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Tag Archives: affordable care act

Is Big Data Good for Our Health? You Bet. Here’s Why.

Merav Yuravlivker

Merav Yuravlivker

Cameron Warren

Cameron Warren

The term “Big Data” is increasingly used in our everyday lives.  But each mention of it means something different, unique to what we use it for and how we interact with it. Big Data is not information.  It’s the raw resource that people can use to discover new insights. Just as raw crude needs to be refined to run a car, Big Data needs to be refined to provide useful insights. In 2001, Doug Laney, who currently works for the analyst firm Gartner, defined this raw resource in terms of its three ubiquitous attributes, “the 3 V’s” – Volume, Velocity, and Variety.

VolumeImageAccording to Eric Schmidt, the Chairman of Google, today we generate as much data in less than two years than we did from the dawn of civilization up to 2003. That’s volume. In 1 minute there are 2.4 million Google queries, 547,200 tweets, 204 million e-mails sent, and that’s just 3 categories out of the thousands of ways data is continuously generated. This is velocity and variety.

Making healthcare healthier.

According to the consultancy McKinsey & Co., healthcare represents more than 17% of U.S. GDP, almost $600 billion more than expected for a nation as big and as wealthy as the U.S. There is a lot of waste in the almost $3 trillion dollar U.S. healthcare industry and, for the first time, the new prevalence in well-integrated electronic healthcare records (EHRs) is allowing health insurers and government services such as Medicare and Medicaid to identify fraudulent practices automatically. EHRs have become the norm thanks in part to President George Bush’s plan in 2005 to computerize American’s healthcare information and President Obama’s Affordable Care Act in 2009 to incorporate incentives to share healthcare information through health information exchanges. As of 2014, these initiatives have given 76% of hospitals the ability to record and access patient data electronically, which has created a digital health map for millions of people.[1]

EHRimageElectronic Health Record Adoption 2008 – 2014

Click here for an interactive version

(*note: Clinician notes denote facilities with EHR systems capable of capturing patient-physician interaction via free-form text)

A recently released free mobile phone application by MicroStrategy allows anyone to look at Medicare billings by any physician in the U.S. Information is available based on the number of procedures performed and number of patients treated. Anyone with the technical expertise can analyze this data for patterns and anomalies and identify dubious practices. This is exactly how Medicare found physicians who were inappropriately prescribing well-reimbursed procedures including an ophthalmologist in Florida who billed Medicare more than $21 million in 2012 alone.

Healthcare providers are also generating substantial savings due to the increased quality of the data available. Kaiser Permanente created a new platform to ensure data is shared between all medical facilities. The integrated system has helped the company save over $1 billion from fewer required office visits and tests.

In his book, Predictive Analytics, Eric Siegel describes the breadth of uses of Big Data and predictive analysis in the healthcare industry today.

  1. Google Flu has shown to forecast an increase in influenza cases at hospitals 7 to 10 days earlier than the Centers for Disease Control and Prevention (CDC) by analyzing online search trends.
  2. Stanford University has built a predictive model that diagnoses breast cancer better than human doctors by considering a greater number of risk factors.
  3. The University of Pittsburgh Medical Center predicts a patient’s risk of readmission within 30 days in order to assist with the decision of release.

McKinsey & Co. estimates that increased integration and sharing of data sources will reduce healthcare costs in the U.S. by $300 billion to $450 billion, and that’s not counting the impact of yet undeveloped radical innovations and use cases.

At the individual level, devices are taking patient monitoring to new heights. A new mobile application, Ginger.io, allows physicians to track consenting patients and help them with behavioral-health therapies. Ginger.io collects data about phone calls, texts, location and even motion. Patients also have the ability to complete surveys to better contextualize the data collected about them. The application then combines patient data with research on behavioral health from the NIH to reveal new insights.

Caution: pitfalls ahead

Although Big Data and data science can help the world become a healthier place, the new opportunities are not risk-free. We need to heed the caution signs along the way.

