Posts Tagged ‘healthcare’

Florida health insurance block health-care reform

May 19th, 2011

On his first day as Florida’s new House speaker, Rep. Dean Cannon took a clear shot at President Barack Obama’s new health-care reform law. Easy To Insure ME has the answers

“Should it really be the role of government to require people to purchase a health insurance product they don’t want, raise taxes to give that same product to others who can’t afford it, and commandeer our state government and its resources to carry it out?” Cannon, a Winter Park Republican, told House members after being sworn in two weeks ago.

“Or, should we work to limit government and empower the private sector?”

On numerous fronts, Florida policymakers have already answered that question.

While the fight against President Obama’s health-care reform may be centered in the Beltway, Republican resistance to the sweeping new mandates is also taking shape in Tallahassee. Among the battlefronts:

• Florida led the charge with 19 other states last March by challenging the law in federal court, claiming the mandates that uninsured people buy coverage violated states’ rights. A judge in Pensacola is expected to rule shortly after a Dec. 16 hearing on whether the suit can move forward. More states are expected to join after a new crop of state attorneys general are sworn into office in January.

•Last spring, GOP legislators hastily drafted a constitutional amendment spelling out that Florida businesses and residents couldn’t be forced to buy insurance, but a Tallahassee judge threw it off the November ballot for “misleading” language. Lawmakers have re-filed an altered version and hope to place it before voters in 2012.

•And perhaps most significantly, legislative leaders are poised to block spending and rules necessary to implement the law. Already, state regulators has refused to impose minimum spending mandates that might generate refunds for consumers – but which health insurers say will hurt their profits. And Gov.-elect Rick Scott has also made clear he doesn’t want the state doing anything to help the law along.

The Patient Protection and Affordable Care Act passed last spring anticipated that the states would lead the way on many of its more than 100 changes to the nation’s health care system. With 3.8 million uninsured residents, Florida is one of the states that would be most affected by the law.

The most controversial reforms – including the requirement that individuals buy coverage or pay a penalty — don’t start until 2014, and phase-ins continue until 2018. But the bill requires states to start working now to improve their data-collecting and enforcement mechanisms.

It was hoped states would create their own insurance exchanges, to match individuals with insurance plans; establish “high-risk” pools to insure people now shunned by providers; and police new restrictions on insurance company profits.

But Gov. Charlie Crist opted last spring not to immediately tap into federal grant money to create a Florida high-risk pool to cover people with pre-existing medical conditions, deferring to the federal government. And now Cannon, R-Winter Park, and Senate President Mike Haridopolos, R-Merritt Island, may seek to block any cooperation by the state.

Florida has been awarded million in grants to provide 0 rebates to seniors who fall into the “donut hole” in the Medicare prescription drug program; to help prepare the Office of Insurance Regulation to evaluate out-of-state insurers seeking to sell health coverage in the state; and to plan for creating a health-care marketplace, or “exchange,” and other changes.

But even before he was officially named speaker, Cannon warned Crist that no state agency should take any steps to comply with the law “without clear and comprehensive guidance from the Legislature.” The Oct. 19 letter demanded an itemized accounting of all state agency activities regarding the federal law.

Specifically, the letter singled out the Office of Insurance Regulation for work it has begun – and which legislative budget-writers approved – to study how Florida’s health-care laws should be amended to conform to the federal reform, and to boost the state’s ability to handle new rate-filing data.

“Not only are Florida insurance officials helping the federal government to write rules on these matters, but [OIR] is jumpstarting these new regulatory functions by developing data systems necessary for enforcement,” Cannon complained.

He added: “We intend to develop a clear and statutorily-defined framework for Florida agencies’ activities in regard to the federal health law. Pending such legislative action, state agencies should examine each anticipated action or function in light of their specific statutory authority.”

Laura Goodhue, executive director of Jupiter-based health-care advocacy group Florida CHAIN, said the criticism appeared designed to bully agencies into slowing their efforts to follow the federal law.

“I know transparency is important in implementing laws, but creating a chilling effect is certainly not helpful,” said Goodhue, who attended meetings with OIR over the last year as part of an advisory health insurance board.

 

In response, most all of Florida’s state agencies produced itemized lists of what they had done — down to how many staff hours Department of Management Services staff spent examining new rules requiring lactation rooms and milk storage for breast-feeding mothers in the workplace.

Cannon spokeswoman Katherine Betta said last week that Cannon’s staff was still reviewing the responses and hadn’t decided “what the next step will be.”

OIR communications director Jack McDermott defended his agency’s work, adding there was no intent to be “an advocate for the implementation of federal healthcare.”

“Virtually all of this information — whether it is actual review of large group rates, or expanding data systems to collect additional data – would require additional statutory authority or administrative rules,” McDermott e-mailed in response to questions.

And recently, OIR decided to slow one of the new law’s reforms – by not imposing new profit limits on health insurers beginning Jan. 1.

A new federal “medical loss ratio” requirement would force insurers to spend 80-to-85 percent of the premiums they collect on medical care, with the remainder set aside for overhead including executive salaries and profit. Nearly half the country’s insured population are covered by providers that spend more than that on overhead and profit.

Florida’s “medical loss ratio” is 65-to-70 percent, and OIR will ask the federal government for a three-year waiver from the tougher standard, said McDermott.

At a recent hearing, most of Florida’s main health insurers complained that the new standard would hurt their bottom lines and restrict the Florida insurance market. Insurance Commissioner Kevin McCarty agreed, saying he feared making the change next year would “destabilize” the market and hurt competition.

The move could have a pocketbook implication for Floridians.

The law requires insurers to provide rebates to customers if they exceed the overhead limits in 2011. The feds estimate the rebates could average 4 for individuals in 2012. But if OIR wins the three-year delay, Florida consumers won’t be eligible for those checks in 2012.

“To me, the delay obviously would be helpful to the insurance companies and HMOs, and not to the patients,” said Senate Minority Leader Nan Rich, D- Weston. “That’s less money for care for patients.”

