Let’s Increase Life Expectancy in America in 2018 – A New Year for Opioids, Social Determinants, and Financial Health

For this end-of-year post leading into 2018, I choose to address the big topic of how long we live in America, and what underpins the sobering fact that life expectancy is falling.

Life expectancy in the United States declined to 78.6 years in 2016, placing America at number 37 on the list of 137 countries the World Economic Forum (WEF) has ranked in their annual Global Competitiveness Report 2017-2018.

The first chart shows the declining years for Americans compared with health citizens of Australia, France, Canada, Finland, and the UK. While Australians’ and Britons’ life expectancies declined from 2015-16, their outcomes are still several years greater, at 82.5 for the Aussies (#10) and 81.6 for the Brits (#20).

The U.S. falls between #36, Qatar, and #38, Poland, in this analysis, below lower-income nations like South Korea (#12), Malta (#16), Chile (#18), and Slovenia (#29).

The WEF report talks about countries’ abilities to do business and mashes up dozens of data points, well beyond life expectancy. The Global Competitive Index is made up of factors covering institutions, infrastructure, macroeconomics, health and primary education, higher education and training, goods market efficiency, labor market efficiency, financial market development, technological readiness, market size, and innovation.

There are three sub-indexes that make up the big GCI: basic requirements, efficiency enhancers, and innovation and sophistication factors. Overall, the U.S. scores very high, #2, on the macro Global Competitive Index, just after Switzerland and before Singapore; good news, indeed, for business.

But you have to dive deep into the 393 page document, to page 326, to see the low performance of the U.S. in one specific sub-index which is what underlies America’s declining life expectancy and risk factors to living well: on the “basic requirements sub-index,” the U.S. garners the 25th spot on the list of 137.

What comprises “basic requirements?” we’re begged to ask. These pillars are shown in the second diagram on the left third of the chart: they are institutions, infrastructure, macroeconomics, and health and primary education.

Most of the datapoints underneath these pillars are social determinants of health: beyond health and primary education, macroeconomics set the context for health citizens’ financial wellness, job and income security. Infrastructure can bolster or diminish public health through clean (or dirty) water, clean (or dirty) air, safe and healthy physical built environments, and accessible and active transportation networks.

The U.S. performance on basic requirements improved at the margin in 2016, with the macroeconomic environment at a low of 83 out of the 137 world nations.

Health Populi’s Hot Points:  Thinking about the WEF “fine print” on basic requirements can help us understand what underlies declining life expectancy in the United States of America.

Most of the coverage of this statistic has been focused on the impact of the opioid epidemic in the U.S. A few others, rightly, point to obesity and the risk factors for non-communicable disease.

The U.S. is hardly “united” in this statistic: for people who live longer, it helps to be born and raised in a wealthier zip code, have access to better education and healthy food sources. A Lancet article published earlier this year, Inequality and the health-care system in the USA, noted that “widening economic inequality in the USA has been accompanied by increasing disparities in health outcomes.”

Overlay these new data from the U.S. Bureau of Economic Analysis (BEA) on personal consumption, credit card use, and declining savings rates among Americans. These stats were published on 22nd December 2017, so are current as of end-of-year 2017.

Americans’ personal income grew 3.8%, up from 1.5% a year ago. That sounds like good news; however, this was driven in major part by inflation, which increased in 2017 (blame that primarily on energy prices). Adjusted, people’s disposable personal income growth was only 0.88% after taxes and inflation.

Couple this with consumer spending, which may be topping out. Why? Because the personal savings rate in the U.S. hit a new low, falling to 2.9%, shown in the diagram. Based on this new low savings rate, consumers are turning more to credit to pay for consumption.

So credit card use is rising while personal saving is falling.

“The consumer is maxed out,” notes Eric Basmajian who so wisely parsed the BEA data. See this chart for which Eric arrayed the tax rates for OECD nations, from highest to lowest. Check out the U.S., second from the bottom, just above South Africa.

While income disparities continue to widen in the U.S., the Tax Cuts and Jobs Act signed by President Trump on 22nd December does not have as an explicit objective of redistribution of wealth from the very wealthy to the lowest-earning 20% of Americans.

Thus, the dramatic disparity between rich and not-so-rich, at the root-of-the-root of declining health in America, will persist into 2018.

Filter this personal economic data through a health care lens. Most Americans live paycheck to paycheck to make ends meet, a CareerBuilder survey learned earlier this year. Over one-half of Americans could not pay for a $400 emergency without borrowing money from someone or taking it out of their 401(k) retirement fund.

Gallup’s November 2017 poll on health care costs found that about one-third of Americans put off medical treatment due to costs, and more women (37%) than men (22%) do. This may be due to the fact that women’s healthcare costs are typically higher than men’s. What’s most somber about this statistic is that nearly two-thirds of people who forego care due to cost say they have a serious condition. Self-rationing of care due to cost can lead to earlier, avoidable, disability and death.

Let 2018 be a year when we value health, health care providers, and truth-telling so we can join together to help make America’s healthcare great again.

The post Let’s Increase Life Expectancy in America in 2018 – A New Year for Opioids, Social Determinants, and Financial Health appeared first on HealthPopuli.com.

Let’s Increase Life Expectancy in America in 2018 – A New Year for Opioids, Social Determinants, and Financial Health posted first on http://drugsscreeningpage.blogspot.com/

Friday Links

• Vox’s best stories of 2017.
• What is the value of treating blindness?
• Workers’ comp is shrinking.
• Is Taiwan a model for the U.S.
• Are changes to the Orphan Drug Act coming?

Friday Links posted first on http://drugsscreeningpage.blogspot.com/

Top Health Economics Stories of 2017

What were the top stories at the intersection of health and economics stories in 2017?  Here is the Healthcare Economist’s take.

Obamacare repeal. One of the top stories clearly must be the on-going debate around the repeal of the Affordable Care Act (ACA, a.k.a. Obamacare).  Although the ACA was not fully repealed, the most recent Republican tax legislation will repeal the individual mandate. Donald Trump today predicted that the repeal of the individual mandate will eventually cripple Obamacare leading to the need to replace it.  This prediction is not crazy as by repealing the individual mandate may cause healthy individuals to drop out of the health insurance market, leading to rising premiums, and the potential for an adverse selection death spiral.

Digital medicine is here.  The FDA this year approved the first digital medicine, an antipsychotic with an embedded sensor linked to patient’s smartphone’s and the cloud to better track patient adherence.  My own research has shown that giving physicians real-time, accurate patient drug adherence information can improve treatment decisions for providers treating patients with serious mental illness.  In fact, these types of digital medicines could lead to over $2000 in cost savings if physicians used this improved adherence information.

