MEDICAID: Putting It Into Perspective

61761844 - medicaid word cloud concept

Medicaid is in the news every day. People, politicians, policymakers, providers, and payers are expressing points of view ranging from kill it to expand it. Unfortunately, most people are not well informed about what Medicaid is. I would like to help on the informing part of the issue by describing what it is, how it works, who qualifies, how much it costs, and some policy choices I see. This is a very complex subject, so I will lay it out in bite-sized posts. Consider this first post as a backgrounder. If you want to dig deep into the subject, I recommend visiting The Center on Budget and Policy Priorities.
Read More ...

The Long And Painful Decline Of The Hospital Has Begun

hospital

Distress signals are starting to sound in two of the country’s major sectors, retail and healthcare. Last week, the discount shoe retailer Payless ShoeSource filed for Chapter 11 bankruptcy and announced it will close 400 brick-and-mortar stores throughout the United States and Puerto Rico. The announcement comes on the heels of a seemingly unending parade of bad news from traditional retailers in recent months. So far this year, Walmart, Macy’s, J.C. Penney among others, have all announced significant store closures. Ralph Lauren is shuttering its flagship Polo store, a foot-traffic magnet on tony Fifth Avenue in Manhattan, the latest step in a massive cost-cutting effort.
Read More ...

Cost Eats Revenue for Breakfast In the New Value-Based Care (VBC) Payment Landscape

magnifying-glass-1001506_640The payment landscape is shifting dramatically in the US health care industry and this has serious implications for the survival of providers. With the volume-to-value transformation, traditional fee-for-service payments are being replaced with a financial incentive framework that rewards for improved quality and outcomes. Although this impacts only Medicare payments today, it lays the groundwork and provides strong incentives for other payers to move in the same direction, thus potentially disrupting the health care system at all levels.

Ultimately, value-based payments transform traditional business models by putting significant revenue– and risk– at stake. Building the outcomes-based financial models to maximize value-based care (VBC) reimbursement pathways will be fundamental to sustainable growth in the future.
Read More ...

A New Prescription for Healthcare: Creativity, Innovation and Entrepreneurship

health-2082630_1280We are living through what is arguably the most challenging time for the health care industry. Globally, health care appears to be on a collision course with patient needs and economic reality. No one is happy with the current system, and the combination of rising costs, poor access, inequitable care, and diminishing quality and safety has created anxiety and frustration for all. Decades of interventions have failed to improve the situation; if anything, things have become worse. Current approaches tend to focus on a single issue or problem (the price of drugs, rising numbers without medical insurance, provider incentives to over treat), but an overarching solution has remained elusive.
Read More ...

Trumping Obamacare . . . How a Market Based Approach to Universal Healthcare can Work

US Medical care illustrated by flag and stethoscope

There is no issue more important to the future of America than it’s long-term fiscal sustainability. And the long-term fiscal sustainability of the United States has been placed in jeopardy primarily by the structure and expense of America’s healthcare system. According to the Congressional Budget Office, nearly the entirety of the growth in federal spending as a share of the economy—excluding interest—can be explained by government health programs: Medicare, Medicaid, the Medicaid-related Children’s Health Insurance Program, and the Affordable Care Act. In addition, one of the principal economic challenges faced by middle- and lower-income Americans is the expense and instability of American health insurance.
Read More ...

March 13-19 Celebrating Brain Awareness Week – Is Your Social Life Bad for Your Brain?

Happy group of adult friends having fun

 3 Reasons Why Staying Social Matters to Your Thinking

How many friends do you have? Do you rarely see family, go out for the evening or join your community for an event?

You may not realize it, but your social life may just be bad for your brain.

In the immortal words of Bette Midler, “you’ve got to have friends.” Little did the Divine Miss M know that in addition to our souls, she was hitting a high note on brain health as well.

A recent AARP survey found that adults 40 and over with a higher number of social connections report better brain health.
Read More ...

Trumping Obamacare…Decoding the American Health Care Act

American Health Care Act

After a seven year wait to repeal and replace President Barack Obama’s signature health care law, the GOP’s much-anticipated replacement collectively called the American Health Care Act (AHCA) was unveiled this week. Amidst a revolt from the left and right, doctors, hospitals and insurers, the plan cleared its first hurdle at 4.30 am on Thursday- approval by the House Ways and Means Committee and The House Energy and Commerce Committee after 18 and 27 of hours of debate respectively. It now has to be approved by a full House and the Senate…the former likely (although not guaranteed) and the latter impossible without bipartisan support.
Read More ...

Fixing the Drug Pricing Problem . . . lessons from around the world

fixing the drug pricing problem

The one thing that all Americans agree on – politicians included- is that prescription drug prices are on an unsustainable trajectory. Americans pay, by far, the highest prices for prescription drugs in the entire world. On average, Americans pay $1,100 per year for their drugs — $300 more than Germans or Canadians do. In addition, total US drug spending has more than doubled in the past 15 years, from $121.2 billion in 2000 up to nearly $374 billion in 2014, squeezing both payers and insurers alike……all of this while the largest pharmaceutical companies are cumulatively earning $80-$90 billion per year in profits at higher margins than other industries.
Read More ...

What the Next President Should Do: Healthcare Common Sense

image09

The 2016 election is over, and a top priority for the new administration and Congress is healthcare. The candidates discussed little substance about healthcare during the campaigns, despite the fact it is approaching 20% of our economy and touches every American. You could say the problems in healthcare have been caused by action by one party and inaction by another party. You could say Republicans want this and Democrats want that, but I don’t think labeling should be the focus. The problem is Congress (both parties) are tied to special interest groups. Insurers, medical device manufacturers, pharmaceutical companies, and the plaintiff’s bar, along with Congress created our unaffordable healthcare system.
Read More ...

Telehealth Performance – How Good Is It?

2blog

Telehealth is here to stay, but it will go through an evolution like all new technology shifts. A new study evaluated performance of teledermatology. The results were mixed. There were incorrect diagnoses and missed diagnoses. Treatment recommendations were not always consistent with guidelines. Prescriptions frequently lacked disclosure about possible adverse effects.  The study was limited because there are not yet large numbers of cases to evaluate. A significant limitation to the study was the authors were unable to assess whether clinicians seeing these patients in traditional in-person encounters would have performed any better.

On balance, telehealth is a good thing. It has the potential to expand access to more patients, and the medical literature is filled with examples of telehealth systems providing quality care.


Read More ...