Posts Tagged ‘health policy’

Happy holiday Health Wonk Review

Thursday, December 14th, 2017

Santa reading Health Wonk Review

First, let us go on record for saying that there is no sly political motive to our use of the term “holiday” in the title of this post. Admittedly, we have a bit of a liberal slant, but we have no aversion to using the phrase “Merry Christmas.” But ho, ho, ho, we do have an inordinate fondness for alliteration. Of course, we might have called it the Happy Hanukkah Health Wonk Review instead, but we wanted to encompass Hanukkah, Christmas, Kwanza, New Year’s, and even the dubious Festivus. Whatever your flavor or inclination, we wish you a merry, happy, joyful one. Pentatonix says it better than we ever could, so a bit of a seasonal interlude before we get to this week’s entries.

The Happy Holiday Health Wonk Review

*** First up, at Managed Care Matters, Joe Paduda is never one to shy away from calling it as he sees it and this week his submission takes on the GOP tax bill, which he describes as “a mess, riddled with math errors, contradictory language, and un-implementable directives.” Congressional leaders say they have reached some agreement and will vote before the end of the year, so Joe’s post will give context.

*** Roy Poses proves once again that the devil is in the details and he consistently makes it his blogging business to dig through the details to hold feet to the fire. At Heath Care Renewal, he tracks down more about a barely-reported Pfizer settlement for “alleged” anti-competitive behavior that nearly slipped through the radar. He says that the lack of negative consequences suggests that the impunity of top health care leaders is is worsening. Check out his post One Barely Noticed Settlement by Pfizer Suggests the Futility of Polite Protests about Health Policy.

*** How will the CVS purchase of Aetna affect the healthcare landscape? Jason Shafrin aka The Healthcare Economist weighs in with his informed observations.  And another of our regular wonks weighs in on the merger. David Williams of Health Business Blog posts CVS + Aetna. Are we sure this adds up? Despite talksthat this combo will lead to a revolution in care delivery, he remains a skeptic and talks about why.

*** Acknowledging that the individual market for health insurance has become unaffordable for many of the unsubsidized — particularly older would-be enrollees — Andrew Sprung outlines various ways to keep Modified Adjusted Gross Income (MAGI) below the subsidy line. Check out his post Steering clear of the subsidy cliff in the ACA marketplace at xpostfactoid.

***  Vincent Grippi of CareCentrix submitted a fun #CareTalk video podcast, featuring HWR regular David Williams teaming with John Driscoll of CareCentrix. In a point-counterpoint format, they spar about the implications of 2017 elections on healthcare (think Maine), move on to value-based healthcare and they close the 10 minute segment with a lightning round.

*** Brad Flansbaum of The Hospital Leader has an interesting post about Locums vs F/T Hospitalists, posing the question, do temps stack up? He reports on a JAMA study, adding his perspective. Now I must confess that the term “locums” was a new to me, but Brad gives it good context. But if you are curious to the origins, as I was, Wikipedia is your friend.

*** In his post The Positive Side of Sharing, InsureBlog’s Henry Stern has the latest on a reader’s experience with a Health Care Sharing Ministry. (He offers this spoiler alert: it’s actually been pretty good).

*** Shopping for individual health insurance or know someone who is? If your state uses HealthCare.gov, you have until December 15 to enroll, but in other states, you may be able to enroll as late as January 31. Victims of Hurricanes Irma and Harvey may also have extensions. Louise Norris has all the details in her  guide to buying individual health insurance at healthinsurance.org. For more, see Timothy Jost’s post on Health Affairs Blog: Open Enrollment Ends Friday—Except For Those Qualifying For Special Enrollment Periods.

*** For our post, we’re delving into our archives for an expose of a mysterious employer. Many have nothing but good to say about him, but others think he is not a good employer. Judge for yourself:

Santa’s workshop: “OSHA problems galore” say whistleblowers
The risks of being Santa
Is Santa Claus a bad employer?

 

Health Wonk Review and a tribute to our veterans

Friday, November 10th, 2017

At Healthcare Economist, Jason Shafrin has posted the latest compendium of posts from the health policy bloggers: Health Wonk Review: Quote-of-the-day Edition. He frames each submission with a pithy quote. While the overall shape and politics of the healthcare debate are still a primary theme of posts, there are other entries, including two videos. Grab a coffee and catch up on the latest thinking from the wonks.