CAR-T launches with value-based pricing.  Two life sciences firms have gotten FDA approval for new CAR-T (chimeric antigen receptor T-cell) therapy.  The treatments have shown dramatic improvements in patient outcomes, but and are administered one time–rather than in multiple doses across months or years as would be the case for many chemotherapies.  Although the treatments cost $475,000, some payers–such as Medicare–will only pay for the treatments if they demonstrate improved patient outcomes. Not only is this medical breakthrough newsworthy, but so is this innovative pricing scheme.

The opioid epidemic is here.  The CDC reported that opioid deaths are rising among America’s teens.  Donald Trump declared that a state of emergency due to this crisis.  One film I saw, Heroin(e), documents not only the opioid epidemic but the first responders, police officers, judges, and others who are helping to fight this epidemic.   Unfortunately, this health story is likely to make the list again in 2018 unless there are serious efforts to combat the epidemic.

Antibiotic resistant bacteria represent a major public health challenge.  One report identified a numerous outbreaks of antibiotic resistant bacteria, known as CREs.  Seth Seabury and Neeraj Sood argue for a new model to incentivize life sciences firms and researchers to develop new antibiotics to fight this new and deadly threat.  Antibiotic resistance is a top priority at the World Health Organization as well.

Follow the money. An interesting paper by Sood, Shih, Van Nuys and Goldman tracks the flow of funds through the pharmaceutical system.  They find that “…for every $100 spent at retail pharmacies, about $17 compensates for direct production costs, $41 accrues to the manufacturer ($15 of which is net profit), and $41 accrues to intermediaries in the distribution system: wholesalers, pharmacies, pharmacy benefit managers and insurers (with $8 of net profit split among them).”

The Innovation and Value Initiative launches its Open-Source Value Project.  With value frameworks gaining more an more traction, IVI has launched an open-source tool to help a variety of stakeholders evaluate treatment value.  The tool is completely transparent, is based on the latest scientific findings, and allows users to measure treatment value based on their own preferences or preferences over the population which they are managing.  The first Open-Source Value Project covers DMARDs treating patients with moderate to severe rheumatoid arthritis.

 

Top Health Economics Stories of 2017 posted first on http://drugsscreeningpage.blogspot.com/

Nurses Rate Highest for Ethics in American Professions Once Again in Gallup Poll

Nurses working in the U.S. are number one when it comes to ethics and honesty, the Gallup Poll found for the sixteenth year in a row. After nurses, military officers, grade school teachers, medical doctors and pharmacists rank second through fifth in ethical-line behind top-rated nursing.

It’s important to note that consumers have ranked pharmacists and doctors in second and third place in this annual survey for many years. This year, both professions fall below the military and teachers. Nurses have been #1 in this study every year since Gallup launched the survey in 1999, except for 2001 when firefighters topped the list after 9/11.

At the bottom end of honesty and ethics we find lobbyists, auto sellers, and members of Congress ranking lowest in this year’s Gallup Poll, with Members of Congress as a profession garnering the greatest majority of Americans ranked “low” or “very low.” To that point, Gallup notes, “In a rare show of unity, roughly six in 10 Republicans, independents and Democrats alike rate the honesty of members of Congress lower than all other professions tested.”

The survey question is: “Please tell me how you would rate the honesty and ethical standards of people in these different fields — very high, high, average, low, or very low?” The Poll was fielded among 1,049 U.S. adults between 4th – 11th December 2017.

You can review some of my previous looks into this important study at the following links:

2016 – Nursing Seen As the Most Ethical Profession in America 

2013 – Nurses Are the Most Trusted Professionals in America

2012 – Nurses, Pharmacists and Doctors Rank Top in Honest Says the Gallup Poll 

2009 – Health Workers Are the Most Trusted Profession

Health Populi’s Hot Points:  The precipitous honesty/ethics ratings drop in consumers’ trust in pharmacists is stunning in 2017: see Gallup’s line chart to realize that 3 in 4 health consumers ranked pharmacists with very high or high ethics and honesty just two years ago, falling 13 percentage points in just two years. Gallup calls out the opioid crisis as a key contributor to this decline.

I agree, and I would also add patients’ growing exposure to high prescription drug prices via both the pricing of medicines coupled with enrollment in high-deductible health plans where patients, now consumers, are financially responsible for paying first-dollar for specialty drugs and health care. Because consumers pay for medicines at the point-of-purchase in pharmacies, they may be under the impression that drugstores set prices for drugs. Many consumers do not understand the job PBMs play in developing formularies (approved drug lists) and price tiers for co-pays and coinsurance. Consider this a prescription drug pricing literacy gap. Companies like GoodRx, Blink Health and Oration are playing important roles bridging this gap.

The third chart is the one I created from last year’s Gallup Poll, illustrating that nurses, pharmacists, and doctors ranked first, second and third in line (tied with engineers).

What held from last year’s Poll is the lowest ranks of Congress people, car salespeople, and ad practitioners.

What has also held — for nearly all of sixteen years — is that nurses are the most trusted form of human capital in America. Imagine how health care can be made better if nurses were supported to the highest level of their license to deliver patient care? Imagine if nurses provided input into service and UX design for healthcare? What if more nurses were deployed in pharmacies and grocery stories to help people bolster health and wellness?

Wouldn’t it be nice if those Members of Congress could design health care legislation that boosted, through funding and licensing, nurses’ starring and valued role in health and health care in America? Might this effort even help the political profession rebuild some long-lost ethical capital?

The post Nurses Rate Highest for Ethics in American Professions Once Again in Gallup Poll appeared first on HealthPopuli.com.

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Promoting a drug free workplace: wellness activities for employees

How important is workplace culture in keeping your company drug free? While many think of an office environment as things such as equipment and products, what really makes a workplace run is the people behind the business.

The best way to prevent drug use in the workplace is to have processes and programs in place for managing employees that first deter drug users from applying, and then by creating a work atmosphere that supports personal development and self-care.

If your company has already created a clear Substance Abuse Policy, then a majority of would-be applicants that are drug users will likely not apply for positions at your company. Maintaining a “No Tolerance” policy is not just about keeping your company free of the many pitfalls that come with drug use in the workplace, but also about a greater responsibility to create an alternative choice in workplace culture to that which accepts drug use.

A proven route for promoting workplace wellness is to create a regular program that offers information about the impact of drug use, and resources for adopting healthier alternatives. These alternatives can take the form of having guest speakers or practitioners of health-related services visit the office, providing healthy snack options instead of junk food during breaks, or by creating activity programs which create healthy competition among employees.

