Norris tells us that the Trump administration has finalized rules that will make it easier for many Americans to buy short-term health insurance plans that may be less expensive – but aren’t as comprehensive as ACA-compliant plans. She explains the rules and how they’ll affect consumers in her post at healthInsurance.org Blog: ‘So long’ to limits on short-term plans.

• Folks at the Medical Care Blog look at an important public health issue, a children’s health crisis. Dr. Julie Graves – a family medicine and public health physician who previously served as a regional medical director in Texas – addresses the ongoing family separation crisis at the border: What’s Next? The Ongoing Crisis for Children Taken from Families Seeking Asylum at the US-Mexico Border. (Related, see her recent article on the topic at CNN: The surgeon general needs to step up for migrants.)
• When should services be covered by government insurance compared to private insurance? How does the public/private insurance vary around the world? Jason Shafrin, the Healthcare Economist investigates: What should be covered by government vs. private insurance?

• At Healthcare Renewal, Roy Poses says “This is starting to get tedious. ” He notes that it used to be nearly all the cases we found of ill-informed and/or mission-hostile health care management were about top leaders of big private health care organizations, eg, hospital systems, insurance companies, pharma/ biotech/ device companies, etc. But he notes that since 2016,  the locus has shifted: Ill-informed, Mission-Hostile Health Care Leadership… in the White House and the US Department of Health and Human Services. He makes his case with a roundup of cases.

• At InsureBlog, Patrick Paule puts paid to the notion that Medicare4All is any great deal or panacea. he makes his case in his post On BernieCare.
• What’s worse than needing help with gait, mobility and balance? Being told you need a walker. No wonder, when the typical walker basically screams “frail elderly,” and is difficult to use as well. At Health Business Blog, David Williams talks with neurologist Patricia Kavanagh about how she teamed up with a design and production team to a modern device that is more functional and stylish in an effort to get her patients with Parkinson’s and other movement disorders to use a walker.
• Vincent Grippi of the CareCentrix’s Homefront Blog submits this month’s episode of #CareTalk, in which David Williams (Health Business Group) and John Driscoll (CareCentrix) discuss Trump’s fight with Pfizer over drug pricing, and more.
• Here at Workers Comp Insider, we’ve yet to do a post on this important occupational health issue, but call it to your attention. We were horrified to see that the EPA is loosening regulations that will expose more workers to a know carcinogen:  EPA is now allowing asbestos back into manufacturing. At least one town in Russia – Asbest – is celebrating.

Next issue: September 20 – Andrew Sprung – xpostfactoid

Seasons come and seasons go. Yes, in healthcare, too. We’ll open this week’s HOT Health Wonk Review looking at an enduring issue as Roy Poses of Health Care Renewal very nicely summarizes pharmaceutical marketing tactics and their effect on physicians and patients as it pertains to opiates. Some practices just keep coming around again.

Hope in a Bottle: Components of Purdue Pharma Stealth Marketing Campaign for Oxycontin Revealed by Legal Documents from Tennessee

The return of the good old days, sort of: a legal filing from the Tennessee Attorney General’s lawsuit against Purdue Pharma revealed multiple internal Purdue documents showing elements of the company’s stealth marketing campaign for Oxycontin.  These included: implied psychological manipulation of vulnerable physicians; perverse incentives for sales representatives; and use of third-party strategies (including creation of “astroturf” organizations) and miscellaneous deceptions.  More awareness and better understanding of such integrated, but deceptive marketing campaigns enables better resistance to them, and hence hopefully better professional decision making leading to better patient outcomes.  Previous stealth marketing campaigns have been revealed through litigation by the US government.  The Trump administration seems uninterested in pursuing corporate health care’s bad actors, but at least the baton has now been picked up by some state law enforcers.  Read more from Roy here.

While We’re Talking about Opioids…

Louise Norris of HealthInsurance.org tells us this year there has been an abundance of discussion about our national opioid abuse crisis and about strategies for addressing that challenge. But was the Affordable Care Act already helping address that crisis? Louise looks at how that ACA improved mental health coverage – including dramatically expanded access to additional treatment in some of the states hardest hit by the opioid crisis.

#CareTalk Podcast: Wry Healthcare Commentary with David Williams and John Driscoll

Podcast time, today our hosts David Williams and John Driscoll opine about the Right to Try law. “A great impulse and a dumb law,” says Carecentrix CEO John Driscoll. David Williams of Health Business Group agrees, “Right to try…who could argue with it, but it is a pretty cynical law.” It is redundant with compassionate use, and just removes the FDA to “take the smartest people out of the way,” says John. Lots of good stuff here as they look at a few other ways politics uses healthcare as a football. Watch, listen, learn right here.

High Deductible Health Plans: A Blunt Instrument that Doesn’t Work

High deductible health plans don’t work, so says Joe Paduda of Health Strategy Associates. Hear about why Joe calls high deductible plans “the bluntest of instruments” that has lots of nasty side effects and doesn’t reduce costs or improve care. Joe wonders “why the health plan industry is still selling these crappy plans.” Read more at Managed Care Matters where Joe talks about the ill effects of this health plan variant.