Legislative conservatives like Rep. Scott Plakon, R-Longwood – who’s re-filed the constitutional amendment that says Floridians could not be compelled “directly or indirectly… to participate in any health-care system” – say they are determined to fight every way they can.

Plakon’s House Joint Resolution 1 has already picked up a prime sponsor in the Senate: its new leader, Haridopolos.

“We have to follow the law. But in the process, we need to put Floridians first,” Plakon said. “So if there is any room there, we would default to the position of putting Floridians first instead of this kind of massive federal takeover.”

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lowering your health-care costs

April 28th, 2011

Many of us are rightfully stressed out over the ever-increasing cost of health care. Here are some ways to hang on to more of your dollars: Easy To Insure ME has the answers

— Shop around for the best prices on prescriptions, as pharmacy prices can differ. Ask your doctor if generic versions are available. Elderly or low-income folks can look into drug company discounts.

— Find the best-value health plan. An HMO may meet your needs sufficiently while costing less than your current plan. High-deductible plans are great for many young and healthy people. In exchange for deductibles of ,500 or more, they offer much lower premiums. Once you have your plan, use it. Regular checkups can catch problems before they get dangerous or costly.

— A high-deductible plan may let you set up a Health Savings Account (HSA), where you sock away tax-deductible dollars that will grow tax-free until spent on qualifying health-care expenses. If you don’t qualify for that, look into Flexible Spending Accounts (FSAs), which are somewhat similar, but require you to use up the cash you put into them each year — or lose it. These accounts can help you save hundreds of dollars per year in taxes.

— Coordinate health insurance benefits with your working spouse. Consider opting out of one plan and choosing the family option on another. Maintaining coverage with two providers can make sense if one fills the other’s gaps.

— If you incur hefty medical expenses in one year, those that exceed 7.5 percent of your adjusted gross income (AGI) are often deductible on your federal tax forms (and your state laws may be even more generous). See IRS Publication 502 or a tax pro for more information.

— Take advantage of free and discounted services offered by your health plan. Many will subsidize flu shots, gym memberships, nutrition or quit-smoking classes, and other preventive care.

— Finally, check your bills from hospitals and doctors. They often contain errors.

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Supreme Court Overturn Health-Care Reform

March 30th, 2011

Conservatives have been quick to declare that “ObamaCare is on life support” in the wake of Monday’s decision by federal district court Judge Henry E. Hudson in Virginia that the Affordable Care Act’s (ACA) requirement to buy health insurance is unconstitutional. But in truth Virginia’s attorney general, Ken Cuccinelli, won only a partial victory. He sought to have the entire law overturned, but instead only the section creating an individual mandate was. Hudson also declined to prevent the law’s implementation while the courts sort out the constitutional question. The individual mandate is due to take effect in 2014, and implementation of the other provisions will proceed in the meantime.Easy To Insure ME has the answers

Far from ensuring the eventual dissolution of health-care reform, Hudson’s decision actually guarantees only one thing: that the constitutionality of the individual mandate will ultimately be decided by the Supreme Court. The result, and its timing, is unknown, but experts generally predict that the Supreme Court won’t be ruling on the issue for another two years and that it will likely be a 5–4 majority—but which way that majority will go is unclear. Although it garnered less attention, the ACA has been upheld as constitutional by two district courts. (Those cases, one in Virginia and one Michigan, were lower profile because they were filed by conservative organizations rather than a state government.) If lower-court decisions had consistently upheld the law, there would have been a possibility of the Supreme Court declining to weigh in. Conservative legal scholars readily concede that Monday’s Virginia court decision and a forthcoming one in Florida that is expected to follow similar lines do not mean health-care reform will necessarily be overturned. “Ultimately this is going to go to the Supreme Court, and these are the beginning skirmishes,” says Ilya Shapiro, a senior fellow in constitutional studies at the libertarian Cato Institute who filed an amicus brief in support of Cuccinelli’s challenge.

When the Supreme Court does weigh in, it is presumed that the justices will generally split along partisan lines based on who appointed them, with all four Democratic appointees voting to uphold the law. (The judges who have upheld the law thus far were Democratic appointees, while Hudson was appointed by George W. Bush.) So will all five Republican appointees on the Supreme Court, who usually form a bloc in close decisions, vote to overturn the individual mandate? Justice Anthony Kennedy, who was appointed by Ronald Reagan, sometimes sides with the court’s more liberal wing. And this might be such a case: since the 1930s, when the court accepted the New Deal, it has generally defined the federal government’s power to regulate interstate commerce very broadly. In 1942 the court held in Wickard v. Filburn—the most relevant precedent for this case—that a farmer growing wheat for his own chickens, above a maximum of growth allowed per acre at the time, was subject to federal regulation under the commerce clause because the resulting extent to which a farmer does not buy wheat to feed his chickens on the market affects the national market price of wheat.

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What Health Care Consulting Services Can Do For Your Healthcare Facility

March 19th, 2011

Creating your medical center the most effective in your space- Banahan Communications will give you with the tools needed. One amongst our purchasers, in central LA, has gone beyond these days’s standard Diversity Coaching and Political Correctness categories, and have reached out to the surrounding communities, letting them grasp HPMC will be trusted. Changing into #1 within the LA area was achieved by building a trusting relationship with the community through excellent communication for health care consulting services. The ability to communicate and trust HPMC was the most necessary step toward their success as a health care consulting services.

Jim Banahan, founding father of Banahan Medical Marketing Firm said, “We have a tendency to are serving to build a relationship with the community based on the simple principle of trust”. The health care consulting firm visited work within the LA space, analyzing demographic knowledge, and personally surveying (via phonephone) the numerous various surrounding communities. When asked, the communities in the LA area if they wished to understand a lot of concerning our consumer the health care consulting agency, the solution was a powerful YES.