Below are some great examples of wellness activities that will keep the focus on self care, and lead the way towards preventing drug use in the workplace:

Start Celebrating “Wellness Wednesday”

The key to a successful Wellness Program is regularity. What better way to get employees through the rest of the week than to dedicate the middle of the week to wellness topics? Form a wellness committee, or place a person (usually someone volunteers to do this) in charge of wellness in your office be in charge of planning weekly informational sessions with healthy snacks. Doing so will accomplish a few important things:

Firstly, it will get employees involved, even if they’re only there for the free food at first. Secondly, having a regular discussions and opportunities for exposure to health topics will encourage experimentation with such activities. Just like exposure to drugs creates familiarity and an eventual relationship to drugs which might seem normal, the same applies to wellness – the more an employee sees and knows, the more likely they are to try it out.

Participate in a 5k Run

A great way to unite employees and encourage healthy camaraderie is to sponsor their participation in a local 5k race. Research local fundraising races and offer to cover the registration fees for any of your employees who want to join. Of course, some training days should be scheduled in advance of the day of the race, so that employees can train together and learn how to run properly and safely if they aren’t currently participating in such physical activities.

As the employer, you could supply them with company T-shirts, or other branded gear to support them in the completion of the race. Taking pictures and sharing them on a bulletin board is a great way to spread the fun of such an event, and might encourage a new person to join in for the next race.

Start a 7 Hour Sleep Challenge

Getting a good night’s rest promotes wellness without much effort! Start a 7 hour sleep challenge in your office, and whoever accomplishes the most nights of good sleep at the end of the month gets a prize!

Since drugs are often used to change one’s personal energy level, addressing energy from the source – that of getting enough sleep in addition to enough physical activity during the day, will promote a healthier group of employees. The benefits of getting enough sleep are many. Getting enough sleep has been shown to decrease the risk of heart attack, lower blood pressure, and inflammation in the body. Sleep also has been shown to prevent depression, regulate metabolism, promote creativity, decrease stress levels, improve cognitive and memory function, increase one’s ability to focus, and might also help your employees live longer.

As an alternative to an office-wide sleep challenge, perhaps creating an area for napping will encourage your employees to get the rest they need during their breaks. Even short naps, also known as “power naps”, help people regain focus and lower stress at work.

Use Holidays to Celebrate Health

Holidays are the perfect time to make sure your employees are staying healthy. While family stresses and personal matters may get more intense around these times, knowing that when they come to work, they will be in an environment where they will be able to make smart and healthy choices empowers them both on and off the clock.

Instead of bringing in cookies, sweets, and rich foods during these special times, opt for healthy alternative. For example, holding a Thanksgiving potluck of healthier versions of traditional foods, offering green smoothies on St. Patrick’s day, fresh strawberries or red peppers and hummus on Valentine’s day will naturally promote wellness while reducing employee stress which could otherwise lead to drug or alcohol abuse use during these times of the year.

Also, encourage the creation of discussions or memory boards among employees who may be suffering during the holidays due to losing a close friend or family member. This will create the awareness that not everyone gets into the same spirit during these times, and will give everyone the opportunity to show respect for each other, particularly to those who need emotional support during these times.

Post your company’s values and core mission all around

Knowing why an organization is run the way it is inspires employees in their everyday activities. Find a spot with a lot of foot traffic, like a waiting area or employee break room, that will encourage employees to take the time to read the signs. Make the signs big, bold, and inspiring.

Sharing your company’s goals and values gives employees a feeling of purpose in their daily work, and can lead to heightened moods and a more positive workplace morale. It is also appropriate to take pride in the fact that your company is drug free. Putting up signs around the office that celebrate this, or that share the number of days the workplace has been drug free, will promote everyone being on the same team.

Celebrate Work Anniversaries

Making your employees feel valued is the key to having a thriving workplace. Taking the time to acknowledge and celebrate work anniversaries is an incentive to stay with a company for a longer period of time, and creates a more personal bond between an employee and employer. Creating mutual respect is the key for maintaining company standards, and your employees are more likely to follow the rules when they feel truly valued.

Sometimes, an employee might already be in recovery for a drug or alcohol addiction. If they would like to be recognized for their accomplishment in sobriety, then by all means, be sure to recognize these employees either on a bulletin board, at a meeting, or in a newsletter. These employees become the best advocates for those who might be privately struggling with an addiction, and become an excellent support system when someone needs help or is returning to work after probation.

If you employees make it through a year without a drug-related incident, DO throw them a party! Celebrating a drug free workplace each year is a great way to instill a sense of personal responsibility and ownership in employees who are doing the right thing.

Host a Tea Time

While coffee has become a staple in many offices, having an area for hot teas, particularly herbal teas with calming or wellness benefits, will create a spa-like environment at work. Creating an area to fix tea with supportive messages and quotes that inspire personal reflection and wellness will keep your employees focused on self-care while at work.

If your company has an outdoor area for breaks, give this area a little sprucing up. Make an area for those non-smokers who might want to enjoy their tea outdoors. Placing fragrant herbs and plants all around, or perhaps adding a small garden to walk through will make Teatime a relaxing way to make use of break time at work.

Shine A Light on Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder affects primarily individuals who live in areas with limited exposure to direct sunlight during Winter months. When the coldest months arrive, a lack of daily light intake cause individuals to experience severe depression, lethargy, significantly decreased productivity levels, that can be traced back to primordial hibernation tendencies.

If you notice the energy level around the office reaching a low in winter months, adding additional lights, particularly those which are known to have adequate UV exposure that could properly mimic natural sunlight, your employees will benefit in their moods and even in their circadian sleep patterns.

Provide Company Branded Health Goodies

Water is nature’s best kept health secret. Encourage your employees to drink their fair share by providing them with water bottles that are imprinted with your company’s logo. Many exciting new water dispensing machines are on the market which offer infused and flavored waters on demand, which could help employees abstain from sugar filled energy drinks, or taking energy-producing drugs while at work.

Other health-related company goodies could be non-physical, or service related. Partnering with a local fitness club to offer a reduced membership rate to your employees is a great way to support a healthy lifestyle. Scheduling a company event in the park with a certified Yoga Instructor (and perhaps you could offer yoga mats to go along with the event), or a day where a masseuse comes in for 15 minute sessions for each employee in the office are other ways to give the gift of wellness.

Snack subscription services are now available, which deliver a selection of goods according to whichever frequency best suits your workplace. Ordering a regular delivery of healthy snacks is a sure way to make your employees feel appreciated.

The Effects of Wellness Programs on Workplace Drug Use

How does feeling valued and part of a team decrease drug use in the workplace? Just as children need the support of friends and family, adults continue to have these social emotional needs as they navigate the ups and downs of life.

Most people don’t expect an employer to become a major support system, but many employees of companies with active social engagement programs will tell you that their fellow employees are like family. A workplace becomes an extension of a person’s personal identity, and when they feel encouraged and supported to be their best at work, they will take steps toward being their best when they’re off the clock, and may naturally avoid the negative effects of substance abuse.

When a person is surrounded by health, they will choose the easiest route, and so it becomes part of your company’s goal to make the clearest path the one that leads to wellness.

