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De-ranged: 2015 Health Care Cost and Utilization Report (HCCI)

De-ranged: 2015 Health Care Cost and Utilization Report (HCCI) | Apropos health care | Scoop.it
Health care spending averaged $5,141 per individual in 2015, up $174 from the year before.
Out-of-pocket spending rose 3.0 percent in 2015, to an average of $813 per capita.
Greg Judd's insight:

I like Health Care Cost Institute.

 

But I'm not a fan of health care cost averages. So if you MUST make average costs your report's centerpiece, at least supply information on the RANGE of those costs, so that, y'know, people interested in the data could determine how useful - or not - those average figures might be for helping them know what's really going on.

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Here's a health care reform: Leave it to patients first

Here's a health care reform: Leave it to patients first | Apropos health care | Scoop.it
This week, ICER is targeting psoriasis medicines. It is all but certain to recommend that patient investment is too expensive, that reductions are necessary – but that patient access will be unaffected.
Greg Judd's insight:

I doubt many DO miss it, but this is Beaver Cleaver defending untrammeled drug pricing, rather than any kind of value-focused health treatment strategy. 

He tells a good human-interest story - and gee, that's swell, Wally - but rolling over for drug company prices (though he tries to make health insurers the Eddie Haskell of the piece) is what this is all about.

 

But this post isn't about all that.

 

It's about my freedom to post a health strategy & innovation entry headlined by Beaver Cleaver. Because who doesn't live their lives waiting and hoping for the opportunity to do just that?

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A Doctor Shortage? Let’s Take a Closer Look - NYTimes.com

A Doctor Shortage? Let’s Take a Closer Look - NYTimes.com | Apropos health care | Scoop.it

...there is strong evidence we are thinking about this the wrong way....we fail to recognize that what we really have is a distribution problem....

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Because who can resist working "medication creep" into a headline? | Patients are often the victims of medication creep

Because who can resist working "medication creep" into a headline? | Patients are often the victims of medication creep | Apropos health care | Scoop.it

....In an attempt to reach target numbers, there is a natural tendency to escalate doses and add medications. Often, we as clinicians fail to evaluate whether a prior therapy was effective, and to stop it if it isn’t.

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Side effect of low sample size: confirmation bias | What side effects? Most consumers don't read drug risk information

Side effect of low sample size: confirmation bias | What side effects? Most consumers don't read drug risk information | Apropos health care | Scoop.it

....A recent study found that, while about 80 percent of those viewing risk information for a fictitious allergy drug claimed to have read at least half or more of the warnings, an eye-tracking tool found they actually read little to none of the cautionary material on a product website.....

Greg Judd's insight:

Study assessed the habits of 29 script recipients. Interesting & kind of predictable outcome, but Id need lots more instances to be convinced of the results.

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How do you do (it) | PokitDok takes on Pharmacy Claims and Eligibility

How do you do (it) | PokitDok takes on Pharmacy Claims and Eligibility | Apropos health care | Scoop.it

...In addition to filing claims, Pharmacies use NCPDP to gain information about their customers’ benefits, like whether a particular drug is covered on their plan or whether prior authorization is needed.  There is an NCPDP message called a “Predetermination of Benefits”, also called a D1, which is designed to transmit this kind of benefit information, but unfortunately we have not found anyone that supports it.  

 

What pharmacies have to do to get this information is submit a claim (a B1 message) and quickly reverse it (a B2 message).  If the claim gets paid out, then clearly the drug was covered and the out-of-pocket cost is discovered.  Otherwise, if the claim is rejected, issues like prior authorization will surface in the rejection message. It’s a bit convoluted in a way that Tweedledee would appreciate, “Contrariwise, if it was so, it might be; and if it were so, it would be; but as it isn't, it ain't.” 

Greg Judd's insight:

Cap-tip to Chilmark's John Moore, from whence I learnt of PokitDok's project....

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Size ISN'T everything | Are micro-hospitals the next big trend in health care?