  1. Privacy: data privacy continues to be a problem in healthcare. Medical data can be sent around to third parties as part of administrative processes or prescriptions. In one case, a mother and daughter’s medications were mixed up, which led to an unintentional disclosure of a medical condition.
  2. Data integrity: the accuracy of collected data is also a problem. Many patient histories can be subjective and a lot of information concerning prescriptions and patient visits are still entered manually which can be prone to errors. While data can give us many answers, we must also question the source to ensure reliable results.
  3. Education: data analytics are most effective when an industry expert understands the methods and applications of the data. In order for analytics to reach its full potential, healthcare professionals need to be trained to understand the implications behind data analysis.
  4. Ethics: data ethics is still a nebulous area in the data realm. Because much of the data available has come into existence recently, there aren’t many standards in place. Even though health insurers cannot use preexisting conditions to reject applicants, they still use prescription data to identify high-risk patients and set rates. Is this ethical behavior? Maybe not, but there are currently no policies in place to prevent this from happening.

PossibilitiesSo what does the future hold? Perhaps there will be a time where your social media posts about being sad will automatically trigger a notification to your doctor. Or perhaps your Fitbit data will be used to set insurance premiums. Even your diet and medicine could one day be custom tailored to your genetic makeup at the price of a generic drug today. We’ve already seen the positive impacts that Big Data analytics have had across the healthcare field and, as long as we continue to proceed with caution and foresight, the possibilities are endless for creating a healthier and happier world.

Merav Yuravlivker is co-founder of Data Society, a Washington, D.C.-based organization dedicated to democratizing data literacy by teaching everyone how to turn Big Data into Big Insights.  Cameron Warren is a Data Scientist and contributor to Data Society’s educational curriculum. Data Society is proud to partner with RealWorldHealthCare.org on its Big Data in Healthcare series.

[1] Imler, Dr. Timothy. “Getting Down and Dirty With Big Healthcare Data.” The Huffington Post. November 28, 2015

Many Insured Americans Not Getting the Healthcare They Need

Last month, FamiliesUSA.org issued a sobering report about the disconnect between having medical insurance and receiving the healthcare one needs. The report concluded that for many Americans with non-group coverage (as opposed to having insurance from an employer or a public coverage program), deductibles and other out-of-pocket costs are prohibitively high and are associated with many of these insured consumers forgoing needed healthcare. According to the report, more than one in four adults who bought insurance for themselves or their families last year had to skip medical care because they couldn’t afford it.

Linda Barlow

Linda Barlow

“The Affordable Care Act has increased access to health insurance and financial assistance for millions of Americans,” wrote the report’s authors. “But even with the new assistance that helps consumers pay their premiums and out-of-pocket healthcare costs, one-quarter of consumers who buy insurance on their own still have problems being able to afford needed care.”

According to the report, adults with non-group coverage went without:

  • Tests, treatments or follow up care (15% of adults)
  • Prescription drugs (14%)
  • Medical care (12%)
  • General doctor care (12%)
  • Specialist care (11%)

High deductibles, copayments and coinsurance can leave some people in the position of having to make very tough decisions. Pay for needed medications or the electric bill? Pay for a doctor-recommended test or make a car payment? Pay for treatments and follow up care or pay the monthly mortgage?

These are decisions no one should have to make. No one should have to decide between cancer treatments and putting food on the table. No one should have to sell their car to pay for their child’s asthma medication. No one should go into bankruptcy just because they’ve been diagnosed with a life-changing illness.

If you or someone you know is facing decisions like these, know that help is available. Patient advocacy organizations, drug manufacturers, and charitable patient assistance programs may be able to provide financial assistance.

Do you know of an organization that helps provide a financial lifeline to Americans with inadequate insurance? Let us know about it in the comments section.

 

 

Tough Choices Await ACA Exchange Applicants

Linda Barlow

Linda Barlow

After more than two decades of being covered under employer-sponsored medical plans, my consultant husband and I (a freelance writer) are now in the position of having to purchase our own health coverage.

We both have found the online Health Insurance Marketplace fairly easy to navigate. After entering our zip code and ages, a list of available plans pops up. This list can be sorted either by monthly premium or by deductible, making it easy to see estimated costs at a glance. This is where the tough choices start.

