Health for life

Joe Paduda of Managed Care Matters is hosting the latest "Streaming" Health Wonk Review.  If youre interested in technology, CMS, health orm, mainstream media and the influence of money, there is something here for you.

Enjoy!

The bloggers are really swarming in the latest Health Wonk Review.  While the mainstream news pasteurizes the progress of health care orm, Sarah Sonies and Jennifer Salopek of Wing of Zock brings insights and occasionally contrarian perspectives from around the web: aging immigrants, medical device gamesmanship, insurance rate (non)sticker shock, the insurance subsidy miasma, the real IRS problem and the possible unintended consequences from messing with solid organ transplant rules.  Hey, if no one else is going to look at these issues, why not us bloggers?

Enjoy!

Wright on Health is hosting the latest Health Wonk Review with an interesting line up of bloggers on either side of the Presidents assurances about keeping your health plan.  Given the spectrum of insights and opinion, the Disease Management Care Blog declares this latest Review .....a keeper!

Enjoy!

"Baseball isnt boring, you are!" goes the adage. While the DMCB struggles with the implications of that, the Wing of Zock has a baseball-themed Health Wong Review that certainly isnt boring.  Whats more, after you read all the submissions of other health policy bloggers, youll be more exciting.

Enjoy!

How can you reconcile all this seasonal merriment with your need to achieve one or two more days of productive learning?

Easy, says the Disease Management Care Blog.  Head on over to the Workers Comp Insiders "Holiday Edition" of the Health Wonk Review.  Health insurers arent following the ACA script, pharmas bad behavior shows no sign of abating, expert mandarins continue to plot transformizations, Medicaid continues to vex and stymie and Santas workshop is in serious need of insurance.

And thats only a sample.  Much more can be found here.

Enjoy!

Please join the Disease Management Care Blog in welcoming Wing of Zock to the pantheon of bloggers that have hosted the Health Wonk Review.  They must be really happy to have joined that elite group, because theyve dubbed their just posted collection of wise bloggery links as the "Shiny Happy (Mostly) Edition."

Enjoy!

A host of brainy insightful posts awaits you at the Spring Hath Sprung edition of the Health Wonk Review, ably hosted by Hank Sterns Insure Blog.  Theres contrarian stuff here you wont find anywhere else.

Enjoy!

Even the Disease Management Care Blog was wowed by Bubbas winning slice out of the rough during the recent Masters sudden death round.  Youll be wowed by all the links to the latest insights that health wonk bloggery has to offer at Brad Wrights "Masterful" edition of the Health Wonk Review.  Read it an your health policy chops will be strokes ahead of the competition!

Enjoy!

The Disease Management Care Blog votes for David Williams latest version of the Health Wonk Review at his election themed "October Surprise Edition."  His Health Business Blog has lots of links to both sides of the health orm debate plus some other timely bloggy insights.

Enjoy!

A Festival of Lights and Insights awaits you at the latest Health Wonk Review.

This edition is hosted by the unsinkable Hank Stern over at the InsureBlog. You can learn about latke, the IOM, dreidls, cuts to graduate medical education, chanukiahs, premium taxes, sufganyot, deductibles, fried chickpeas and whether "Oy Vey!" is a good toast if youre drinking Aquavit.

Enjoy!

OK... its not THAT new.  But there is a great compendium of recent posts that has been assembled by the Center for Objective Health Policy.  There are some great links to topics on health orm, insurance and policy.

Enjoy!

Tis the season for elections, so the DMCB votes for the Campaign 2012 Edition of the Health Wonk Review hosted by the Colorado Health Insurance Insider.  Enjoy!

The Disease Management Care Blog (DMCB) welcomes readers to this edition of the Health Wonk Review. The DMCB is a physician-writer with knowledge and experience in primary care, health insurance, population health and health information technology. Thats why its delighted to host this compendium of recent writings from the best health policy bloggers offering insights you wont find anywhere else. Read this and the DMCB assures your Huff Po addled colleagues will admire you and your USA Today reading opponents will envy you.