To date, micro-hospitals are launching in just a few states: The SCL Health Community Hospital-Southwest facility opened in Denver earlier this year. Dignity Health opened a micro-hospital in Phoenix last year and plans to open more in the coming years. St. Elizabeth Hospital in Wisconsin has also launched micro-hospitals centered around a Clinical Nurse Leader who works to coordinate services.

Analysis: The move from volume to value in health care and the increased attention to consumer demands for convenient, accessible care may be shifting the landscape. The growing interest in micro-hospitals is likely in part connected to the shift toward providing more care in outpatient settings.
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US healthcare sector is WAY tertiary. Too many of those talking about changing it are too quaternary. Discuss

US healthcare sector is WAY tertiary. Too many of those talking about changing it are too quaternary. Discuss | Apropos health care | Scoop.it
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The CTO of HHS is neither 'illegal' nor 'sneaky'. discuss | How the illegal, sneaky can inspire healthcare innovation

The CTO of HHS is neither 'illegal' nor 'sneaky'. discuss | How the illegal, sneaky can inspire healthcare innovation | Apropos health care | Scoop.it

 

...Fox talked about herself and Todd Park, who co-founded athenahealth but was also HHS’ chief technology officer, as part of a “rebel alliance” that brought the entrepreneurial spirit to the department and began talking about open data, innovation and prize competitions.

 

The same spirit makes her eyes light up when she talks about the Maker Movement in healthcare and her efforts to shine the light on their efforts within HHS.

Greg Judd's insight:

**Readers, please note: I am not a lawyer, have no legal training, am neither equipped nor credentialed to make authoritative legal judgments on any topic, much less the subject of this article. 

Which puts me on the same solid ground as the authors of the piece, and those quoted in it, with respect to identifying behavior as illegal, and maybe even as sneaky..**

 

Uber & AirBnB - going in, definitely illegal. Jon Bush/athenahealth? Well, his/athena's "illegality" may depend on which statutory lenses you happen to be appraising him/it through, and when....

 

But Suzannah Fox? Not illegal. Nor 'sneaky' (unless you count her being CTO when she's, let's admit it, not really 'technical'). She's not really even edgy.  

 

Suzannah Fox has l long been a canny & not-to-be-missed observer & synthesizer of the emerging importance of communications tech for making health care - particularly health care in the US - more systematic. And wow can she network. But as HHS CTO, she's been ... functional, mostly because, let's admit it again, the role permits about that much.

 

"Illegal" and "sneaky" are probably terms better applied to cults like Epic/Judy Faulkner, and not with any implicit faux-edgy, boomer-self-delusional meaning attached.... but I could be persuaded to wager that there won't be any Trojan-horsing around with the stranglehold that, say, Epic has on its markets, certainly not from a stable located within the DC beltway....

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Po(or)tential, maybe | Potential for Healthcare Kiosks in Improving Care Delivery (mHealthintelligence.com)

Po(or)tential, maybe | Potential for Healthcare Kiosks in Improving Care Delivery (mHealthintelligence.com) | Apropos health care | Scoop.it

....With kiosks, bigger does not always mean better — a lesson learned the hard way by HealthSpot, which emerged in 2012 with a high-tech, eight-by-five-foot, wholly enclosed room and went bankrupt in January 2016....

....“It was not a failure of concept,” Matt Stanton, Business Director for Telemedicine at the Cleveland Clinic, said following the company’s collapse. He said the kiosks met with initial success, but the health system gradually shifted its attention and resources to smaller, less complicated and more nimble projects, like mHealth apps and platforms.

In short, the kiosk looked great and did a good job giving the consumer a virtual checkup, but it was too much — consider the popular analogy of using a sledgehammer to pound in a nail....

Greg Judd's insight:

Over-invention is a classic peril for innovators/would-be entrepreneurs. Just because you can contrive and implement particular physical configurations for service delivery, does not mean either that you should, or more importantly that there is an economic market for such a configuration.