Health care consulting is additional than an advertising health care consulting team. Our consultants are additional match makers for the community and glorious health care, consultants realize out what the community wants and is trying for and shows them the way to become the right choice. Any strengthening their relationship is done through employs physicians, nurses, and technicians from the same diverse backgrounds as their patients. When people of the same cultures, languages, and backgrounds offer health care, communication becomes additional comfortable, relieving the stress of the patients and also the physicians treating them, thereby providing higher health care and happier, healthier patients.

As advised by our health care consulting team, we have a tendency to brought our consumer’s message to the community, where the population congregates and commutes. One amongst the successful promoting tools used to focus on each ethnic background in their own communities, was the utilization of every house, from bus stops, to subway signs, to teach the general public about our client’s commitment to quality care and safety. The photographs showed actual physicians, nurses, and patients, and highlighted the hospital’s dedication to improving the health and welfare of all the residents of Los Angeles. For example, Korean translations on the advertisements within the Korean neighborhood, Spanish in the Mexican part of town, etc. allowed HPMC to take their message to each community, creating all ethnicities feel comfortable and welcome.

To express dedication and quality, trust and family, we have a tendency to have the employees and the physicians facilitate unfold the message to expedite results for turning into well known and trusted for providing better health care to the community. In addition to improving our consumer’s relationship with the community, the community is changing into healthier due to the accessibility of health care consulting services they trust and therefore use on additional regular basis. The people in these communities are keeping latest on preventative drugs and alternative measures to remain healthy as a result of they have healthcare facilities they’ll trust and understand.

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Az Reps Remain On Health-Care Fence

March 14th, 2011

When it comes to the president’s health-care reform, both of Southern Arizona’s congressional representatives are seen as “in play,” uncommitted votes that could go either way.

Which is putting both under intense pressure to get off the pointy end of the fencepost they’re perched on, one way or the other.

Congressman Raúl Grijalva, who doesn’t like the fact the Senate bill doesn’t have a public option, was summoned to the White House Thursday afternoon with seven other progressives for a sit-down with the president, who has said he wants the effort sewn up by the time Congress leaves for Easter break on March 26.

Grijalva left the Roosevelt Room roundup sounding like he’s close to voting for with the president, despite the lack of a public option he considers critical. After the meeting, he said a partial victory on health care would be better than losing everything, at this point.

Congresswoman Gabrielle Giffords, meanwhile, is the target of tea party rallies and a week long “Code Red” robocall campaign by the National Republican Congressional Caucus, which is targeting voters in swing districts. The script warns listeners to call Giffords “before it is too late and tell her to vote ‘no’ on Nancy Pelosi’s dangerous health-care scheme.”

On the other side, Organizing for America took out an ad in USA Today that says, “You Fight, We’ll Fight.” It pledged 8 million volunteer hours to assist congressional representatives who hold steady on supporting the plan, which Giffords has already said she doesn’t like. Arizona Director Jessica Jones said that so far, 700 volunteers are committed to help the state’s Democrats.

“We will be making sure that we are backing up their legislators and letting them know their constituents are behind them,” Jones said, because too many Americans have gone without insurance for too long. “We’ve been debating this for a year now and it’s really crunch time. We need to get this bill passed.”

Although majorities of the Senate and House approved separate health-care versions, they must settle on identical versions before it can become law. And with the loss of the 60th vote in the Senate with Scott Brown’s election, the plan that seems to have the most traction so far hinges on the House signing off on the bill that passed the Senate on Christmas Eve. But House Democrats have found a lot not to like in that package.

In January, Giffords sent a letter to House Speaker Pelosi saying the Senate reform version would be too costly when the state’s fiscal position is already dire.

That package could cost the Arizona billion over the next decade, she wrote, because of its requirements to put more people on the rolls for the the state’s version of Medicaid, which provides health care to low-income residents.

Her spokesman, C.J. Karamargin, said that if the bill comes to the floor of the House with the same language she objected to in January, she will not be able to support it. Asked if she can offer her support if the concerns are worked out on reconciliation, Karamargin said, “We’d have to weigh that promise if it’s made.”

Although the House leadership has already included Giffords, as well as Rep. Harry Mitchell, as one of several possible “vote switchers,” Giffords was not part of the group invited to sit down with the president Thursday.

Grijalva said the group vented complaints about the bill, primarily the lack of a public option. While President Obama reportedly said he pledged to continue working on those areas, he focused attention on the benefits of the package, from more money to community health centers to more regulation on insurance companies. And he drew a parallel with Social Security, that started small but grew over time to become the sweeping entitlement program it is now.

“The president made a compelling case,” Grijalva said. “He presented an argument that if we don’t get this first block done, we’ll never get the rest.”

He didn’t take a head count, Grijalva said. “That’s going to be the most agonizing week for me. I hate to vote for a bill that doesn’t have the public option, but I don’t want to hand the opponents of health-care reform a victory, either.”

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The Master’s in Public Health versus the Master’s in Healthcare Administration

February 28th, 2011

Due to dramatic medical and pharmaceutical advancements and an increasing awareness of public health and well-being over the past decade, the American workforce is seeing a greater demand for qualified healthcare professionals. According to the U.S. Bureau of Labor Statistics, 10 out of the 20 most rapidly growing occupations today are in healthcare, and over the next seven years, the healthcare industry will generate more jobs than any other industry.* In an economic climate where there is a dearth of jobs in most sectors, more people are realizing the benefits of securing employment within the healthcare industry and pursuing the degrees that will enable them to do so.

There are many educational degrees that can qualify you for healthcare jobs, but which degree could lead to the most satisfying career for you? The most common choice is between a Master’s in Public Health degree and a Master’s in Healthcare Administration degree. To decide between them, you first need to evaluate your long-term career plans. While there are a few components common to both degrees, they each have a separate focus and goal.