For example, this HWR has a conservative who actually likes health insurance exchanges and a progressive who is disappointed with a key aspect of the Affordable Care Act. Theres also a unique description of an important collaboration among competing commercial health insurers and a thoughtful discussion of the downsides of preventing HIV infection.  Youll also find a detailed report on how the evening news blew the coverage of an important cancer screening guideline update.

And dont be put off by the wide ranging number of posts.  Read what captures your interest, follow the links and come back as often as you like.   The DMCB will leave the light on for ya.

HOSPITALS

Hospital Quality

Most readers of this Health Wonk Review are undoubtedly sophisticated and dispassionate experts on hospital quality, consumerism, patient satisfaction and outcomes.  Well, Neil Versel of the Meaningful Health IT News blog shows us how that learning contrasts with watching a terminally ill loved one with Multiple System Atrophy struggle with distant physicians, medication errors, incomplete care planning, lack of basic health services, ignored advance directives and occasional Keystone Kops style encounters with health workers who should know better.  And we wonder why Americans are so fed up with the U.S. health care (non) system?  Egads, says the DMCB.

A Medicare Hospital Measure Called "MSPB"

Speaking of hospitals and quality, CMS has started to publicly report peri-hospitalization health care costs using a metric called the Medicare Spending Per Beneficiary (MSPB). According to Jason Shafrin of the Healthcare Economist Blog in this post titled "Measuring Hospital Efficiency," Medicare is now reporting a roll-up of all payments made to docs and the facility three days prior, during and 30 days after a hospital stay. Non-surprisingly, some areas of the country have much higher MSPBs than others. Yet, despite its merits, Jason reports that the measure is not without controversy because we dont know enough about the link between the MSPB and outcomes (does more spending result in high quality?) or if reported higher costs were the the result of waste (for example, unnecessary or redundant testing) versus additional necessary care (perhaps extra days in a rehab facility after discharge were worth it).   The one thing the DMCB does know is how necessary it will be to use the acronym "MSPB" the next time it steps up to a microphone at a health policy confab.  It cant wait.

"Observational Status"

When is an admission to the hospital not an admission?  Thats the conundrum tackled by Dr. Brad Flansbaum of The Hospitalist Leader blog, who helps the reader understand how hospitals use their inpatient facilities to treat outpatients. The key distinguishing factor is a limited 24-48 hour course of care that is aimed at returning the patient home.  Unfortunately, outpatient care is covered with an outpatient insurance benefit that can include significant out-of-pocket expenses.  Medicare has policies that require providers to inform beneficiaries of the financial impact of being in "observation status" but as the line that separates inpatient and outpatient care continues to be blurred, its likely well have to wait for global payments or shared risk arrangements to reconcile patient coverage expectations and billing systems.  Until that happens, Brad has quotes a Medicare official who assures us that CMS is "considering caully how to simplify the rules in a way that best meets the needs of patients and providers without increasing costs to the system."  Right.

HEALTH SYSTEMS

Accountable Care Organizations

While the mainstream focuses on Medicares ACOs (for example), Blue Shield of California, CalPERS, Hill Physicians Medical Group and Dignity Health quietly partnered back in 2007 on a shared savings program that apparently resulted in a noisy $20 million in savings.  Glenn Melnick and Lois Gree over that the Health Affairs Blog have authored an interesting interview-narrative about this initiative that is full of interesting lessons. These lessons include the importance of physician buy-in and participation, a system-wide working familiarity with old-fashioned capitation, a supportive pre-existing provider culture, an emphasis on reducing readmissions, using wellness to reduce use of pricey bariatric surgery services, data liquidity, increasing use of evidence-based guidelines at the point of care, patient "repatriation" from non-participating care settings, data dashboards and empowering non-physicians to engage patients in self-care.  The California HealthCare Foundation has committed to completing a full evaluation of the outcomes next year. The DMCB commits to using some new health policy jargon it discovered in reading this post: "actualize" and "head in a bed."