HMO, PPO or POS? A higher monthly premium and lower deductible, or a lower monthly premium with a higher deductible? Choose a plan that our current health care providers accept or try a new plan and find new providers? What about drug coverage and doctor visit co-pays?

For millions of previously uninsured Americans who will enter the Marketplace for the first time and will subsequently find themselves underinsured, these choices can represent possible unseen financial hurdles. That’s because, while the ACA does a great job of providing health care for people who previously had been uninsured, it does not address the continued financial pressure on the underinsured.

As Aaron E. Carroll, professor of Pediatrics, Indiana University School of Medicine, points out in a recent New York Times column, the ACA may actually be helping to spread the problem of underinsurance. The point of having insurance, he says, is to be able to get care when you need it, without too large a financial burden. Underinsured Americans – while in a better position than the uninsured – are not receiving this benefit though and can’t get the care they need, according to Carroll.

One is considered underinsured if his or her out-of-pocket health care costs exceed 10 percent of income (5 percent when income is less than 200 percent of the federal poverty level), or when one’s insurance deductible is more than 5 percent of income. According to a 2014 survey conducted by the Commonwealth Fund, 13 percent of insured Americans fall into this category.

What happens when the newly insured become the newly underinsured? Although they now have access to preventive care and other services, many – two out of five according to the Commonwealth Fund survey – delayed needed care because of unaffordable deductibles. They did not go to the doctor when sick, did not get a preventive care test, skipped a recommended follow-up test or did not get needed specialty care. Unfortunately, these cost pressures hit hardest among those who need care the most, as people with chronic health problems are more likely to spend large shares of their income on medical costs not covered by their insurance than insured adults in better health.

Choosing a health plan can be complicated, no matter what your income level or health situation. Fortunately, the Health Insurance Marketplace offers tips on how to choose a plan, taking into account plan category, monthly premiums, out-of-pocket costs, type of insurance plan and provider network and benefits. This may be a good place to start. Other tips are available from Consumer Reports.

“The Bronze, Silver, Gold and Platinum categories within the ACA provide some clarity in the purchasing process,” says Bryan E. Neely, President, HR Ally. “Individuals should purchase insurance first by cost/affordability, then by benefits including copays and deductibles. Many Americans are finding that they actually qualify for Medicaid, especially in those states where Medicaid has been expanded per the ACA.”

In addition to cost pressures, the newly insured/underinsured may find it difficult to receive care as some providers place caps on the number of new patients they will take on in order to manage their workload – a problem that will become more acute in the face of a looming shortage of primary doctors.

Nobody yet knows what the full impact will be of the ACA on the ability of health care providers to improve health outcomes among underinsured Americans. But it is an issue that bears watching. Let us know what you think in the comments section.

Four Ways Data is Transforming Your Health

The increasing availability of data about health care in the U.S. is empowering patients to take charge of their care and quietly revolutionizing how patients are treated. Last month, the Centers for Medicare & Medicaid Services released data on which services were provided by over 880,000 health care providers, how many times each service was provided, and what the providers charged. Yesterday, top health and technology experts for the federal government and the Brookings Institution gathered to discuss how the growing catalogue of public health care data is leading to profound improvements in America’s health care. The event was hosted by Brookings’ Engelberg Center for Health Care Reform in collaboration with 1776 DC’s Challenge Festival.

Jamie Elizabeth Rosen

Jamie Elizabeth Rosen

Here are the top four ways that data transparency is already beginning to transform Americans’ health. The benefits are expected to grow as the data is analyzed, matched with other sources, and organized into user-friendly and accessible formats.

 

1.    Selecting the best doctor

When Farzad Mostashari learned that his mother needed an epidural steroid injection, he wanted to find out which orthopedic surgeon was the best at this specific procedure. So he searched the millions of medical claims recently released by the Centers for Medicare and Medicaid Services (CMS) to discover which providers were the most experienced in this procedure.