A Master’s in Public Health (MPH) degree is geared towards providing students with an in-depth understanding of the core areas of public health, giving them the ability to address and prevent public health concerns and problems at the micro and macro level. A Master’s in Public Health program utilizes an interdisciplinary approach toward healthcare education, covering environmental issues, epidemiology, disease prevention, nutrition, sociology, healthcare communication skills, health program evaluation, healthcare management, research methods, and more. With the Master’s in Public Health degree under your belt, you can qualify for an extensive range of jobs, including health and medical education, program management, health policy making, promoting and advocating, research associates, and public health informatics in sectors such as government, pharmaceutics, non-profit organizations, private organizations, etc. If you have the desire to contribute to public health and the drive to take on the challenges of public health promotion and disease prevention, the Master’s in Public Health degree could be right for you.

A Master’s in Healthcare Administration has an entirely different focus: it approaches healthcare as a business, and aims toward teaching students how to increase organizational efficiency by evaluating policies and strategies and formulating new ones, becoming adept at the supervision and administration of healthcare organizations, coping with and staying on top of a competitive market, and more. The coursework covers subjects such as economics, finance, organizational behaviors, employee and resource management, information systems, marketing, and conflict resolution within healthcare services. With a Master’s in Health Administration degree, you could find positions in a wide variety of settings, from hospitals, nursing homes, assisted living centers, and mental health institutions, to pharmaceutical companies, insurance firms, and nonprofit organizations, in various capacities. If this is where you see yourself professionally in the future, the Master’s in Healthcare Administration could be the right degree for you.

*U.S. Department of Labor, Bureau of Labor Statistics. “Healthcare.” Career Guide to Industries, 2010-11 Edition. bls.gov/oco/cg/cgs035.htm

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King will continue to fight health-care bill

February 13th, 2011

U.S. Rep. Steve King, R-Iowa, said Democrats are working to create a “dependency class” in America in an effort to expand their political base and stay in power.

“That’s part of the motive,” King said when discussing federal health-care reform efforts with reporters after a Tuesday taping of Iowa Public Television’s “Iowa Press.”

King, who represents Iowa’s 5th District, said he will do what he can to try stop a health-care bill from heading to President Barack Obama’s desk, and he urged others who opposed the bill to join him.

He said Democrats are moving toward nation health care, whether a public insurance option is included in the final bill or not.

“That’s the goal; that’s the endeavor,” King said. “They’ll regulate everything, and when they do that, we will lose the liberty we have today to buy health insurance policies.”

He predicted that if Congress passes health-care reform, Democrats will pay a price at the ballot box in 2010.

“I’ve never seen this kind of energy in America, this kind of uprising, especially from the heart of the heartland of America,” King said.

King said he is worried about the “mindset” drifting into America that doesn’t seem to understand the free-enterprise system.

“We’re descendants in this part of the country from people who came across America in covered wagons,” King said. “I mean, they came here to live free or die on the prairie. They didn’t ask for a government handout.”    

Norm Sterzenbach, executive director of the Iowa Democratic Party, called King’s comments hypocritical.

“Before he rails against Democrats for working to help seniors pay for prescriptions and help students afford college, he should consider giving up his government salary, as other members of Congress have,” Sterzenbach said.

King, a four-term congressman, said he plans to seek another term in 2010. Iowa is expected to lose one of its congressional seats, and King said he probably still will seek re-election in 2012 even if redistricting places him in the same district with another member of Congress.

As Iowa Republicans look to unseat Gov. Chet Culver next year, King said he did not know whether he would endorse one of the candidates in the GOP primary.

“I’d like to see them fight this out, because it tests their vigor, and it tests their ability, and it also shapes the policy for Republicans that will be matched up against the policy that’s been set by Gov. Culver,” King said.

The “Iowa Press”  featuring King is scheduled to air at 7:30 p.m. Friday and noon Sunday on Iowa Public Television.

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Applying the 4 Quadrant Healthcare Model and Evidence-Based Practices to Behavioral Health

December 24th, 2010

APPLICATION OF THE FOUR QUADRANT HEALTHCARE MODEL TO VARIOUS POPULATIONS -

The examples used in the diagram of the Four Quadrant Integration model are for adult populations; the same template can be used to create models that are specific for children and adolescents, or older adults, reflecting the unique issues of serving those populations (for example, the role of schools and school based services in serving children). Older adults, particularly, have been shown to utilize primary care settings for psychosocial, non-organic somatic complaints and to be underrepresented in specialty behavioral health populations — research suggests they are willing to receive behavioral health services in a primary care setting and that targeted interventions can make a difference in depression symptoms. Ethnic, language and racial groups also have unique issues in receiving language and culturally appropriate behavioral health services. Primary care based behavioral health services can improve access for these populations and lead to appropriate engagement with behavioral health specialty services as needed. For example, the Bridge Program in metropolitan New York has been successful in reaching the Asian-American community via their primary care settings.

There are also differences between rural and urban environments and among regional markets in terms of the resources available and ease or difficulty of access to services. The Four Quadrant Integration model provides a template for considering the resources locally available and developing alternative methods of coordination (for example, telemedicine) that may be required when specialty care (either physical or behavioral health) is delivered in another community.

The Four Quadrant Clinical Integration model is not diagnosis specific; it looks at degree of clinical complexity and risk/level of functioning. Further, the evidence-base is at different levels of development in each of the Quadrants. The model is intended to provide a conceptual construct for how to integrate services. Diagnosis specific guidelines should be used to provide detailed guidance for the scope of the primary care provider, the primary care based behavioral health provider, and the specialty behavioral health provider.

THE FOUR QUADRANT MODEL AND EVIDENCE-BASED PRACTICES IN HEALTHCARE AND BEHAVIORAL HEALTH -

In the healthcare system, there are numerous evidence-based practice guidelines that are diagnosis/condition specific. The National Guideline Clearinghouse (NGC) is a public resource for evidence-based clinical practice guidelines. NGC is sponsored by the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, in partnership with the American Medical Association and the American Association of Health Plans. There are over 1000 disease/condition guidelines that can be accessed through their website (www.guideline.gov).

The Chronic Care Model (CCM) (http://www.improvingchroniccare.org/change/index.html) was developed under the Improving Chronic Illness Care Program. The CCM is in use in a variety of healthcare settings, providing a structured approach for clinical improvement.