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What happens to CHIP?

The Children’s Health Insurance Program (CHIP) is a federal program that provides matching funds to states in order for them to provide health insurance to children.  The program was designed to cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid.

Currently, however, the program is in jeopardy.  In fact, federal funding for CHIP expired September 30.  Some states, such as Colorado, have supplied emergency funding to keep CHIP afloat in their states.  On December 21, the federal government did pass $2.85 billion of emergency funding.  As funding was backdated to October 1, the 6 months of funding will only cover expenses through the end of March, 2018.

There are arguments on both sides of the aisle about the merits of CHIP.  Provide health insurance to kids has clear value to these children and their families.  Also, CHIP makes the U.S. society more equitable.  Those opposed to CHIP may prefer other ways to help kids get insurance, such as vouchers to purchase private insurance, or may even prefer to end CHIP and spend the tax money on other federal programs (e.g., education, defense), or tax cuts or may fear that CHIP may decrease the labor supply of parents who otherwise would work to get coverage for their kids.

Regardless of where you stand on the political spectrum, this uncertainty is clearly bad for all involved.  States have a hard time planning their budgets if they are unsure whether federal funds will materialized.  The federal government’s need to dip into emergency funding leads to a lack of fiscal discipline.  These expenses should be planned for.  Most importantly, parents and their children need to be able to plan for the future.  If CHIP is available, clearly many parents will want this coverage for their children.  If the program is not available, however, then perhaps some would return to work at suboptimal jobs rather than continue a job hunt in order to get health insurance for their family.  Large purchases (e.g., house, car, durable goods) clearly depend on the amount disposable income families have and this amount would decreases significantly if they had to buy insurance rather than be covered through CHIP.

Clear planning, transparency, and predictability are the hallmarks of good government.  This debate over CHIP funding–similar to the debates over the “doc fix” over physician reimbursement–shows that these emergency funding approaches are not only bad for the budget, but they hurt the people they are supposed to help by increasing the amount of uncertainty in their lives.

What happens to CHIP? posted first on http://drugsscreeningpage.blogspot.com/

Friday Links

• An open-source approach to value assessment
• Economic freedom in North America.
• Cyberbullying and suicide.
• Why are we moving away from academic medical centers to academic health systems?
• Reform within state employee health plans

Friday Links posted first on http://drugsscreeningpage.blogspot.com/

Why fighting disease is hard

Without a doubt, medicine has made tremendous gains over the last decades and even more progress when viewed across centuries.  Often to treat diseases, physicians and researchers identify a single or primary pathway that is causing the disease.  Maybe there is a gene mutation which causes an abnormality.  Maybe there is a bacteria or virus that is invading the body.  Typically, we look for a single disease cause and identify treatments to that can address this root cause.

Things get much more complicated, however, when disease a disease is caused by numerous factors.  Consider the following example from the book I Contain Multitudes: The Microbes within us and a gander View of Life, examining the case study of researcher Herbert Virgin and his analyses of mice with genetic mutations for Crohn’s disease.

These rodents developed inflated guts, but only if they were infected by a virus that knocked out part of their immune system, and were exposed to an inflammatory toxin and had a normal set of gut bacteria.  If any of these triggers was missing, the mice stayed healthy.  It was the combination of genetic susceptibility, viral infection, immune probles, environmental toxin, and their microbiome that gave them IBD [Irritable Bowel Disease].

Identifying multiple root causes is complex.  In this case, by addressing one of these causes, IBD could be cured.  In practice, however, sometime there many be cases that without addressing all causes, the individual may not recover normal health.

This complexity certainly makes for interesting research for scientist, but also highlights that perhaps medicine has only begun to address the low hanging fruits.  While there is much potential to further cure human diseases, doing so will likely become increasing complex.

As a side note, I do recommend the by I Contain Multitudes book by Ed Yong.  The book describes how bacteria act symbiotically in both positive and negative ways with humans, other animals, and other organisms as well.  The book highlights some recent research, while presenting the content in a non-technical manner.  I found it an enjoyable read to introduce non-biologists to the importance of the microbiome.

Why fighting disease is hard posted first on http://drugsscreeningpage.blogspot.com/

What Healthcare Can Learn from Volkswagen: A Scenario of a Post-Healthcare World

As I am finalizing my schedule for meet-ups at CES in Las Vegas for early January 2018, I’m thinking about digital devices and wearable tech, connected cars, smart homes, and the Internet of Things through my all-health, all-the-time lens.

My friends at TrendWatching write today about the automaker, Volkswagen, which has a division called MOIA started in 2016. VW, like most car manufacturers, is working on strategies to avoid being disrupted and made irrelevant as tectonic forces like autonomous cars and shared rides innovate and re-define the nature of personal transportation.

MOIA is a brand and a self-described “social movement.” The organization’s objective is, “to develop and offer an extensive portfolio of on-demand mobility services that make the lives of people living in urban areas better, cleaner and safer.”

Ole Harris, the brand’s CEO, said that ultimately, MOIA’s goal will be to, “take one million vehicles off the road by 2025.”

Here’s an automaker stating the intention to remove autos from the road.

As TrendWatching puts it: “What would it look like if we launched a start-up whose aim was to reduce sales by one million units?”

Health Populi’s Hot Points: For the legacy healthcare system, some analogous questions would be:

• What is a pharmaceutical company without pills?
• What is a hospital without beds?
• What is a doctor without bricks-and-mortar exam rooms?
• What is a health plan beyond a health insurance marketer?
• What is an electronic health record where data are owned and controlled by patients?

Today, carmakers are challenged by Tesla, Lyft, Uber, Zipcar and shared bicycle services, along with emerging autonomous car developments, some of which are sponsored by the auto companies themselves.

Healthcare providers, plans, and suppliers are challenged by their own equivalents of Teslas and Ubers. Some of the disruptors are obvious — Amazon, of course, along with Health 2.0 companies delivering transparency, new business models for healthcare delivery, medical banking programs, and IoT devices that melt and blur into peoples’ daily lives through enchanting design and useful services.

But there are more subtle forces at work to disarm and disrupt healthcare as we know it: among them, the demographic force that are Millennial consumers and younger, and at the older age spectrum, Boomers. Younger and older patients alike will challenge healthcare providers and suppliers to provide and supply services and products that serve and (co)produce health.

Note that MOIA seeks to, “make make the lives of people….better, cleaner and safer.”

Sounds a lot like health, doesn’t it? That’s no surprise to me: in the Edelman Health Engagement Barometer, we learned that consumers in fact look to auto companies as partners in health.

I’ll be thinking about the implications and lessons of MOIA in and beyond 2018 through my health/care lens with my clients and colleagues. I advise that you do, too.