"Charismatic Leaders"

Roy Poses of Health Care Renewal continues to expose the folly running rampant in the U.S. health care system, this time by looking at the "CEO as False Messiah." Dr. Poses cautions readers to pause any time they run into local or national leaders who are uncritically hailed as "visionary."  Its far more likely that their fawning admirers have been seduced by a toxic level of charisma that often leads to catastrophe.  Get real, advises Roy, and admire such folks for being smart while keeping a skeptical eye on their ability to produce results.

PROVIDERS

The Doctor-Patient Relationship

David Williams of the Health Business Blog uses a Health Affairs article on "shared decision making" to lect on the upsides of being labelled a "difficult patient."  Researchers found that an important barrier to forming a doctor-patient relationship is the fear among health care consumers that expressing a perence will annoy their doctor.  David argues thats not such a bad thing, especially since modern consumers now have the option of seeking a second opinion, getting another doctor and ultimately using a questionable treatment. The DMCB really agrees with Davids perspective because it wants to be liked by him.

DRUGS

HIV Prevention Is Good News, Right?

 Nate Ogden of the InsureBlog walks readers through a fascinating exercise on the costs and ethics surrounding the FDAs approval of HIV-prevention drug called "Travuda." While readers may initially want to hail this medical breakthrough, Nate suggests its not so simple: 1) the retail cost of the drug is $11,000 a year, which a) contrasts with the $30 a month cost of equally effective condoms and b) would be enough to treat 20 HIV positive patients, 2) persons taking the drug may misuse their new found protection and paradoxically engage in increased risk-taking sexual behaviors and 3) coverage may be mandated as an insurance benefit, which means therell be one more driver of health care costs for all of us.  Another silk purse turned into a sows ear, says the DMCB.

Would You Like Some Drug Monitoring Along With That Refill?

Never at a loss for words, Joe Paduda of Managed Care Matters takes umbrage with Missouri State Senator Robert Schaafs opposition to the states "Prescription Drug Monitoring Program Act." Joe argues that the act would reduce the incidence of drug-drug interactions and lessen prescription drug abuse through doctor shopping.  Without passage of the bill, says Joe, kids will lose their moms, Scout troops will have to meet without their den mothers and schools will have teacherless classrooms.Dr. Schaff, who by the way is a family physician and leads a prominent physician liability insurance carrier, has a different perspective. The DMCB predicts the Senator will not find Joes disapproval very compelling.

HEALTH INFORMATION ANALYTICS

Health Insurer Data Mining

If its one thing that Medicare has done better than the commercial insurers, its making its claims data available to health services researchers.  The DMCB suspects that the commercial insurers have been reluctant to do so because of the considerable effort involved, concerns about inadvertently running afoul of HIPAAs unwieldy confidentiality provisions, giving their competition otherwise confidential information about payment rates and the lack any relevant value propositions. According to Martin Gaynor at the curiously named Wing of Zock Blog, those barriers have finally been overcome. Aetna, Human, Kaiser and United have all agreed to ship billions of lines of claims data to the not-for-profit Health Care Cost Institute which will make the deidentified data available to researchers.  The DMCB agrees that this is a significant development that will allow researchers to mine insights that, thanks to relatively low numbers of patients, non-generalizable health care settings and limited imagination, have been out of reach. The DMCB hopes the data will be made democratically available on as close to an "open source" basis as possible.

HEALTH INSURANCE

 Group and Individual Insurance Markets

Need a quick lesson on the fundamental differences between group and individual health insurance policies?  Louise over at Colorado Health Insider has a terrific "101" on health insurance guaranteed issue, mandates, underwriting, the role of high risk pools and the impact of Affordable Care Act. The DMCB recommends that everyone - except the White House - bookmark this page just in case were forced by the Supreme Court into a health insurance orm do-over. The White House is being given a pass by the DMCB because if that happens, no one will really care what they think.