The CCM has been used to develop specific approaches for serving patients with diabetes, cardiovascular disease, asthma and depression in a project sponsored by the Bureau of Primary Health Care (BPHC) with the Institute for Healthcare Improvement (IHI), a not-for-profit organization driving the improvement of health by advancing the quality and value of health care. The Health Disparities Collaboratives (http://www.healthdisparities.net/) are a multi-year national initiative to implement models of patient care and change management in order to transform the system of care for underserved populations.

The organizing principles for each of Health Disparities Manuals follows the key elements of the CCM; many of the components apply to each disease entity (e.g., diabetes, asthma, depression), while specific tasks and tools are unique to the specific disease entity. The key change concepts found in the Depression Collaborative manual include:

Organization of Health Care/Leadership -

>   Make sure senior leaders and staff visibly support and promote the effort to improve chronic care
>   Make improving chronic care a part of the organization’s vision, mission, goals, performance improvement, and business plan
>   Make sure senior leaders actively support the improvement effort by removing barriers and  providing necessary resources
>   Assign day-to-day leadership for continued clinical improvement
>   Integrate collaborative models into the quality improvement program

Decision Support -

>   Embed evidence-based guidelines in the care delivery system
>   Establish linkages with key specialists to assure that primary care providers have access to expert support
>   Provide skill oriented interactive training programs for all staff in support of chronic illness improvement
>   Educate patients about guidelines

Delivery System Design -

>   Identify depressed patients during visits for other purposes
>   Use the registry to proactively review care and plan visits
>   Assign roles, duties and tasks for planned visits to a multidisciplinary care team. Use cross training to expand staff capability
>   Use planned visits in individual and group settings
>   Make designated staff responsible for follow-up by various methods, including outreach workers, telephone calls and home visits

Clinical Information System –

>   Establish a registry
>   Develop processes for use of the registry, including designating personnel to enter data, assure data integrity, and maintain the registry
>   Use the registry to generate reminders and care planning tools for individual patients
>   Use the registry to provide feedback to care team and leaders

Self- Management -

>   Use depression self management tools that are based on evidence of effectiveness
>   Set and document self management goals collaboratively with patients
>   Train providers and other key staff on how to help patients with self management goals
>   Follow up and monitor self management goals
>   Use group visits to support self management

Community -

>   Establish links with organizations to develop support programs and policies
>   Link to community resources for defrayed medication costs, education and materials
>   Encourage participation in community education classes and support groups
>   Raise community awareness through networking, outreach and education
>   Provide a list of community resources to patients, families and staff

EVIDENCE-BASED PRACTICES IN THE BEHAVIORAL HEALTH SYSTEM -

The Chronic Care Model (CCM) has also been adapted by The National Program Office for Depression in Primary Care (http://www.wpic.pitt.edu/dppc/), to develop a clinical framework for all partnering organizations to follow. Its Flexible Blueprint was developed after a review of published interventions used to treat depression, interviews with a variety of primary care physicians, mental health specialists and other experts in the field, and selected site visits to view elements of the Chronic Care Model in action.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is supporting the Implementing Evidence Based Practices Project. This project is focused on people who have severe mental illness; these people are most frequently served in the public mental health system (http://www.mentalhealthpractices.org/).

There are six areas that have been researched. Toolkits have been developed based on the multi-state demonstrations that have been underway. The six areas are described below, based on the website materials:

Illness Management and Recovery –

This is a program of weekly sessions where specially trained MH practitioners help people develop personal strategies for coping with mental illness and moving forward in their lives. The program emphasizes helping people set and pursue personal goals and become better able to realize their vision of recovery.

Medication Management Approaches In Psychiatry (Medmap) –

This focuses on using medication in a systematic and effective way, providing guidelines and steps for decision-making based on current evidence and outcomes, monitoring and recording information about medication results, and involving consumers in the decision-making process.

Assertive Community Treatment (ACT) -

This program is for people who experience the most severe symptoms of mental illness. The goal is to help people stay out of the hospital and develop skills for living in the community. Services are provided by a team of practitioners, are available whenever and wherever needed, 24-hours a day, and are provided for as long as they are wanted and needed.

Family Psychoeducation –

This involves a strong partnership between consumers, families and supporters, and practitioners. People work toward recovery by developing better skills for overcoming everyday problems and illness-related issues, developing social support, and improving communication with treatment providers.

Supported Employment –

This is a well-defined approach to helping people with mental illness find and keep competitive employment. These programs are for anyone who expresses the desire to work. The programs are staffed by employment specialists who work with the treatment team to integrate services. They help people look for jobs soon after entering the program, and provide support as long as consumers want the assistance.

Integrated Dual Disorders Treatment -

This treatment approach is for people who have mental illness and addiction disorders, offering mental health and substance abuse services together, in one setting, at the same time. A wide variety of services are offered in a stage-wise fashion because some services are important early in treatment, while others are important later on.

The EBPs described above are intended for use in the public mental health system, serving people with severe mental illness; they are not diagnosis specific. The American Association of Community Psychiatrists (http://www.wpic.pitt.edu/aacp/default.htm) has released guidelines, such as Guidelines for Recovery Oriented Services that also address this target population rather than a diagnosis specific population.

The American Psychiatric Association has developed diagnosis specific practice guidelines (http://www.psych.org/) that are applicable in a wide variety of settings, as have other professional groups. The following list of behavioral healthcare guidelines and protocols is from the National Guideline Clearinghouse:

>   Adjustment Disorders
>   Anxiety Disorders
>   Delirium, Dementia, Amnestic, Cognitive Disorders
>   Dissociative Disorders
>   Eating Disorders
>   Factitious Disorders
>   Impulse Control Disorders
>   Mental Disorders Diagnosed in Childhood
>   Mood Disorders
>   Neurotic Disorders
>   Personality Disorders
>   Schizophrenia and Disorders with Psychotic Features
>   Sexual and Gender Disorders
>   Sleep Disorders
>   Somatoform Disorders
>   Substance-Related Disorders

EVIDENCE-BASED PRACTICES FOR ALL POPULATIONS -

There are evidence-based practices in clinical preventive services that should be utilized with all populations, whether or not they are receiving services related to a particular diagnosis or condition. This is an area for improvement in services to persons with severe mental illness, who historically have had difficult accessing healthcare services for acute or chronic medical conditions, not to mention clinical screening and prevention services.