Please stay connected to the Health Populi blog and my Huffington Post columns during CES week, 7-12 January 2018, for more on new-new digital health things. 

The post What Healthcare Can Learn from Volkswagen: A Scenario of a Post-Healthcare World appeared first on HealthPopuli.com.

What Healthcare Can Learn from Volkswagen: A Scenario of a Post-Healthcare World posted first on http://drugsscreeningpage.blogspot.com/

How is Washington State using evidence-based medicine?

A paper by Rothman et al. (2017) explains what goes on at the Washington Health Technology Assessment Program’s (WHTAP), the first state-administered health technology assessment (HTA) program in the U.S.:

Over the past 9 years, Washington State has been pursuing an innovative and generally effective program to use evidence-based medicine to determine state health care coverage decisions. Its Health Technology Assessment Program committee evaluates diagnostic and therapeutic technologies—except pharmaceuticals, the responsibility of a different group—by the criteria of safety, efficacy, and cost-effectiveness.

How are new diagnostic and therapeutics to be evaluated?  The answer is purely based on cost. As one state official said:

We will be looking for emerging or fast-growing technologies that could have the biggest impact on the state’s budget.

Once treatments are selected, WHTAP determines whether to cover a technology, cover it with conditions, or simply deny coverage.  These decisions affect coverage decisions for state employees, Medicaid, state worker’s compensation programs and correctional health.  Between 2007 and 2013, 67% of technologies of the 39 technologies that were reviewed were covered with conditions, 26% denied, but only 8% covered with no conditions. The key factors affecting this decision were lack of efficacy and lack of safety; a lack of cost-effectiveness only because relevant for technologies with significant capital outlays (e.g., robotic surgery purchases). The factor with the smallest influence was cost-effectiveness.

While using treatments supported by evidence is clearly a good thing, the effect of WHTAP’s decisions on state finances or clinical outcomes is not well known as data are limited.  Further, practicing top-down medicine to identify treatments that are high-value for the average patient may be problematic if there exists significant clinical heterogeneity that physicians, nurses or other health professionals can observe on the ground, but that WHTAP committee members may not be able to see.  Identifying evidence-based treatments is useful; however, we need to keep medical decision-making in the hand of the physician-patient relationship informed by–rather than mandated by–evidence based medicine.

Source:

• Rothman, David J., Kristy L. Blackwood, Whitney Adair, and Sheila M. Rothman. “Evidence‐Based Medicine and State Health Care Coverage: The Washington Health Technology Assessment Program.” Health services research (2017).

 

How is Washington State using evidence-based medicine? posted first on http://drugsscreeningpage.blogspot.com/

The Big Five

UnitedHealthcare, Anthem, Aetna, Cigna and Humana are the five largest health insurers in America. To learn more about them, check out a recent paper by Schoen and Collins (2017) in Health Affairs.

The five largest US commercial health insurance companies together enroll 125 million members, or 43 percent of the country’s insured population…In 2016 Medicare and Medicaid accounted for nearly 60 percent of the companies’ health care revenues and 20 percent of their comprehensive plan membership. Although headlines have focused on losses in the state Marketplaces created by the Affordable Care Act (ACA), the Marketplaces represent only a small fraction of insurers’ members.

With CVS and Aetna merging, it will be interesting to see if Aetna’s market share grows or shrinks based on this merger.

The Big Five posted first on http://drugsscreeningpage.blogspot.com/

Health Consumers Face the New Year Concerned About Costs, Security and Caring – Health Populi’s 2018 Forecast

As 2018 approaches, consumers will gather healthy New Year’s Resolutions together. Entering the New Year, most Americans are also dealing with concerns about healthcare costs, cybersecurity, and caring – for physical health, mental stress, and the nation.

Healthcare costs continue to be top-of-mind for consumer pocketbook issues. Entrenched frugality is the new consumer ethos. While the economy might be statistically improving, American consumers’ haven’t regained confidence.

In 2018, frugality will impact how people look at healthcare costs. 88% of US consumers are likely to consider cost when selecting a healthcare provider, a Conduent survey found. Physicians know this: 81% of providers say patients have talked with them about health care costs.

Consumers confront chaos in U.S. healthcare reform, with the over-arching GOP health reform efforts scuttled by a slim margin of “nay votes,” but the just-passed tax bill repealing the individual mandate. “Repeal and replace is now coopt and confuse,” Dr. Ann Hwang, a primary care physician, wrote in Modern Healthcare this week.

Millions of people in the U.S. won’t have health insurance in 2018, and so will face a truly retail experience with health care providers and suppliers in their communities. Cost is the barrier to coverage. Having health insurance makes a difference in whether people get medical care they need, and impacts how healthy people are. Health insurance is a social determinant of health.

“All health sectors have started to try their hand at social interventions,” PwC’s 2018 top industry issues report notes.

One healthcare industry that will get increased consumer and legislative scrutiny in 2018 will be prescription drugs. Across Democrats, Independents and Republicans all, most consumers would like the U.S. Federal government to take more action on lowering the cost of medicines. The Conduent poll also found that 60% of U.S. consumers believe making Rx drugs more affordable should be the nation’s top healthcare priority. Americans are quite aware of their role as payors of the highest prices of prescription drugs in the world. Scott Gottlieb, the current FDA Commissioner, has talked about this policy priority for 2018.

Because consumers have a retail relationship with prescription drugs through pharmacies, the issue gets peoples’ attention due to greater price transparency – at least in the form of co-pay, coinsurance, or first-dollar payment under a high-deductible health plan. Pharmacies understand their role as accessible retail health on-ramps for medications and counsel, and growing role as health care providers. In 2017, CVS launched a drive-up service for consumers to collect their prescriptions at the curbside. Then the company announced intentions to deliver Rx to patients’ homes. Finally, CVS announced its intention to acquire Aetna, the health insurance company.

This vertical integration will be just the start of new business models developing to bring healthcare more conveniently and, potentially, cost-effectively to the consumer in 2018. Perhaps Walmart will buy Humana, Ana Gupta of Leerink Partners recently discussed on CNBC’s Squawk Box.

Expect more retail-facing health delivery programs in the New Year, such as the relationship recently struck between Walgreens and New York Presbyterian’s On-Demand suite of consumer digital health services. Walgreens has been an important influencers in promoting consumers’ use of wearable technology to track health, through the company’s Balance Rewards loyalty program. The company started the Center for Health and Wellbeing Research to expand research into consumer health and self-care. This is but one more sign of the evolving retail health landscape that’s positioned to meet consumer demand for greater access to cost-effective, empowering care channels in the community.

Promoting the use of wearable tech has been part of Walgreens’ consumer health strategy for several years. There’s a growing “retail of physical wellness” Field Agent’s research talks about. 96% of U.S. adults expect to exercise, work out, or play a sport in 2018. People will endeavor to do more physical activity in the New Year, along with nutrition and diet, weight management, and better managing stress and anxiety levels. 57% of Americans own at least one wearable technology to enhance fitness and sports participation, Field Agent found, from activity trackers to apps.

