Archive for June, 2012

The Individual Mandate Will Still Leave Many Uninsured

Tomorrow is the big day, when the United States Supreme Court (“Supreme Court”) will decide whether or not the Patient Protection Affordable Care Act commonly known as the “Healthcare Reform Act” is constitutional, partially unconstitutional or completely unconstitutional. One of the main issues at stake is a foundational tenet of the Healthcare Reform Act to increase the number of individuals who have insurance coverage. In fact, one of the most controversial provisions requires for each individual citizen to maintain health insurance coverage unless an exception applies. Specifically, the individual mandate as set forth in the Healthcare Reform Act requires for individuals to pay a penalty to the United States Government in the event the individual fails to maintain health insurance coverage. The amount of the penalty increases each year from 2013 through 2016. These payments are paid as a penalty with the filing of individual tax returns. . However, even if the …

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Role of Clinical Integration in Question of Doctors’ Relevance

Recently, another columnist on this blog posed a very serious and very pertinent question that the healthcare industry has been facing for some time now.  The question relates to how the current evolution and changes of the fundamental healthcare delivery model is gradually moving physicians away from the center focus of that system.  This was posed in an article that Mr. Olsen alluded to from The Economist titled, “The Future of Medicine:  Squeezing Out the Doctor“.   Among other topics, the original article and Mr. Olsen on this blog continued to discuss the impact that technology is gradually having on the way healthcare is delivered, such that today much less of a patient’s primary point of care is exclusively provided by their actual physician.

One of the primary drivers that the original article discusses can be summed up with this quote:  ”To treat the 21st century’s problems with a 20th century approach to health care would require an impossible number of doctors”. …

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The SCOTUS Ruling and What Happens Next?

As the country is awaiting the Supreme Court’s ruling on whether they will repeal the healthcare reform law, politics around healthcare policy has continued to swell with speculation, projections and promises from both sides of the political aisle.  Meanwhile, the healthcare industry has mostly remained quiet, waiting for the ruling, which would likely determine the primary driver for future changes to our nation’s healthcare delivery system unlike any other that we have ever seen before in the last half-century.

A mid-June article in the Wall Street Journal noted that, “When the court rules […] the waves it sets off will be tricky for both parties to navigate.” This certainly appeared to be one thing that both Republicans and Democrats could agree on, as the parties’ leadership were trying to develop political strategies for all of the possible outcomes, resulting from the Supreme Court’s decision.

The majority of speculation prior to the ruling was that the Court would …

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The Affordable Care Act – Beyond the Individual Mandate

Among the more popular provisions is the extension of health insurance coverage for adult children through age 26.

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Sustainable Cost Reduction of Healthcare Delivery Requires an Aligned System

Healthcare providers from all setting of care (ambulatory, acute and post-acute) are feeling the constraints and reduction of healthcare reimbursement year over year. Reimbursement rates will continue to decline while healthcare demand grows. This is a burning platform requiring healthcare providers from all disciplines to look at their delivery and range of services, costs, utilization (supplies and resources) and associated clinical outcomes. The acute healthcare provider needs to take a leading role coordinating patient care across all the settings and help the delivery points of care (ambulatory and post-acute) understand their contribution, value, and associated costs. The acute care provider has the informatics and sophistication to measure the performance of each delivery point of care, provide feedback on clinical outcomes and associated costs. This information helps each organization assess their own practice patterns to make the appropriate adjustments in care …

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How do you get to Carnegie Hall?

An old joke: A tourist in New York approaches a woman carrying a violin case and asks, “How do you get to Carnegie Hall?” and the woman answers, “Practice, Practice, Practice!”

The new version of that joke goes how to we find the best way to get cost effective high quality health care. The punch turns out to be Experiment, Experiment, and Experiment. You could argue that United States has been conducting a variety of health care funding, financing, and delivery experiments for the last 100 years. We created a private health insurance market designed to mitigate risk selection while assuring the sustainability of hospitals. We developed public programs that both increased access for individuals shut out of the private market and increased financing for research. As costs increased we have experimented with a variety of forms of insurance that were intended to provide incentives for consumers and/or providers to seek and delivery cost effective care.

As a result of this …

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Health Literacy in Health Information Technology

In 1999, the American Medical Association reported that poor health literacy is “a stronger predictor of a person’s health than age, income, employment status, education level, and race”. A profound statement which I believe still rings true. Health literacy is defined  by the department of Health and Human Services as, “”The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” This is important considering that surveys show that up to 50% of patients walk out of their providers office not understanding what they were told are instruction about self management (orcamd.com). Let’s make it clear. Health literacy has nothing to do with your IQ. It is literacy as related to health information.

In the middle of “Health Information Technology” is the word “Information”. Information for whom? Information for all stake holders of the health system in a private and secure …

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Are Docs Less Relevant Today Than Ever Before?

The Economist came out with an article last week, “Squeezing out the doctor:  The role of physicians at the centre of health care is under pressure,” which argues that a physician’s traditionally exalted status in our society is weakening.  The authors cite the health of the world is changing in a way that may find many physicians unprepared.  First, with technology becoming a larger part of health, the role that doctors play may be diminished or shaped in a way that gives less flexibility in their decision-making (through automation, variation elimination through evidence-based medicine, etc.).  In addition, as it is reported that about half of American adults have a chronic condition, many doctors who are educated to address episodic care (broken legs, flu, surgery, etc.) lack the training to deal with chronic health problems like diabetes and asthma.

I found this topic very relevant and thought I would continue the conversation myself.  It is true that physicians are …

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Health Reform Regardless of the Supreme Court’s Decision

Legal experts and political pundits are filling the airwaves and newsprint with their thoughts on what will happen to federal health reform (ObamaCare) when the US Supreme Court rules later this month (NFIB v Sebelius). What will happen to the individual mandate? Will they strike down the entire law? What about insurance coverage for my 24-year old college student?

All that speculation aside, there are common sense reforms that are being implemented today — in the private sector — without 2,700+ pages of Congressional mandates.

Let’s pick three areas where we can make a difference NOW: 1) Accelerate a Patient-Centered Model of Care; 2) Support the migration to Health Information Technology (Health IT) by Physicians and Hospitals; and 3) Demand Disclosure and Transparency of Healthcare Quality and Price Measures.

We should accelerate the development of a patient-centered model of care. When providers put the patient at the center of the relationship and do what is in the …

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Connecting with Today’s Empowered Consumer

Technology is rapidly changing human behavior. With the rise of digital, social media, mobile devices and emerging technologies, our culture is changing more than ever before. And consumers are changing right along with it. Look no further than the emerging trend of today’s “empowered” consumer.

New technologies are enabling consumers to take a direct and engaged approach to their healthcare and wellness. According to the Pew Research Center, more than 80% of consumers use the Internet for healthcare related information. And social networks give consumers a platform for real-time, two-way communication. No more playing the waiting game, consumers are actively reaching out and engaging about their health. PwC’s recent survey found that 32% use social media outlets to connect with health organizations or with other people with similar health-care interests. And that number is rising daily.

Healthcare businesses need to take note of this trend. It’s not a fad; it’s here to stay. …

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