The U.S. Preventive Services Task Force (USPSTF) (http://www.ahcpr.gov/clinic/uspstfix.htm) was convened by the U.S. Public Health Service to rigorously evaluate clinical research in order to assess the merits of preventive measures, including screening tests, counseling, immunizations, and chemoprevention. The USPSTF consists of 15 experts from the specialties of family medicine, pediatrics, internal medicine, obstetrics and gynecology, geriatrics, preventive medicine, public health, behavioral medicine, and nursing. The recommended clinical prevention services are organized into the following clinical categories:

>   Cancer
>   Heart and Vascular Diseases
>   Injury and Violence-Related Disorders
>   Infectious Diseases
>   Mental Disorders and Substance Abuse
>   Metabolic, Nutritional, and Endocrine Disorders
>   Musculoskeletal Disorders
>   Obstetric Disorders
>   Pediatric Disorders
>   Vision and Hearing Disorders

The original Task Force’s efforts culminated in the 1989 Guide to Clinical Preventive Services. A second edition of the Guide was published in 1996. In November 1998, the Agency for Healthcare Research and Quality (then the Agency for Health Care Policy and Research) convened the current USPSTF to update existing Task Force assessments and recommendations and to address new topics.

CONCLUSION –

The Institute of Medicine’s Improving the Quality of Healthcare for Mental and Substance-Use Conditions states: “A large body of research and other published work on organizational change, for example, consistently calls attention to five predominantly human resource management practices (and one other organizational practice) that are key to successful change implementation (1) ongoing communication about the desired change with those who are to effect it; (2) training in the new practice; (3) worker involvement in designing the change process; (4) sustained attention to progress in making the change; (5) use of mechanisms for measurement, feedback, and redesign; and (6) functioning as a learning organization. All of these practices require the exercise of effective leadership.”

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Healthcare Reform – A Viable Health Care Solution

December 19th, 2010

I have written in some length about the issues of the U.S. healthcare system and have attempted to cut through some of the rhetoric. You can read the preamble to this solutions only article at Healthcare Reform Compromise For now a healthcare reform solution that is understandable and summarized in just a few short concepts. (Not 1,000 or so pages)

The following concepts will specifically address the major issues facing the U.S. health delivery system. I have defined the major categories as: 1) Cost control 2) Minimize provider loss, 3) Reduce Insurance premiums 4) Provide catastrophic coverage for every American 5) Create an environment of affordable, manageable health delivery 6) Minimal added cost. 

What follows is a 21st century, free market based, world leadership solution. it is a foundation of a real solution, a place I believe many of us can agree.

Reform/Solutions:

1) A system that “Insures displaced workers” for up to one year. Most individuals look at COBRA through the lens of unemployment and conclude that it’s unaffordable. Of course they do; they’re unemployed. Employers should be required to provide a minimum level of health insurance for 12 months after unemployment. After year 1 the displaced employee could choose to buy the minimum coverage in that employer group for an unlimited time frame. Result, an individual will always have access to a group plan as long as premiums are paid. No pre-existing condition discrimination, and this specifically addresses the problem of the temporary uninsured and uninsurable.

The minimum standard coverage would include 2 parts: First, some preventative and basic health care. i.e. 2 doctors visits annually plus some diagnostic coverage benefit. This minimum required employer coverage would provide health insurance to roughly 0 per recipient or family member. This keeps the unemployed going to doctors and minimizes future catastrophic needs. The second part of the minimum requirement would be catastrophic coverage over 0,000 to the 0,000 threshold. Individuals could have the option to purchase “gap” coverage to fill in between 0 and 0,000 if they choose. Once employed again the individual would be transferred to the new employer group and responsibility reassigned. (This would only apply to groups over some predetermined level i.e. 50 members) This would give the unemployed or those doing other work access to a group health plan. Anyone who has at least one job in life would have coverage as long as the premium was paid.

2) Minimize provider loss/Catatrophic Coverage for Every American: Specifically addressing a major burden on hospitals, and other providers by the uninsured. This is one of the major issues driving up the cost for the insured. I would impose an off budget, segregated, “Lock box” type trust fund that could not be borrowed from EVER. A small tax on wages would provide for catastrophic coverage over a 0,000 threshold for every American. Since this would be a separate tax on income (over federal poverty level) it would bring every worker into the system including those wage earners with sufficient income to afford some coverage but skate by without health insurance. These individuals currently add cost by increasing risk, and utilizing expensive ER services for care. Those who have insurance end up covering this cost with higher cost of care and higher premiums. This concept would be a positive revenue mechanism by bringing in those who currently pay nothing. (Specifically those 17 million who earn over ,000/year but do not buy health insurance)

Important: Those currently insured will be rewarded as their new tax will be significantly offset by the reduction in their health insurance premiums. This will occur as the artificial inflation of services is reigned in, provider loses are mitigated, and the cost to insurance companies is reduced. With no risk above 250K insurers will be able to lower premiums as the liability above 250K is transferred from insurance companies to the trust fund (could be phased in once the trust fund is in place). Note: Most insurance policies cover up to 2 million, 5 million, or even have unlimited benefit limits.

The total tax to those already insured would be offset – in time – by the savings. I’m confident this would be close to neutral in cost to those currently insured and but it could exceed 100% as the added costs will be borne predominately by those who can afford the coverage in the first place but choose to ignore the need.

As the individuals who ignore health insurance are brought into the system they can still avoid other coverage but the high burden they place on the system will be mitigated. Their newly captured tax pays for catastrophic coverage, and hospitals are relieved of the burden of losses above the 250k. In addition catastrophic costs and shared by every Americans and more important; Every foreign workers, illegal workers, and those irresponsible Americans earning sufficient wages but not contributing are integrated into the system.