Consumers’ interest in virtual and telehealth will grow in 2018: Accenture’s Voting for Virtual Health poll found that 3 in 4 consumers are interested in using digital technologies to track health status like blood pressure, to follow up appointments after seeing a doctor, to follow-up hospital stays, and to receive reminders for healthy living.

Don’t think it’s only Millennials who demand virtual health services. PwC’s consumer survey found an older age cohort 65 and over willing to use digital devices at home and engage in telehealth visits, too. What underpins older consumers’ willingness-to-try digital health tools is their increased adoption of smartphones: two-thirds of people aged 55-75 had smartphones in 2017, up from 53% in 2015, Deloitte’s Mobile Consumer survey learned.

The FDA’s newly-issued guidance defining what constitutes a medical device clarifies what software and digital health tools constitutes a “medical device.” These reg’s should enable more products to come to market in 2018 for consumers’ use at home and on-the-go for self-care. Consumers’ purchases of digital assistants, like Amazon ECHO and Google Home, will also expand peoples’ digital health adoption through voice-first technology in 2018. With CES 2018 happening in January 2018, I’ll be curating innovations for consumers’ healthcare, so do stay tuned to Health Populi for new-news on the topic of consumer-facing wearable and digital health.

Notwithstanding the FDA’s greater clarity on the supply side development of digital health tools, consumers remained very concerned about the security of their personal health information. The Equifax breach of 2017 made the majority of Americans quite aware of the value of personal data. Most doctors’ information systems have been breached, research from the American Medical Association and Accenture reported. “Physicians, overwhelmingly, are finding themselves the target of cyberattacks that disrupt their practices and put patient safety at risk,” the report observed. “More support from the government, technology and medical sectors would help physicians with a proactive cybersecurity defense to better ensure the availability, confidentially and integrity of health care data,” AMA and Accenture recommend.

But people have a trust paradox when it comes to their digital connections, based on a new poll from Cisco. The paradox is that consumers’ perceived value of the Internet of Things may be high, but trust is low. Despite this chasm, peoples’ connectivity is integrated into daily lives, so much so that many people are unwilling to disconnect. While security breaches erode consumer trust, we may be at a “point of no return,” in Cisco’s words, when it comes to people unwilling to disconnect due to their values for convenience, efficiency, and cost-savings generated through connected cars, smart homes, and wearable technologies.

It may give health consumers some solace to know that hospital leadership looks to increase funding for cybersecurity in 2018, based on UPMC’s Center for Connected Medicine joint survey with The Academy.

And so stay connected people will, some voicing, “Alexa, remind me to eat cleaner today.” Two-thirds of Americans are determined to eat healthier in the New Year, Field Agent’s research found. More people vow to eat less fried food, fast food, and sugar. And, more consumers look to eat more fruit, vegetables and salads, per the CDC’s recommendations based on the Center’s recent report finding that too few Americans consume enough fresh produce in daily diets. Food prescriptions, whether self-imposed or recommended by physicians or health coaches, will be more common in 2018. Emerging food trends will include neuro-nutrition for “mood food” and brain health. Examples of this are Honeybrains, a café with a menu developed by a neurologist, and the subscription meal vendor Euphebe (an abbreviation for their mantra, “You’ll Feel Better”).

Why growing attention to self-care among U.S. healthcare consumers? It’s to feel better and manage healthcare costs, for sure, but there’s another factor: other people. 53% of Americans are engaging in better self-care to be better for others, Field Agent’s poll found.

I conclude this tea-leaf reading on consumers and healthcare for 2018 with another form of connectivity: social. Loneliness takes a toll on our health: “We can’t discount the risks of being socially isolated even if people don’t feel lonely,” Julianne Holt-Lunstad of Brigham Young University said. Despite growing digital connectivity, socially isolated individuals are “a growing epidemic,” according to Dr. Dhruv Khullar at Weill Cornell Medicine NYC.

The APA Stress in America Survey – The State of Our Nation poll found that 59% of Americans say we’re at the lowest point in our nation’s history that people can remember. The biggest sources of stress among Americans are worry about the future of the country, health care, money, work, political climate, and violence and crime.

Let 2018 be a year of greater social connectivity, in real-life, in real-time.

Wishing you a healthy, loving holiday season and New Year of community and personal peace.

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Friday Links

• The cost-effectiveness of CAR-T.
• Cancer gene testing breakthrough.
• Uninsured vs. Insured: ER use.
• Doulas for death.
• What’s the problem with digital DNA?

Plus, please check out the Happy Holiday Health Wonk Review at Workers’ Comp Insider.

Friday Links posted first on http://drugsscreeningpage.blogspot.com/

Net Neutrality is Dead: What Happens to Connectivity as a Social Determinant of Health?

Today’s FCC’s repeal of the net neutrality rules for internet service providers will have an impact on healthcare — in particular, the channeling of telehealth services.

“The Federal Communication Commission overturned a two-year-old set of rules passed during the Obama administration to protect consumers against bad behavior from their Internet service providers, overriding protests from consumer groups and Internet companies,” USA Today wrote just after the ruling.

The concern from advocates to keep net neutrality is that the large ISPs — AT&T, Comcast, and Verizon, among them — could be so-called “bad actors” in favoring fast-lane communications for certain content versus other information that consumers, under net neutrality, could access equally. Ultimately, “could ISPs become content-controllers, or charge additional ‘tolls?” those who wish to preserve net neutrality have asked.

The adoption of telehealth, telemedicine, and any healthcare services delivered to consumers via the Internet could face barriers or slow due to the impact of net neutrality, according to several opinions published in the healthcare trade press and academic journals.

“Telecommunication policies may have unintended healthcare consequences,” the Health Affairs blog explained. High-speeds are crucial for connecting healthcare providers to patients for remote health monitoring, and overall connectivity is still needed in rural America.”

To that point, Mei Kwong, policy adviser for the Center for Connected Health Policy, warned, “The last thing you want is for the interaction to suddenly freeze or the audio to go out or for the picture to be pixelated,” in Modern Healthcare today.

Children’s health may be negatively impacted. The American Academy of Pediatrics wrote, “The general public, including parents and caregivers of children, use web-based platforms to access children’s medical records, make appointments and find health information. Having slower access to these tools could potentially result in delays in care and seeking information, and place an undue burden on ready access to quality healthcare and health information,” AAP wrote in testimony to the FCC back in 2014.

Health Populi’s Hot Points:  Broadband access is a social determinant of health, I have argued for some time, such as here in the Huffington Post in July 2016.