Speaking of the Individual Market....

In case you think all progressives uncritically support the Affordable Care Act, Maggie Mahar at the healthinsurance blog inconveniently points out that a big part of the individual health insurance market will remain broken come 2014. Maggies post offers up some compelling statistics that demonstrate that many middle aged boomers (yikes, including the DMCB) who are between ages 50 and 64 years wont meet income thresholds for subsidies.  As a result, theyre looking at the prospect that health insurance premiums could reach an unaffordable average of $7500 a year. Combine that with a lackluster job market, declining incomes and substantial out-of-pocket costs and it is clear that health orm will remain a contentious, time-consuming and difficult work in progress for years to come. In the meantime, the DMCB will wonder about the affordability of essential benefits, the merits of value-based insurance designs, how population health-based care management can help blunt the impact of chronic illness and the wisdom of  using limits on age rating to shift costs to the DMCB spawn.

STATES

One States Perspective on Federal Health Reform

While Californias budget slides into the sea thanks to an unending budgetary earthquake, every dollar counts. Thats why Anthony Wright of the Health Access Blog points out that in addition to the patently obvious merits of assuring access, lowering costs and protecting consumers, the Affordable Care Act is also a windfall for the Golden State.  He quotes and links a California-based Bay Area Council Economic Institute report that calculates that the ACA will add close to a 100,000 new California-based jobs and $4.4 billion in additional state output.  Alas, says the DMCB, between the U.S. Supreme Court and less-than-expected taxable income from the disappointing Facebook IPO, it looks like fixing Sacramentos budget woes may need a Plan C.

How Should States Respond to Health Insurance Exchanges?

Conservatives hate those ACA-mandate insurance exchanges, while progressives love them, right?  And any Republican Governor that sets up an exchange under the terms of the ACA is a hypocritical closet-supporter of Obamacare? Is that so?  John Goodmans Health Policy Blog point-counterpoint posting teaches us that its not so simple.  It turns out that states 1) may fare better with or without the ACA if they maintain control over exchanges, 2) could use the flexibility that comes with control to make insurance exchanges more effective and fair, and 3) with that control will also have a say over the commercial insurance subsidies that will add up to gazillions of dollars.  Just in case you think Johns post is just a lot of hot air, check out this telling Pennsylvania-based Op-Ed.

WORKERS COMP

Links Between Workers Comp and Health Promotion

Many health care providers regard "workers comp" as something as a policy sideshow, but Workers Comp Insider Jon Coppelman shows us that this multi-billion dollar industry is not only a big deal but also not immune to the growing costs of our sedentary lifestyle. When a 50 year old fat ambulance workers stroke was blamed on a lower extremity paradoxical embolism resulting from hours of sitting, the lifelong care costs were ruled "compensible." Next stops are the diabetes-causing donuts on our way to work and the hypertension from those generously salted fries in the company cafeteria. Mr. Coppleman recommends early adjuster involvement in the claims adjudication. The DMCB wonders if the Workers Comp insurance industry should think about being more proactive, including using risk stratification and advocating for common sense health promotion.

WELNESS AND HEALTH PROMOTION

Wellness!  Gotta Have It!

No Health Wonk Review would be complete without one enthusiastic endorsement of all things wellness. Kat Haselkorn of Corporate Wellness Insights steps into that role with copious praise of all the benefits of health promotion, including positive culture change, huge returns on investment, enriched social networks and accelerating employee productivity.  Kat suggests that if just one person buys into wellness, the effect can ripple through the company faster than spandex-clad yuppies swarming at an after-work Zumba class.

Wellness!  Gotta Keep Funding It!