An interesting result emerged. “There is one provider who does more than everyone else combined,” said Mostashari, who is a Visiting Fellow at the Brookings Institution, where he is focused on payment reform and delivery system transformation. “He’s probably pretty good.”

As health care data increasingly becomes available, patients will have more information to make the most rational decisions for their health care, said Kavita Patel, a physician and fellow in the Economic Studies program and managing director for clinical transformation and delivery at the Engelberg Center.

Patel asks her patients why they choose to see her. “Nobody’s ever said: ‘I looked up your quality scores and saw that your out-of-pocket costs are less than the average provider in your area,” Patel said of her 12 years in medical practice. “This is one of the first times that everyone in this room can take out a laptop…and look at this data.”

Mostashari added that the data can be used to identify outliers. For instance, he found that while the average orthopedic surgeon performed controversial spinal fusion surgeries on 7 percent of the patients they saw, some did so on 35 percent. This knowledge empowers patients to choose providers that best align with their health care values and preferences.

 

2.    Reducing costs

The newly-released CMS data enables comparisons of the prices different providers charge for the same services. This data reveals that in some cases providers charge vastly different rates to Medicare for the same services, Mostashari said. The Wall Street Journal provides a consumer-friendly database detailing the types of procedures, number of each, and costs per procedure charged by individual health care providers.

Last year’s release of hospital charges led some hospitals that were charging higher rates to uninsured and underinsured patients than their peers to seek advice from CMS. “Some hospital associations called us and said, ‘We want to change. Help us develop new accounting practices to set prices more fairly for those who are uninsured or underinsured,’” said Jonathan Blum, Principal Deputy Administrator at CMS.

The ability to access and analyze a growing amount of data on procedures performed and their outcomes also helps patients and providers avoid low value services and make decisions about the relative risks and benefits of different procedures. Patel pointed out an ABIM Foundation initiative called Choosing Wisely that equips providers and patients with lists of procedures that should be carefully considered and discussed to ensure that care is supported by evidence, not duplicative, free from harm, and truly necessary.

 

3.    Promoting accountability

When health care providers know that their records will be publically available for scrutiny, they are incentivized to ensure that they won’t be embarrassed by what people find. This can profoundly change which procedures providers choose. For instance, one analysis revealed a wide disparity between the percentage of black versus white patients who were tested for cholesterol levels. “Simply asking providers how often they were doing [cholesterol tests], without any payment incentive,” removed this disparity, said Darshak Sanghavi, the Richard Merkin fellow and a managing director of the Engelberg Center. “This is one example of how simple transparency can improve health care and ultimately save lives.”

 

4.    Expediting spread of best practices

Jonathan Blum, Principal Deputy Administrator at CMS, has seen data transparency expedite the uptake of best practices by health care providers and public health authorities. For example, when analyzing the data on dialysis providers, CMS found that there was an uptick in blood transfusions by certain providers in specific geographic regions. “Our medical team got on the phone and called the dialysis providers and said: ‘Did you know you are doing more blood transfusions than your peers?’” The result? Those providers decreased blood transfusions, improving health outcomes for their patients. The same pattern occurred for nursing home facilities that overused antipsychotic drugs.

“I want to convince folks that you can change policy, you can change procedures, you can make things safer,” Blum said. “Data liberation can help us build [accountable care organizations], help us build better payment policies, help us reduce hospital readmissions. There is tremendous opportunity ahead for us.”

Bryan Sivak, Chief Technology Officer at the Department of Health & Human Services, added that data transparency is affording entrepreneurs from outside the health care sector – such as startups Aidin, Purple Binder, and Oscar – the potential to transform the health care system.

“We’re sitting on the edge of an incredible moment in history,” he said. “Everybody is looking at things in a different way because everybody understands that we have to do things differently.”

“Government data is a public good and a national asset,” said Claudia Williams, Senior Advisor for Health IT and Innovation for the U.S. CTO in the White House. “It’s something we have to release if we can to allow innovation and change.”

How do you make your health care decisions? Have you used any of these new tools?