Interestingly enough, consumers ‘get’ that ISPs haven’t delivered on customer service, we know from Temkin’s consumer experience survey, shown in the second chart. Note that peoples’ ratings of user experience with Internet service are lowest, ranked with health insurance plans.

In 2018, Internet connectivity should be seen as a basic human right and necessity for health and wellness, such as clean water, clean air, healthy food, and access to basic healthcare services. As America continues to debate the shape of healthcare reform, net neutrality diminishes an important building block to public and individual health for Americans, telehealth and virtual health services. These new modes of healthcare delivery can help the nation lower costs, expand access, and enhance patients’ and healthcare providers’ experience.

 

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Does the value-modifier improve quality and reduce health disparities?

In short, no.  That is the answer Roberts, Zaslavsky and McWilliams reach in their 2017 paper in Annals.

Some background on the value modifier program.  In 2013, practices with 100 or more eligible clinicians were rewarded just from reporting quality measures. By 2014, however:

Practices with 100 or more clinicians were subject to upward, downward, or neutral performance-based payment adjustments, those with 10 to 99 were subject to upward or neutral—but not downward—adjustments, and those with fewer than 10 were unaffected. In 2015, all practices with 10 or more clinicians were exposed to full VM incentives (both penalties and bonuses). Base payment adjustments ranged from 2% to 2% on the basis of 2014 performance and from 4% to 4% on the basis of 2015 performance, but high-performing practices have received much higher bonuses (for example, rate increases of 16% to 32% in 2016), because the VM’s budget neutrality provision stipulated that penalties for failing to meet reporting requirements be redistributed as bonuses.

Because of the eligibility cut-offs at 10 and 100 clinicians and the staggered role-out of the design, the authors use a regression discontinuity approach based on practices around the 10 and 100 clinician threshold.  They use 2014-15 Medicare claims data to examine three outcomes: (i) inpatient admissions for ambulatory care–sensitive conditions, (ii) Medicare spending per beneficiary, and (iii) all-cause readmissions within 30 days of hospital discharge.  Using this approach, they find that:

…differences in hospitalization for ACSCs, readmissions, Medicare spending, and mortality between practices above the size thresholds and those below (the adjusted discontinuities) were small in 2014 and not statistically significant…size. Analyses of the threshold of 100 or more clinicians that used 2015 data revealed no statistically significant discontinuities associated with a second year of full exposure to the VM.

In short, no effect was found. In addition, they found that risk adjustment was inadequate.  Adding addition risk adjustment factors narrowed differences in performance between high and low performing groups in particular among practices that served a disproportionately disadvantaged population.  While the value modifier is built from good intentions–pay more for high quality, low cost care–in practice, the results are not overwhelming.

 

Source:

• Roberts, Eric T., Alan M. Zaslavsky, and J. Michael McWilliams. “The Value-Based Payment Modifier: Program Outcomes and Implications for Disparities.” Annals of Internal Medicine (2017).

Does the value-modifier improve quality and reduce health disparities? posted first on http://drugsscreeningpage.blogspot.com/

Support for the Affordable Care Act the Highest Since Passage

Americans’ approval of the Affordable Care Act reached its apex in December 2017, the Pew Research Center found. The proportion of people approving the ACA has been growing since the middle of 2016, now at 56% of the public.

The timing of this survey, conducted at the end of November and first few days of December 2017, coincides with Congress’s arm-wrestling a tax bill that would eliminate the individual mandate for health insurance which is an ACA building block for universal coverage in the United States.

Most people in the U.S. also believe that the ACA has had a positive impact on the nation, at a margin of 44% positive versus 35% negative impact.

Looking at the demographics of who feels positive about the law, shown in the second chart, reveals that more women than men approve of the ACA (61% versus 50%); more people of color versus whites, who are split 47/47; and, younger people under 50 versus older folks.

There continues to be a huge chasm between Democrats and Republicans on how members of each party view the law. More Democrats have come to appreciate Obamacare more today, now at 85% of Democrats approving of the ACA. However, the proportion of Republicans approving the ACA remains flat at 14%.

Health Populi’s Hot Points:  Will yesterday’s election of Doug Jones to represent the State of Alabama as a Democrat in the U.S. Senate change the dynamic for the GOP’s tax bill to pass or fail? Vox presents the argument this morning for a tax bill #fail.

Dropping the individual mandate for health insurance would leave 13 million fewer Americans out of health insurance, the CBO calculated, with even more health plan premium increases on Americans seeking coverage.

There are additional health care access challenges that Congress has yet to resolve, namely the re-authorization funding CHIP for children’s health, and funding Federal Qualified Health Centers that cover safety net populations who do not have health insurance.

More Americans are aware of these cracks in U.S. health citizens’ coverage, thus building up more support for the ACA that Pew’s research learned.

At 2017, Americans find a nation facing a new year of health policy chaos and under-funding. With dreams of cancer moonshots, precision medicine, and the promise of AI for improving healthcare, we must ensure the basic human needs of health coverage, access to primary care, nutritious food, and a basic list of drugs. These are what I wish for every American’s Christmas stocking to hold.

For now, the only certainty is the equivalent of a health care lump of coal.

 

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How one project will change the way value is measured in healthcare

That is the title of a recent article in Managed Healthcare Executive on the Innovation and Value Initiative’s new Open-Source Value Project.  The magazine interviewed Mark Linthicum, IVI’s Director of Scientific Communication.  An excerpt is below:

Linthicum: Many healthcare stakeholders are now being asked to make decisions based on value, but few are also given the tools to make those decisions in an evidence-based manner. IVI seeks to solve that problem. The OSVP allows unmatched input by giving diverse stakeholders a seat at the table, especially patients. Future changes to the model and supporting research to advance the underlying methods will all be based on the feedback received from these stakeholders. This process—as well as the open-source nature of the models themselves—incentivizes stakeholders to offer their feedback to ensure that their unique viewpoint is captured in the tool and can be built upon in further iterations.

Do read the whole interview.

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Will Getting Bigger Make Hospitals Get Better?

This month, two hospital mega-mergers were announced between Ascension and Providence, two of the nation’s largest hospital groups; and, between CHI and Dignity Health.

In terms of size, the CHI and Dignity combination would create a larger company than McDonald’s or Macy’s in terms of projected $28 bn of revenue. (Use the chart of America’s top systems to do the math).

For context, other hospital stories this week discuss layoffs at Virtua Health System in southern New Jersey. And this week, the New Jersey Hospital Association annual report called the hospital industry the “$23.4 billion economic bedrock” of the state.

Add a third important item to paint the state-of-the-U.S. hospital-industry picture: Moody’s negative ratings outlook for non-profit hospital finances for 2018.

So will getting bigger through merger and consolidation make the hospital business better?