This weekend, we pay tribute to our veterans and thank them for their service and sacrifice. We end with this advice: How to honor veterans: Hire one!

Who Knew? Medical Marijuana Works (at least for chronic pain)

Thursday, March 2nd, 2017

Dean Hashimoto, MD, JD, is a highly-respected researcher and teacher, practicing at Massachusetts’s Partners Health Care (think Harvard and Massachusetts General Hospital) and teaching at Boston College Law School. Today, at WCRI’s Annual Conference, his topic was Medical Marijuana and Workers’ Compensation: Recent Scientific, Legal and Policy Developments.

He led off with the results of a January,2017, scientific report from the National Academies of Sciences, Engineering and Medicine (NAS). The NAS report is a comprehensive, in-depth review of existing evidence regarding the health effects and potentially therapeutic uses of Medical Marijuana (cannabis). The report arrived at nearly 100 research conclusions categorized by the weight of evidence (conclusive, substantial, moderate, limited, no or insufficient).

One of the report’s conclusions that had “conclusive and substantial support” was this: Medical Marijuana is proven to improve chronic pain in adults. There is “moderate” support for the conclusion that Medical Marijuana improves short-term sleep outcomes for both fibromyalgia and chronic pain.

Of course, there are downsides. The report also concludes (DUH!) that Medical Marijuana carries with it an increased risk of motor vehicle crashes. Also, however, there was conclusive, substantial support that taking Medical Marijuana can lead to the development of schizophrenia and other psychoses. Yikes!

The NAS report also investigated whether there was an association between cannabis and occupational injury. The conclusion? There was no conclusion, because the available studies do not permit one to be made with any degree of certainty.

The bottom line? Medical Marijuana presents a potentially therapeutic benefit in the treatment of chronic pain.

Well, that’s not really the bottom line. No, because the larger issue is this: Medical Marijuana is being used in a number of states. Today, along with Dr. Hashimoto, we also heard compelling stories from Paul Sighinolfi, of Maine’s Workers’ Compensation Board, and Paul Tauiello, of the Colorado Division of Workers’ Compensation, describing the successful medical use of cannabis which is generating momentum in both states toward the therapeutic use of cannabis. The trouble is the usage of Marijuana in any form is federally illegal in every state. Seems there is a collision coming, and it may not be pretty.

What Is The Meaning Of “Life?”

Wednesday, February 22nd, 2017

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. That to secure these rights, Governments are instituted among Men…” – The Declaration of Independence of the United States of America

“People with type 1 diabetes need to take insulin every day to stay alive.” – The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

““I must pay my mortgage.” If it’s a choice between the mortgage and the insulin, “It’s going to be the mortgage.” – 74-year-old Kathleen Washington. Some months, her insulin runs over $300 a month – more than she can afford.” – CBS This Morning, Anna Werner, 22 February 2017

As politicians and high-paid lobbyists dance around the Washington DC Tower of Babel debating the future of health care in America, here are three questions that, as far as I can tell, have yet to be asked:

  1. In the phrase, “Life, Liberty and the pursuit of Happiness,” what did the Founders mean by the word “Life?”
  2. Is good health care an “unalienable” right?
  3. Should Ms. Washington have to choose between paying her mortgage and buying her insulin?

Let’s begin by considering the phrase, “To secure these Rights, Governments are instituted.” Then, consider, “Pursuit of Happiness.” Those two phrases suggest that one of the prime responsibilities of Government is to insure nothing prohibits citizens from being able to seek Happiness. Everyone must have the opportunity to find Happiness for themselves, the key word being “opportunity.” Government doesn’t guarantee Happiness, just that we have the chance to land on it. It’s up to us, but Government must do all in its power to see that unreasonable impediments are not placed in our way.

But what about Life and Liberty? The Founders did not choose to put the word “pursuit” in front of Life and Liberty. What does that mean? If Life and Liberty are unalienable rights that Governments are instituted to secure, what must Governments do to accomplish the mission?

Consider Liberty. Government has created a national defense system to defend our country and, by extension, our Liberty. The Founders recognized taxation as the most equitable means of paying for this, and so every year each of us kicks in our share (although this might be debatable) to guarantee our unalienable right of Liberty.