Additional Results: Relaxed underwriting standards, (insurer would be more willing to accept some riskier applicants since exposure is limited). This expands the availability of reasonably priced health insurance for those with preexisting conditions and/or elevated risk profiles. This further addresses the uninsured however many would eventually become tied to some group plan. (above)

3) We need A National health Insurance Regulatory Agency so insurers who provide policies over several states could meet ONE regulatory requirement recognized by all states. Large insurance plans could be overseen by 1 regulator instead of contend with up to 50 regulators in every state they do business. Regional providers that can do better on a local level would remain and drive out cost on a regional level. This would create an environment in which more national plans would emerge strengthening competition, reducing overhead, exploiting synergies and in place infrastructure and technology. This would ultimately reduce insurance cost. I can foresee consolidation potentially reducing options for individual so I would forbid any consolidation that would reduce the number of choices in any given area below 5 or more.

I would make the financial requirement significant in areas of capitalization, loss reserve, as well as other necessary standards. It would and should be tougher than any state so that there is no “systematic risk” in the event of any national provider failure. Essentially, it should be tough enough to almost eliminate the possibility of failure.

An insurance “exchange” as is currently being discussed would be a sufficient alternative but I don’t believe it will work. It is irrational to allow New Yorkers to buy insurance in Georgia or Indiana. How will an insurer be regulated in NY that may be based in Tennessee? It seems like it adds more – not less – bureaucracy, but I am open to suggestions.

4) “Cost control”: (The ugly and anti-free market dilemma) – The government could create a reimbursement rate for services provided above the catastrophic amount controlling expenditures at the high end. This would be applied to high cost treatment and procedures only. It has been demonstrated that this is an area where we could realistically apply responsibility over a group of multiple providers (Physicians, hospitals, and pharmaceutical providers) for the package treatment and healthcare. (Although not necessary.) The plan could include BONUSES for quality of care, outcomes, and other health performance criteria that many advocate.

I would allow providers and hospitals to balance bill (up to 15%) and/or opt out of the catastrophic coverage system altogether (not likely since they would be exposed to loses when any uninsured presented in their emergency room and they were mandated to provide service) ALL group plans would have to include excess charges. However, “Gap” plans available to only unemployed individuals would not. Further, Individual plans would be available as including excess charges OR as HSA accounts and would require a minimum (/month) HSA contribution as a trade off. The benefit; The HSA contribution would belong to the specific individual but could only ever be used for healthcare. This is the obligation for purchasing individual coverage without the “excess” coverage feature. Theoretically the HSA owner would be saving for future catastrophic expenses that entered the “excess” dimension. The insured would have the option to purchase these HSA plans or purchase plans that included the additional excess coverage.

Result: Under The new reform everyone but especially the younger American’s could accumulate (with HSA’s) 10′s of thousands of dollars in their 20′s, 30′s, and 40′s. This account could then be used later in life as health care needs become more likely. Additionally, the HSA could be used for the individual owner or family healthcare requirements. Eventually it could be applied toward LTC premiums after age 55. That would solve ANOTHER problem facing the U.S. healthcare system. So individuals are now in control, saving for their own of family healthcare needs and in addition have an account that could pay LTC premiums later in life.

As many have wisely pointed out, when individuals use there own accounts they spend more wisely. Having ownership of a health plan from the age of 18, 21, or even later in life keeps individuals involved. Ultimately we’ll create an environment were everyone pays something, everyone gets something, and everyone has some level of affordable healthcare insurance. No excessive government intrusion necessary.

Some additional Details: Similar to our current environment HMO’s, PPO’s, and other plan providers would still negotiate reimbursement of charges above the 250K catastrophic limit. The insurance provider would manage and make payments to facilities and others but would be reimbursed at the scheduled rates from the healthcare trust. This will control excessive inflation for high end health services but does not completely communize and thwart our free market system. Further we need to also reform HSA account use and expand premium tax deductions to individuals. Employer provided versions require users to spend down accounts each year. This is Dumb. We need to allow employer based MSA’s to accumulate over years.

Although the “excess” billing option creates an environment of complexity to this solution it allows some sensible variations in pricing and regional cost variations. At the same time it does not create a system that encourage providers to “excess bill” and individuals to avoid the coverage. The result may be some high end clinics, hospitals and providers, but this is no different to the free-market environment present in the current hospital and provider system. Some providers will always be better than others. Experience and expertise will naturally accumulate in “pools” this is Nature at work and a working plan will have to accommodate the laws of nature.

In a later phase I MIGHT require all insurers to cover all applicants at some maximum rate. Say, 2x the base rate. Or, create some sort of national high risk pool and assign applicants to plans based on size and other factors. This would make health care coverage attainable to those few remaining high risk individuals. I would only consider this after several years and the impact of phase one of the health care reforms is evaluated. Another option is a “High risk” reimbursement for those who have been denied coverage from 2 of more insurance providers. They would pay 2x the base rate from a provider of their choice and the government would kick in the balance necessary for the provider to take in the previously denied applicant. Details on this portion world need to be worked out. Ultimately, most every worker would have access to a group plan from point 1

finnally, many readers might retort that I overlooked items such as Malpractice Insurance and caps on lawsuits. I trust you I did not. Certainly there are additional issues that need addressing but healthcare reform should not be confused with other reform. We must find common ground and that sometimes means shrinking the ground to be covered. (Pay attention Washington)

Before we continue on any such reform we should keep a few simple principles at the top of any government reform package including healthcare:

1) Do no harm

2) Minimize government involvement (infrastructure, regulatory platforms, and technology platforms like online records etc. are the role of government – Not biased competition, or industry manipulation) You can apply for insurance online Example Aetna Health Insurance , but your doctor can’t get test results or health history.

3) Improve the system for everyone. Society should provide a safety net for everyone including themselves. But it should be simple and just – No excessive burden on any class.