In the wake of the CVS-Aetna plan to join together, the rationale to go big seems rational. Scale matters when it comes to contracting with health insurance plans at the front-end of pricing and financial planning for the CFO’s office, and to managing population health by controlling more of provider elements of care from several lenses: influencing physician care; crafting inpatient hospital care; doing smarter, cheaper supply purchasing; and leaning out overhead budgets for things like marketing and general management.

But the Wall Street Journal warned today the “serious condition” of U.S. hospitals, despite these big system mergers.

Health Populi’s Hot Points:  In the past two years, I’ve had the amazing opportunity of speaking about new consumers and patients growing into healthcare payors with leadership from hospitals in over 20 states, some more rural, some more urban, and all in some level of financial crisis mode.

After describing the state of this consumer in health and healthcare, and how she/he got here, I have challenged hospital leadership to think more like marketers with a fierce lens on consumer experience and values. That equal proportions of U.S. consumers trust large retail and digital companies to help them manage their health is a jarring statistic to these hospital executives. The tie-up between CVS and Aetna marries the retail health/healthcare segments and responds to this consumer trust issue.

But then, I remind them that nurses, pharmacists, and doctors are the three most-trusted professions in America.

These three professional clinicians are the human capital that comprise the heart of a hospital in a community.

Hospitals should be mindful that trust is necessary for patient/health engagement. And the trust is with hospitals if the organization chooses to leverage that goodwill for a value-exchange. Hospitals are economic engines in their local communities — often, the largest employer in town. “Everyone” in most communities knows someone who works in a hospital.

And hospital employees spend money in communities, bolstering local employment and tax bases.

Partnering with patients means empathizing with them as both clinical subjects and consumers. For the latter, refer to the sage column from JAMA which recommends that Value-Based Healthcare Means Valuing What Matters to Patients. This means thinking about the value-chain of the patient journey, from keeping people well in their communities through to managing sticker-shock in the financial office. The financial toxicity of healthcare is one risk factor threatening the hospital-patient relationship with the patient-as-payor.

As Mufasa told Simba in The Lion King, “You are more than what you have become. Remember who you are.”

Dignity Health remembered who they were based on core values of human kindness in their rebranding, from Catholic Healthcare West to the Dignity Health brand, #HelloHumankindness. Here’s more on that good business case here in Health Populi. 

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U.S. Healthcare Spending

The CMS Office of the Actuary released their 2016 estimates for U.S. health care spending.  We’re getting close to health care taking up 18% of the economy.

Total nominal US health care spending increased 4.3 percent and reached $3.3 trillion in 2016. Per capita spending on health care increased by $354, reaching $10,348. The share of gross domestic product devoted to health care spending was 17.9 percent in 2016, up from 17.7 percent in 2015….Enrollment trends drove the slowdown in Medicaid and private health insurance spending growth in 2016, while slower per enrollee spending growth influenced Medicare spending. Furthermore, spending for retail prescription drugs slowed, partly as a result of lower spending for drugs used to treat hepatitis C, while slower use and intensity of services drove the slowdown in hospital care and physician and clinical services.

As baby boomers continue to age, expect health care to continue to rise as a share of GDP, at least in the short- to medium-run.

 

U.S. Healthcare Spending posted first on http://drugsscreeningpage.blogspot.com/

Will MIPS work?

CMS in the past was on a value-based binge. They aimed to reward physicians based on quality of care (PQRS), based on cost (a component in the value modifier), based on use of EHR (meaningful use bonuses).  However, this imposed a large reporting bonus on physicians, pulling them away from patient care.  To solve the problem, CMS implemented Merit-based Incentive Payment System (MIPS) to consolidate all these value-based reimbursement schemes into one.

Will this new system work?  After reviewing the program, MedPAC was skeptical of MIPS:

MIPS, as designed, is unlikely to clearly identify highvalue or low-value clinicians and hence may be of limited utility for beneficiaries (in selecting high-value clinicians), for clinicians themselves (in understanding their performance and what to do to improve), or for the Medicare program (in adjusting payments based on value)

Specifically, they cite the low reliability of measures due to small patient counts for most measures for any individual physician; the fact that since physicians can select their own measures, comparing across physicians is difficult; budget neutrality rules mean that some physicians could get very high or very low bonus payments in the future.

One paper by Joynt Maddox (2017) looks at participation in MIPS based on previous data found that:

5.0 percent of the 899 practices would have received a performance-based bonus and 7.7 percent a performance-based penalty

Thus, the vast majority of practices would receive no bonus or penalty in practice.

Measuring quality of care is a good thing.  Imposing significant reporting requirements on physicians is not.  Thus, identifying a way to measure and pay for quality is valuable but the data collection burden and overall reliability must be increased to be able to do this.  Another approach–balance billing–would allow high-quality physicians to charge more to Medicare patients, where quality would be defined not by bureaucrats, but by the consumers and patients actually receiving this care.  Letting the market work, just might work.

Will MIPS work? posted first on http://drugsscreeningpage.blogspot.com/

Webinars for IVI’s Open-Source Value Project

On November 8^th, the Innovation and Value Initiative (IVI) launched a new effort to help redefine the way we measure value in health care: the Open-Source Value Project (OSVP). A first-of-its-kind effort that engages all health care stakeholders in an open process to advance the way we measure value in health care treatments and services, the OSVP is creating flexible, transparent, iterative, and consensus-based modeling platforms for specific diseases. The first model released as part of the OSVP focused on rheumatoid arthritis, and additional models targeting other diseases are planned. For a quick overview of the OSVP, take a look at this a brief whiteboard video.

IVI is actively seeking input from everyone across the health care system ahead of the January 2018 deadline for public feedback. To facilitate widespread participation, IVI is hosting two public webinars next week to provide information and answer questions:

 WEBINAR 1: Measuring the Value of Health Care Treatments: Time for a New Approach

• Traditional value assessments are often “black boxes” that only account for a single perspective or a single population. The OSVP is designed to better measure value through an iterative and transparent process driven by input from all health care stakeholders. To better understand how the OSVP process works, learn about our first model in rheumatoid arthritis, and find out how to get involved, join us for our upcoming webinar on December 12, 2017 at 4pm EST/1pm PST. Register here.

 WEBINAR 2: Creating Open-Source Models for Value Assessment: A Detailed Discussion of the IVI Rheumatoid Arthritis Model

• OSVP models are built to be entirely open-source, allowing anyone to customize the tool depending on their own assumptions and understanding of value. Learn more about how the IVI model generates customized information on rheumatoid arthritis treatments and how to apply the information in assessing value in health care on December 14, 2017 at 4pm EST/1pm PST. Register here.

 The first webinar is designed to be an overview of the OSVP and our IVI-RA model for a general audience, whereas the second is intended for a more technical audience and will dive into the details of the model and our modeling approach. Both webinars are free and open to the public.

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