Now, think about Life.  Some may say Life is what national defense is all about, but, as I have shown, Liberty is more closely aligned with national defense. If the Founders wanted to make Life and Liberty go together, they would have written, Life and Liberty, not Life comma Liberty.

Then what does “Life” mean? For the answer to that center of the bull’s eye question, I turn to those great English philosophers, the Bee Gees: Life means Stayin’ alive. What should Government be doing to secure this first of the three unalienable rights for us? If Type 1 diabetics require insulin every day to stay alive, to continue Life, should Government guarantee they are only able to pursue it, as in the “pursuit of insulin?” Or, to secure the unalienable right of Life, must Government provide the insulin, paid for by taxation of all citizens, as it provides a national defense system?

It is unfortunate that these most basic of questions are not front and center in our nation’s capital. But to truly “secure” our “unalienable Right” to “Life” requires the goring of too many oxen (or, an unlucky Matador), as Joe Paduda writes in his blog today.

Pity the Republicans. They’ve caught Obamacare, like that dog that caught the bus, a trite phrase, but, in this situation, apt. They need to do something, but whatever they do, a large swath of America is going to pour fire and brimstone on their heads. Damned if they do, damned if they don’t.

Too bad. It didn’t have to be like this.

 

 

Fresh Health Wonk Review at medicareresources.org blog – check it out!

Friday, February 10th, 2017

Steve Anderson has posted the latest and greatest Health Wonk Review – the #alternative_facts Edition at medicareresources.org blog.

The Affordable Care Act (aka Obamacare) is not all that’s on our wonks’ minds of late, but it certainly takes up a huge portion of the mind share as evidenced by the plethora of related posts. We are a diverse crew, though, so there are also posts about a variety of other topics: the reaction to/impact of the immigration ban on healthcare industry, best cancer treatments, the process of healthcare M&As, legal liability in the form of class action suits for a data breach. and workers comp. One thing we find: the contributors are all very knowledgeable people – even if a topic is not on your radar, it’s a good way to learn something new.

Two posts we think are particularly worth calling out:

If ACA is repealed, how many will max out on restored lifetime coverage caps?

If ACA is repealed, how many are at risk of losing coverage by U.S. Congressional District? (Data covers 35 states)

Fresh Health Wonk Review posted at Joe’s place

Friday, January 27th, 2017

As we embark on the second week of a new administration, Joe Paduda has posted Health Wonk Review’s Inauguration Edition at Managed Care Matters. Rather unsurprisingly, the Affordable Care Act is much on the minds of the wonks, so there’s quite a few posts dealing with various aspects of repeal and replace.

Related to the topic of this week’s health wonkery, Joe also has a post on his blog about how the demise of the ACA would impact workers comp, specifically. A key quote:

“If ACA is repealed without a simultaneous and credible replacement, we may well see a rise in the number of workers without health insurance. The key issue to track is a cutoff of funding for Medicaid expansion – ACA added about 13 million more employed people to the insured rolls; if they lose coverage they’ll need a different payer to cover their injuries. Bad news for workers’ comp.”

And we’d point you to one other not-to-miss post at Managed Care Matters – Beware of Astroturf, the infuriating story of the American Pain Foundation, an pharma industry sponsored opioid-peddling outfit masquerading as a patient advocacy organization.

2016 White Paper Evaluates Commonwealth Care Alliance

Monday, July 18th, 2016

In April, 2016, I authored a post about Commonwealth Care Alliance (CCA), a Massachusetts HMO dedicated to serving the Dual Eligible population. Duals qualify for both Medicare and Medicaid, and CCA has been the nation’s incubator for how to do that. The Boston-based HMO operates a Senior Care Option plan for Duals over the age of 65 and an Affordable Care Act demonstration project, called One Care, for Duals younger than 65. I’ve been a CCA Director since its inception in late 2003.

Now, with the support of the Robert Wood Johnson Foundation, JSI Research & Training, Inc., has published an extensive evaluation of CCA’s visionary and groundbreaking efforts to treat the nation’s sickest of the sick and poorest of the poor.

In JSI’s words:

The provisions in the ACA were designed to achieve the Institute of Health Improvement’s Triple Aim of improving patient experience of care and the health of populations while reducing the overall cost of health care.