New blogger Tracey Moorhead of the Care Continuum Alliance writes in the Voice On Population Health Blog about the ill-advised willingness of the U.S. House to steal from the ACAs Prevention and Public Health Fund to extend coverage of student load interest subsidies. Tracey passionately argues the fund has already led to important behavioral health screenings, data infrastructure development and expansion of wellness services in multiple states. Whoa, says the DMCB, which isnt surprised at the Care Continuum Alliances advocacy on behalf of prevention and population health.  Good for them.

And Heres An Added Benefit of Being Fit?

Michael Gavin of the Evidence-Based blog notes that a recently published article in the medical journal Pain shows that athletes have a higher pain threshold.  From his point of view, this is why exercise should not only be promoted as an alternative to using dangerous drugs to control pain but as an added overall benefit from achieving maximum fitness.  The contrarian DMCB took a look at the abstract and wonders if persons who are naturally blessed with higher pain thresholds are attracted to exercise (or at the very least, find it less unpleasant).  While readers are figuring out which is cause and which is effect, they can also show their health knowledge chops by not only erring to exercise related "endorpins" but "endocannabinoids" as the basis for the runners "high."

SPECIAL POPULATIONS

Prisoners

Talk about a disenfranchised population. Suffering with highly prevalent rates of Hepatitis C, HIV and mental illness, huge numbers of released prisoners were being left to fend on their own. Harold Pollack, also of the healthinsurance blog describes how thanks to recently passed federal legislation, hundreds of thousands of these individuals will be able to qualify for Medicaid, obtain tax credits that can defray the cost of private insurance and access basic community-based health care services. While health orm is all about the single mom waitress with two kids, the middle America steel worker and the kid with end stage cancer, Dr. Pollack says we all benefit when ex-prisoners are also staying away from crowded emergency rooms, avoiding unnecessary hospitalizations and not burdening over-stretched safety net programs.

Geriatrics

IF you believe geriatric care is important, THEN you should read this post BECAUSE youll get to learn about the "ACOVE" framework. Thats the message the DMCB got after reading Chris Langstons post on the Quality of Geriatric Care over at the John A Hartford Foundation. It turns out that the Assessing Care of Vulnerable Elders is a handy IF-THEN-BECAUSE tool that identifies the specific health issues afflicting the elderly and targets geriatriccare planning. Chris argues wider use of ACOVE would increase quality of care in geriatrics and clarify the important differences between general medical versus geriatric conditions.

CODING

Hate ICD-10?

Heres another anti-ICD-10 rant, courtesy of a post by TBD Consultings Jonena Relth at the Healthcare Talent Transformation Blog.  She argues that veteran front-line health care workers are deeply skeptical about the ultimate value of the insurance billing systems astonishingly complicated specificity and detail. Jonena is concerned that the new coding will paradoxically lead to billing errors and enable greater health insurer mischief. Too bad there wasnt any credit given to the AMA for CMS decision to delay implementation of ICD-10 as well as the organizations continuing advocacy on the issue. As for the health insurers, the DMCB thinks that given the circumstances of a very hostile Administration and the luster of an ACA-driven enrollment windfall, they quietly came as close as they could to expressing concerns over the wisdom of ICD-10.

and last but not least.....THE NEWS DISAPPOINTS...AGAIN

Prostate Cancer Screening and the News Media

As risks, benefits and alternatives to cancer screening move into the public square, Gary Schwitzers HealthNewsReview blog offers up this balanced scientific review on the merits of prostate cancer screening by Richard Hoffman and this insightful description on how the mainstream news media made a mess of things. It turns out that the U.S. Preventive Task Forces recommendations werent really all that new, that a substantial number of physicians have been PSA skeptics for years and that early detection of prostate cancer - whatever its merits - is hugely remunerative to providers. As testimony to the news elites  selective inattention, ask yourself if you should thank Diane Sawyer et al for avoiding this new wrinkle on the topic of lung cancer screening.

Image from Wikipedia

Do you like data but have trouble turning numbers into insight? Tinker Ready of the Boston Health News shows us how its done with an interesting Health Wonk Review on data, medicine, insurance orm.

Enjoy!