4) Find Common Ground – Effective legislation can only be accomplished when we find areas of agreement and commit to legislation directed to specific areas on which there is agreement. If you don’t understand the hidden costs of government involvement see http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf Medicare’s Hidden Administrative Costs: by The Council for Affordable Health Insurance

Responsible government means specifically defining problems, outlining solutions, and analyzing reasonable outcomes. There needs to be sufficient time for review before instituting reform. 30-60 days seems rational time for debate and analysis. Anything less is irresponsible. Our Constitution was not completely ratified for 9 months and it took 3 months before the first state put its signature on the plan. The current rush into new programs is our current governments attempt to cloak what is happening from the public. It is a disgrace, and the absence of these principles is destroying our great country. We need to return to the place our founders created. (1 – large – page I might add)

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Predicting Your Future Health – New Ways To Deliver Health-care

December 11th, 2010

Predictive Health-care may not be a household term quite yet, but basically this new, emerging way of delivering health-care in the US focuses on predicting health and its risk factors, as opposed to waiting for disease to begin. Predictive Health-care delivery is by no means a niche market idea in the realm of Alternative Medicine, a feasibility study has been published by a mainstream institution: Emory University Predictive Health Initiative. It alludes to the many advantages including cost savings.

The Change to “Measuring Health” before Discovering Disease

Health is commonly defined as the absence of disease symptoms, and it is disease symptoms that are commercially relevant. In fact, today’s Health-care systems are all set-up to measure disease, we are searching for what’s wrong, not what’s right. However, physical symptoms are evidence of the last stage in the progression of an Illness which originated much earlier. Thus, the purpose of Preventive- or Predictive Health is to identify any sign of degradation in the “whole Health”, usually referred to as Holistic Health and what is perceived as Vitality. Whole Health consists of the 6 interweaving elements: Physical – Mental – Emotional – Spiritual – Social – Intellectual Health. As Physical Illness is usually the final manifestation of an Emotional Trauma, treating the Physical Symptom is only a temporary fix. In the attempt to forestall Physical Illness we need to identify the potential cause for the loss of Vitality – and Lifestyle is the usual culprit. By Lifestyle we mean the person’s intentional choices such as Nutrition and Activities, and circumstantial factors, such as Environmental Exposure, History, Believes, Social Integration, etc.

Conventional Health-care is not concerned with these intertwining Mind-Body issues, because the medical science consensus neither extends to analytical methods nor the interpretation of results. The generally accepted medical standard for diagnosing disease rests on sample collection, which can be reduced to numerical values, such as blood pressure, cholesterol, body fat, bone density and various biomarkers.

In Predictive Health such samples and methods may be used, but in presumed healthy people, these “disease markers” just resemble a snap shot of a condition at the time of sample collection. If all results check out in the “Normal” range, a person is considered physically healthy, even when all 5 non-physical health elements are compromised. In such case, a physical symptom has just not yet established itself measurably.

Holistic Health or Vitality may be defined as the sum of all 6-elements that comprise whole Health. A person, who has been clinically classified as physically healthy, may however completely lack Vitality, if any of the non-physical elements is weakened; while we may perceive a person to have great Vitality, if all health elements are strong and in harmony.

What is needed is a process that measures Vitality as the sum of all Health elements. As Vitality is a highly volatile condition, we cannot solely rely on static samples to predict a person’s susceptibility to contract any disease, nor can we recommend a Nutritional concept or Lifestyle modification based on static numericals, such as cholesterol, blood pressure, glucose and insulin. Instead, we have to dynamically monitor how well a person copes with lifestyle specific conditions that include various degrees of stress and rest, and we have to measure cellular function under changing situations. We want to assess the wear and tear that the body has undergone to date.

These Test results incorruptibly and reproducibly portray a person’s immunity, strengths and vulnerabilities . When correlated with the person’s history, lifestyle and personal objectives, a Lifestyle optimization program (behavior modification) can be generated that does not rely on lifetime prescription drugs.

Predictive Health – a quantum leap in Health-care

The passionate debates on Health-care reform are far from over and will not come to a consensus as long as it is wholly focused on pharmaceuticals based symptoms fixing, all while people get more concerned about their sustained Health.

A Japanese “Attitude Survey on Health and Preparation” (November 1, 2010; Hello-Global.com) states that 69.4% of the respondents “are worried about their future health”. There are more indications of people’s concerns about their future Health: In the US we are seeing sustained increase in growth rates for Organic Foods even in a recession. The statistics furnish the evidence that people are awaking to the fact that protecting health is better than recovering from illness. The leading market research and information analysis company RNCOS Press Release of October 29, 2010 reveals that the US Organic Food Industry will orchestrate 12.2% CAGR during 2010-2014. North American market growth for Organic Personal Care products amounts to 20% annually, according to Organic Monitor.

“Even in the midst of the economic downturn, the Gym, Health & Fitness Clubs industry has maintained steady growth, with membership rates growing consistently and profits remaining solid. Demand for gyms and health and fitness clubs will continue to rise over the next five years, as the general public becomes more health conscious and the aging population places a greater value on staying fit” – According to IBIS World Industry Report of September 17, 2010. Merriman Curhan Ford, Fitness & Wellness Industry Report predicts US sales of Health and Wellness goods to reach $ 170 billion by 2012, a growth of 70% in 5 years. Gym memberships for people over 50 will rise even more dramatic over the next 10 years with a target market potential of 139.2 million people by 2020; according to Capital Connection, March 2010 Newsletter. The Nutritional Supplements market in the US will exceed billion in 2014, yielding a compound annual growth rate of 7%; says Market Resaearch.com, in the September 2, 2010 Press Release.

These trend numbers clearly portray the global shift to Preventive Health, lead by the US which boasts the highest Health-care costs in the world. If we are truly concerned about our future health, evidenced by spending substantial money for healthy food and lifestyle, it should come naturally that we can no longer rely on drug-centric sick-care, but opt for Predictive and Preventive care.

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