The 22-page White Paper’s thrust centers around CCA’s “Social ACO” model of care. JSI describes the Social ACO approach this way:

These approaches are based on the idea that improving health and cost outcomes of vulnerable populations will necessitate incorporating health, behavioral health, and social services into the ACO model. Social ACOs serve populations with complex and often unmet social and economic needs that impact health outcomes and health system utilization, including needs related to housing, food security and nutrition, legal assistance, employment support, and/or enrollment assistance.

As I noted in April, Duals represent only 4% of the nation’s population, but consume 34% of its health care dollars. They present a societal problem begging for a solution. The Affordable Care Act offers revolutionary innovators like CCA the chance to prove their worth. So far, as the JSI paper suggests, CCA’s approach is spot on. Here’s JSI’s conclusion:

As a pioneer of the social ACO approach, its (CCA’s) story offers insights into the factors and processes that promote successful realization of the Triple Aim for other emerging ACOs focused on complex patient populations.

Payment and delivery reform promises to transform care for the nation’s most vulnerable citizens. This is needed more than ever given rising healthcare costs and continued fragmentation of the care system. CCA’s social ACO model represents one approach to caring for some of the highest risk populations, though even this approach has had to be adapted extensively for the dual-eligible population under 65. Given its longevity of refining a care model, a global capitation payment model and a culture of innovation to care for high-risk, vulnerable populations, CCA’s experience is relevant to any provider organization seeking to transform care for high-risk populations.

Achieving the Triple Aim of improving the health of America’s dual population while lowering the cost of doing so is a rabbit-out-of-the-hat trick of the first order, but, at least to this point, Commonwealth Care Alliance seems to be onto something that will do just that.

One final thought: On the eve of our two presidential conventions, it would be nice if, at some point in all the bloviation, a cogent discussion regarding health care were to be had. And I’m talking about something other than, “On Day 1 we’re going to repeal Obamacare.”

But I wouldn’t bet on that happening. Would you?

Today’s must-read at Health Affairs Blog

Thursday, June 16th, 2016

ha-mastheadHWR

Get your health policy reading while it’s hot: Chris Fleming has posted A Pot Luck Health Wonk Review at Health Affairs Blog. The biweekly best of the health policy blogosphere usually includes many posts of interest – but this week’s edition seems particularly varied. Maybe because the health wonkers are going to take a bit of a summer hiatus – after this issue, we’ll only be up once a month in the summer, so get your fill of wonkery now.

If you are interested in health care news, then the Health Affairs Blog should be top of your reading list. It’s an adjunct of the prestigious Health Affairs, a  peer-reviewed journal of health policy thought and research. The blog regularly features commentary and analysis from noted health policy experts from a wide variety of perspectives, as well as regular Health Affairs contributors and staff. Health Affairs Blog has been cited in congressional testimony and by members of Congress. Media outlets that have cited the Blog include The New York Times, Washington Post, Forbes, National Journal, Reuters, and many others.

Please join us for a HWR Blab (video conversation / text chat), Health Wonk Review On Air With HealthBlawg Tuesday, 06/21/2016 at 1:00 pm ET for half an hour. You can watch from here or sign in to Twitter account to log in.

New Health Wonk Review at Boston Health News

Friday, May 20th, 2016

Cambridge, Massachusetts-based health and science journalist Tinker Ready hosts the current edition of Health Wonk Review at her Boston Health News blog: The Health Wonk Review: HIT, LGBT and ACA. Check it out! It’s an eclectic edition covering a cornucopia of health policy topics.

And please join us for a HWR Blab (video conversation / text chat), Health Wonk Review On Air With HealthBlawg Tuesday, 05/24/2016 at 1:00 pm ET for half an hour. You can watch from here or sign in to Twitter account to log in.

New Health Wonk Review at Wright on Health

Thursday, May 5th, 2016

Check out the latest & greatest from the web’s noteworthy health policy pundits: Brad Wright has posted Health Wonk Review: Pivoting Towards the General Edition at Wright on Health. We’re 186 days away from the election but his edition is complete with hilarious photos of our next president so you’ll want to check it out.  Lots of good posts, too, from the usual suspects.

Please join the wonkers for a new multimedia experience (video conversation and text chat), Health Wonk Review On Air With HealthBlawg Tuesday, 05/10/2016 at 1 pm ET for half an hour. Watch it live here or click to login via Twitter.