You can look to the future with the latest Health Wonk Review, ably hosted by the Workers Comp Insider blog.  This is a summary of the latest and bestest of the health policy and "wonk" blog postings, with insights you wont get anywhere else.

Enjoy!

Want to get ready for St. Patricks Day?  The Disease Management Care Blog pers May 17 and aquavit instead of Guiness and blarney, it may change its mind after reading Boston Health News Health Wonk Review.  This is an assortment of blog-wisdom loaded with perspectives on health orm that you wont read anywhere else.  Check it out and reward your new insights with an extra beverage!

Theres right and wrong, but when it comes to health policy wonkery, you can also be Wright.  As in Wright on Health, which is hosting the latest Health Wonk Review.  This is a linked summary of the brightest bloggery for your reading pleasure.

Enjoy!

There is something for everyone at the latest Health Wonk Review hosted by David Williams of the Health Business Blog:  Obamacare will grow more popular, the Super Committee will utterly fail, its Obamney crap, shadowly right wingers are afoot, ACOs are a perfect prescription, the mainsteam media will never get it right etc etc etc,  Check it out and youre guaranteed to find something to agree with, further evidence of the nuttiness out there and why its not only fun but endlessly interesting to pay attention to what the bloggers have to say.

Modern political discourse

The Disease Management Care Blog had a Hurricane Sandy choice: either a) leave day before that early A.M. hospital procedure and stay with friends who live close by, or b) stay at home and make the long trip in the wind and the rain to the hospital that same morning.  The DMCB spouse turned to repetitive education to help the DMCB make the right choice.

Does that learning tactic underlie Obamacare supporter Maggie Mahars approach to the latest Health Wonk Review?  Thats what the DMCB thought when it read Maggies posting.

To help the thousands of health orm realists who make up the DMCB readership, Hurricane Maggie repetitively retreads the cost-control talking points from orm architect Peter Orszag, surgeon Golden Boy Atul Gawande and the White House Office of Management and Budget  Rest assured, says Maggie, if you selectively counter the DMCBs fiction with facts, youll realize Washington DCs solutions are the right choice.

The DMCB isnt too sure about that.

Maggie doesnt argue health care costs arent rising, only that the increases are less than widely claimed.  She credits Obamacare.  The Disease Management Care Blog agrees that cost trends are moderating, but it also credits a lackluster economy.
. 
Maggie says be of good cheer, because the increased costs are delivering correspondingly better value for the health care dollar. The DMCB says value remains an inexact science that is ill-suited to simplistic nostrums and blunt force laws and regulations. The latest examples of this conundrum include mammograms and annual check ups.  There are plenty of others like this.

Maggie points to Massachusettss Atul Gawandes brimming optimism about Massachusetts leading the way with risk and performance contracting as a cost-control panacea.  The DMCB awaits the arrival of hard macroeconomic outcomes data that proves the experiment works.  It also points out that the Bay States recently passed cost control legislation speaks volumes on what that states leaders really think about the savings-success of Romneycare.

Last but not least, not everyone on the blue side of political spectrum shares Maggies optimism.

By the way, the DMCB has received a cost estimate from the unnamed hospital mentioned above. That institution is the flagship part of a nationally recognized integrated delivery system that is a basis for much of Maggie Mahars enthusiasm. The DMCBs planned procedure coupled with OR charges and an overnight stay will result in charges, prior to discounts and contracted rates, in excess of $100,000.

For those of us with a lingering doubt that our political classs health orm sound-bites, nostrums, talking points and pronouncements will cut through all those inconvenient facts, the DMCB recommends this catchy tune.  Youll feel a lot better:



Image from Wikipedia

The Healthcare Economist Blog has a summary of the latest and best wonky health policy insights in the latest Health Wonk Review.  Dubbed The Health Wonk Review takes on Healthcare.gov, host Jason Shafrin offers users a two-fer: 1) information you cant find any where else and 2) a web site that actually works as advertised.