 

In general, the arc of health treatment's transformation is constructed on the spreading grasp of the idea that a very large part of "health care" is fairly simple information dissemination & use - and that simply bringing that information to where it can be used by the people who need it (patients and the people who care for them), rather than reformulating that place where care had always traditionally been delivered, is the more durable - if not the more capital-intensive - organizing principle.

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Blood Simple | The Dialysave: An Amazing Health Care Innovation by Anya Pogharian (Amazons Watch magazine)

Blood Simple | The Dialysave: An Amazing Health Care Innovation by Anya Pogharian (Amazons Watch magazine) | Apropos health care | Scoop.it
Greg Judd's insight:

Amy is obviously amazing. That a very bright & ambitious teenager was able to devise a 'commercial grade' health treatment device is actually less so. That the jarring economic reality (unspoken in this account) of Amy's accomplishment is met with shrugs is among the foremost challenges facing 

  • Health care innovators specifically
  • Legacy health treatment enterprises especially
  • Policymakers hoping to successfully cope with the immediate structural challenges confronting western economies generally

 

When the resource drain of the backbone of vital health treatments drops from $30,000 to $500 - when cars drive themselves - when retail delivery of desired goods literally comes from the sky - it cannot be only the clever entrepreneurs who concoct these hyper-low-labor-component wonders who are regarded as the owners of the revenue streams that may emit from them. "We" (however we come to define that group) ALL,in some elemental fashion, are owners - and that will mean significant changes in how we determine and defend allocation of rewards from both innovations like those, and from 'legacy' production processes as well.  It's not really a matter of 'if', but 'when', and 'how'.

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But may make your bulba sore | Pokémon Go shows there is a better way to promote healthy behaviors

But may make your bulba sore | Pokémon Go shows there is a better way to promote healthy behaviors | Apropos health care | Scoop.it
stories like the Pokémon Go phenomenon show us that large-scale changes in healthy behaviors — like physical activity — are possible if we are more creative in how we encourage them.
Greg Judd's insight:

Sunday funnies...?

 

But no, seriously, putting better health behaviors "in the water" (or in the neighborhood) is basically the way for us to do it

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Practice makes imperfect | Retail Clinicians Prescribe Antibiotics More Appropriately Than Primary Care Providers

Practice makes imperfect | Retail Clinicians Prescribe Antibiotics More Appropriately Than Primary Care Providers | Apropos health care | Scoop.it

The society’s recent study, published in the Journal of Internal Medicine, draws attention to the large disparity in antibiotic prescribing across different care settings—specifically, primary care providers’ offices and retail clinics....

 

...In the study, clinicians in retail clinics prescribed significantly more antibiotics than primary care providers, but had a lower imperfect antibiotic prescribing rate. This supports prior work suggesting that retail clinic staff are more likely to provide guideline-concordant care....

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Who Care(Flow)s? | How pharma companies can better understand patients | McKinsey & Company

Who Care(Flow)s? | How pharma companies can better understand patients | McKinsey & Company | Apropos health care | Scoop.it
Consumers have access to more healthcare information than ever. Here’s how pharmaceutical companies can better understand the way people make decisions about their care.
Greg Judd's insight:

I missed this piece when it was first circulated back in May.

 

But I don't think I missed much.

 

If "[a] CareFlow maps a patient’s journey from the first awareness of a problem to treatment, examining the factors guiding their decisions at each stage", why does it leave out the fact that some fraction of the time - my guess is it's MOST of the time - a person detours after "gathering information" to "figures out a remedy, if any, on their own, maybe after consulting with family/friends/loved ones/the mailman/etc". Why would McKinsey not address this in their magical diagram, & simply show a linear path to "seeks professional help" - especially after throwing shade on linear models practically in the previous paragraph?

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Surprise! Insurance Paid the E.R. but Not the Doctor

Surprise! Insurance Paid the E.R. but Not the Doctor | Apropos health care | Scoop.it

....New research published in the New England Journal of Medicine on Wednesday found that more than one in five patients visiting the emergency room [and]...went to a hospital covered by their plan still received a bill from a doctor who was not in the insurance company's network [of treatment providers]....