Much Ado About a Rounding Error? Looking at Sharing Ministries

Henry Stern of Insureblog channels Shakespeare while he questions if the faith-based ACA-compliant alternatives to ObamaPlans – now topping 1 million members – are such a good idea for people who need the assurance and reassurance of insurance or reinsurance. He’ll explain it all at this link.

Exploring Ethics: Is the Cost of Dying Worth It? Research Says Yes

Jason Shafrin at the Healthcare Economist asks if we are spending too much on end of life care and puts a new spin on the answer backed by research. He says we recognize that end of life care is expensive.  Conventional wisdom holds that we are spending too much on end of life care and we should just let people die at home in peace with hospice.  If only things were so simple.  The Healthcare Economist reviews new research that shows that end of life healthcare interventions may, in fact, by worthwhile. Paddle over to Jason’s blog at this link for a good discussion on an important topic.

Brush Up on Your Latin: Quo Vadis, Kentucky?

Tom Lynch of Workers’ Comp Insider recently attended a forum where he heard a presentation on the work requirements for Medicaid beneficiaries, a program called Kentucky HEALTH. Tom offers his perspective on the plan. It should be noted that a federal judge subsequently ruled the plan unlawful, but three other states are still developing plans for work requirements and other states are waiting in the wings. And this entire issue begs the question, where are we going, America? Is healthcare a right for all or privilege for those who can afford it? Tom kicks this football around a bit – on his private beach right here.

So now it’s time, dear Wonkers, to kick back, read the healthcare blogs and enjoy this summer day.

Photo by Anton Karatkevich on Unsplash

“Beware the Ides of March” –Soothsayer to Julius Caesar
“Fear not the Ideas of March” –Health Business Blog to the wonkosphere

Your friendly neighborhood drug dealer

Count on Drug Channels to make sense of even the most convoluted pharmacy business models –and convoluted they are. This time the topic is the emerging trend of point-of-sale (POS) rebates. Did you know that many pharmacy benefit plans act like reverse insurance, with the sickest members subsidizing the healthiest? POS rebates start to right this wrong and bring forth uncomfortable questions such as: Where have the rebates been going until now?

Crocodile tears

Managed Care Matters shares its perspective that the Administration’s efforts to undermine the ACA have yielded bitter fruit on the marketplaces. Some premiums are up by 30% and meanwhile Congress is doing little or nothing.

Two years ago you couldn’t read the news without hearing about the disastrous premium increases due to “Obamacare,” but the media is silent now.

So what’s going on? Our blogger has a theory: The media is being manipulated and chasing bright, shiny objects.

Skimpy is as skimpy does

InsureBlog likes CMS’s proposal to restore the maximum policy length of short-term medical plans to 12 months from three. That’s even though some news outlets call the plans “skimpy” and some healthcare policy analysts consider such plans to be leeches on Obamacare, because they may siphon the healthiest people out of the marketplace risk pool and drive up premiums.

Location location location

When my son was a toddler, we trained him to say “location location location” when asked, ‘what are the three most important things about real estate?’ I still remember him driving a realtor crazy when one tried to pitch us on a house we didn’t like.

Now, Workers Comp Insider has decided that location is destiny in healthcare, too, declaring ‘It’s the Zip Code Stupid.’ Insider cites a recent JAMA Internal Medicine study that shows geography is “the biggest X-Factor in today’s American Hellzapoppin version of healthcare.”

Location: Wonk zone

The Hospital Leader (not to be confused with the Dear Leader) helpfully explains that “We need creative solutions” really means “the problem we are trying to solve has no answer.” Case study: Hospitals, hospice and SNFs – The big deceit.

A pending bill seeks to establish a state-based individual mandate in New Jersey. But a provision targeting employees of small businesses could inhibit Association Health Plans from selling insurance that does not comply with small group rules. Xpostfactoid explains.

Who knew? Health Care Renewal informs us that the ostensibly libertarian Washington Legal Foundation has become a front for healthcare corporate leaders –and leaders from other fields— to operate with impunity. The foundation’s campaign to abolish the Responsible Corporate Officer Doctrine failed, but the damage was done. (Hat tip to Health Care Renewal for anticipating today’s theme by including “methinks” in its cover note.)

Local talent

The Health Business Blog is now a teenager. I ran the annual round-up of favorite posts by month.

CareCentrix CEO John Driscoll and I rant and rave about Amazon and innovation in the latest monthly episode of #CareTalk.

Singing from the himmnal

Health System Ed shares results from the 2018 US HIMSS Leadership and Workforce Survey, a survey of providers and vendors.

Top themes: privacy and security, process improvement and workflow, data analytics, business intelligence to inform clinical decision-making remain top of mind. 

Well that’s it for the Ideas of March edition. Watch your back today!

—

By healthcare business consultant David E. Williams, president of Health Business Group.

Source: https://www.healthinsurance.org/blog/2018/02/15/health-wonk-review-for-february-15-2018/
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Here’s Joe:

“Blog posts!

Health Wonk Review returns to the inter-webs after a holiday hiatus. Refreshed, renewed, and revitalized, we bring you the best from the brightest!”

Thanks much for kicking off the new year, Joe!