Greg Judd's insight:

And presumably a reasonable fraction of those surprise bills were for a portion of the 30% of ER visits that were not clinically necessary in the first place, and could have been handled in walk-in clinic facilities, or avoided altogether....

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Not so much reviving as repurposing... | Reviving House Calls by Doctors

Not so much reviving as repurposing... | Reviving House Calls by Doctors | Apropos health care | Scoop.it

Especially when treating the aging, house calls can benefit doctor, patient and the nation’s health care budget...

 

....One study from 2014 found that for frail elderly people, house calls saved Medicare $4,200 per person per year....

Greg Judd's insight:

...repurposing because, well, those house calls are now taking place for overlapping but not at all equivalent purposes as housecalls took place decades ago....$4,200 covers the annual  health treatment costs for over 15 people among the 50% of the population (all ages) who consume just 3% of total US health care spending....

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Take 40 of these and bill me in the morning | 40+ Drugs to Be Dropped By Insurance (The GoodRx Prescription Savings Blog)

Take 40 of these and bill me in the morning | 40+ Drugs to Be Dropped By Insurance (The GoodRx Prescription Savings Blog) | Apropos health care | Scoop.it

....Notably, Caremark will no longer cover Lantus, one of the most popular insulin brands.

Caremark is the first provider to restrict brand name drugs like Neupogen or Lantus that have (or will have) biosimilars available next year. They are suggesting Zarxio in place of Neupogen, and Basaglar in place of Lantus.

Express Scripts, in contrast, haven’t restricted coverage for either Lantus or Neupogen yet, but are maintaining that they plan to reassess based on upcoming product launches over the next year.....

Greg Judd's insight:

I missed this posting back in August....still relevant, and not broadly understood, especially by people evaluating health coverage choices for themselves and their families for 2017

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Pipeline To Profits: How Drug Middlemen Make Their Money

Pipeline To Profits: How Drug Middlemen Make Their Money | Apropos health care | Scoop.it
Greg Judd's insight:

Nifty - and huge -  infographic on the topic (wasn't aware people were still creating these)

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Run for your (lower) life (insurance rate)! | Life Insurance for Runner - Health IQ

Run for your (lower) life (insurance rate)! | Life Insurance for Runner - Health IQ | Apropos health care | Scoop.it
Get your special rate term life insurance for Runner with Health IQ
Greg Judd's insight:

Wasn't sure where or how to post this - it's an ad, sort of, but one presenting a health-related premium break I haven't seen before (caveat: I don't get around much anymore)....

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City sites | From home visits to new clinics, Puget Sound-area providers 'Uber-izing' healthcare

City sites | From home visits to new clinics, Puget Sound-area providers 'Uber-izing' healthcare | Apropos health care | Scoop.it

In Seattle’s Roosevelt neighborhood, a new urgent care clinic called CityMD has just opened.

 

...Franciscan Health, which partnered with New York-based CityMD to bring the first of what will be a number of clinics to the Puget Sound region....

 


What makes CityMD different is, unlike other urgent care clinics, it’s staffed by board certified physicians you’d normally only find in an ER or your doctor’s office.

Greg Judd's insight:

ANOTHER thing that makes CityMD different - from, say, local-to-Seattle health innovator ZoomCare - is that until now CityMD had confined itself to the friendly confines of New York State - and mainly to the 5 boroughs of NYC. And now, it chooses to go 'nationwide' with an outlet practically in the waiting room of an obvious potential competitor....

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"Solutions" so obvious they make a grown man cry | Uber, Lyft busy chasing healthcare market sans smartphone

"Solutions" so obvious they make a grown man cry | Uber, Lyft busy chasing healthcare market sans smartphone | Apropos health care | Scoop.it

...CareMore Health Plan...showed that its collaboration with Lyft led to a reduction in patient wait times by 30 percent (12.5 minutes to 8.7 minutes) and cut per-ride costs by 32.4 percent ($31.54 to $21.32)....[p]atient satisfaction rates was sky-high: more than 80 percent....

 

...About 3.6 million Americans miss or delay care because they lack transportation to their medical appointments, according to the Community Transportation Association. Medicaid spends about $3 billion a year on transportation,

Greg Judd's insight:

Is anyone really surprised there was money laying around waiting to be scooped up off the ground by providing more systematic medical transportation not siloed within health system operating hierarchies? 

 

A renowned health care innovation guru once observed that "70 percent of success in life is showing up".

 

No, wait - that was Woody Allen....

 

 

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Dial M for Medicine

Dial M for Medicine | Apropos health care | Scoop.it

....Amazon and Uber have shown consumers that you can get whatever you want whenever you want it, and all you need is your phone. Health care, the industry that could make the greatest impact with this customer-centric model, has finally begun to adopt it....

 

 

...In 2015, a third of employers offered telehealth services to their employees. About 50 percent of those who weren’t offering the benefit plan to this year. ...

 

....In a study of Medicare beneficiaries with chronic disease — these are among the most expensive patients in the U.S. — those who incorporated telehealth into their care saw a cost reduction of 7 to 13 percent. That’s about $1,200 to $2,170 in savings a year....

 

 
Greg Judd's insight:

No genuine surprises, but a well-written summary of the state of the teleclinician visit art, in what looks to be a soundly-edited online health issues publication.

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(Phone) # NOT Needed to Treat | On-Demand Healthcare Platform | TreatMD®

(Phone) # NOT Needed to Treat | On-Demand Healthcare Platform | TreatMD® | Apropos health care | Scoop.it
TreatMD.com is an International Telemedicine and On-Demand Healthcare Software Platform. Telemedicine video, patient charts, eprescribe, and submit electronic claims for telemedicine reimbursement.
Greg Judd's insight:

 MedCity News' story on TreatMD captures Treat's proposition more succinctly than Treat does itself: 

 

  1. Global teleclinician visit platform - not just for  doctors or patients in the USA;

  2. Clinicians set their own rates, and presumably many of their service terms

 

So, every doctor a teleclinician - if, and as, they choose to be. Seems both audacious and not especially well protected from potential competitors - but is barrier to entry still a thing for telecom-based business concepts?

 

Among the pros are putting the treatment provider in control - which is also a performance standard complicator for prized "bulk services purchasors", like employers or health systems.

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Sounds like an innovator's Rx | Retail clinics seek to move away from just treating minor maladies

Sounds like an innovator's Rx | Retail clinics seek to move away from just treating minor maladies | Apropos health care | Scoop.it

....NPs in retail clinics have to make better use of technological advances so they are not just working in the isolation of their particular facility....[T]hey must also meet the patient-satisfaction challenge of delivering “an experience that delights” consumers....

Greg Judd's insight:

Worth noting the isolation is not merely from clinical community but also from patients' informal & formal support teams (family, friends, loved ones...), and that part of the "technology" solution has to do with the "technology" of the legal/regulatory infrastructure that constrains communication, mostly by making sharing consent much more difficult than it is with, say, Facebook or Instagram....

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Tutally agree | Atul Gawande: for the first time in human history, ineptitude is a bigger problem than ignorance

Tutally agree | Atul Gawande: for the first time in human history, ineptitude is a bigger problem than ignorance | Apropos health care | Scoop.it

I am drawn to these really mundane things like hand-washing. It’s 2 million people who pick up infections in hospitals and 900,000 people who die from those infections, and most of them would be prevented if they washed their hands correctly....

 

....We make a lot of mistakes all the time. There’s enormous gains that come from just reducing some of these mistakes enough to knock it down 10 or 15 percent....

Greg Judd's insight:

My prediction: this is one of the most worthwhile health care innovation articles you will read in 2016. Pair it with the single most important chart in all of US health care, and your work here is done....

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