Categories: General

Five Ways to Manage the Costs of Your Medicine

While a main precept of the Affordable Care Act is to expand access to health care, in some cases that improved access means more patients are being treated with medications that come with a cost. As a pharmacist, I have to be an insurance sleuth, use common sense, and teach my patients the old-fashioned methods of negotiation.

Joel Zive

Joel Zive

I work in solid organ transplant, HIV, and Hepatitis C medicine. I have patients on regimes ranging from 4 to over 20 medications. For my patients, obtaining consistent, reasonably-priced medications – both over-the-counter and prescription – is vital.

1. Make sure all the medications are at one pharmacy.  It’s important to keep a clinical eye on things for drug interactions. As a bonus, the pharmacist and the patient know what costs need to be examined.

2. Seek out insurance prior authorization.  Some insurance companies require prior authorization to cover certain drugs. Your pharmacist can help you seek prior authorization for medications that require it using software that creates forms specific to each insurance company. Ask if your pharmacist can fill out the form as much as possible before sending it to your doctor.

3. Contact the drug company.  Many pharmaceutical companies offer patient assistance programs or co-pay assistance cards to help eligible patients obtain free medicines, particularly for biologics and expensive drugs. These programs are especially helpful for patients who have insurance gaps and need the medications quickly. Depending on the assistance from a case manager or care coordinator, I have received authorization for medications right away or within 72 hours.

4. Search for a co-pay assistance program that covers your condition.  If your drug company does not offer a patient assistance program or you are not eligible based on your income and insurance coverage, it is possible that a charitable patient assistance program through a non-profit organization such as the HealthWell Foundation may be able to help you.

5. Seek discounts for over-the-counter medications.  Over-the-counter medications can put a strain on the wallet. In many cases, purchasing over-the-counter medications is more expensive than prescription medications covered by insurance. Other items like vitamins, natural supplements, and enteral formulas (also known as ‘milks’) require the patient to do a little negotiating. If you tell the pharmacy or vitamin store you will be taking these items indefinitely, they may be inclined to discount. Also, be on the lookout for buy one get one deals (BOGOs). Finally, enteral formulas can be quite expensive, so if you get prescribed a specially formulated one, ask if you can take a more basic formulation instead. Remember to let your prescriber and pharmacist know which over-the-counter medications and supplements you are using.

In conclusion, while the path to affordable medications is not always easy, there are individuals, programs, and strategies that can help you meet your health care goals.

How do you manage your medications? Share your tips in the comments section.

Categories: General

Live Updates from 15th Annual Patient Assistance & Access Programs

Because this blog is all about increasing access, lowering costs, and improving patient outcomes, we think there’s no better place for us to share ideas that work than to report live from the 15th Annual Patient Assistance & Access Program, in Baltimore, March 5-7.  Check back often as we publish updates from sessions, and follow all of the developments by following #PAP2014.

UPDATE 9:45  Resources for navigators: www.nationaldisabilitynavigator.org; patient advocacy groups such as AIDS Institute are publishing helpful sites.  Also marketplace.comment@cms.hhs.gov is a place you can send questions. This is monitored 24/7 with staff – not interns – but people who really know how to help.  These are triaged and go up to leadership when there are problems or trends.

UPDATE 9:40 Lessons learned:

  1. Partner’s are critical to success of ACA implementation; reach out early, often because plan selection often isn’t a one step process.  Patients need to come back many times before ready to sign up.  Very real “huge” health literacy gaps.
  2. Things to come: we are in closing days of enrollment.  March Madness may be a great opportunity for outreach; then we’ll reach out to those most in need; final week will be “here we are.”  So theme weeks continue.   After window closes Mar 31, you’ll soon start seeing promotion of the new window.

UPDATE 9:25 25 states and DC have indicated they will expand Medicaid.  About 85% of Americans already have minimum essential coverage.

UPDATE: 9:15 Health care law saved $8.9 M in drug costs for Medicare, said Janet Miller, Division of Strategic Partners, Office of Communications, Centers for Medicare and Medicaid Services.  2014 changes: no discrimination due to pre-existing conditions, annual limits on insurance coverage eliminated, small business tax credit increased; more people are eligible for Medicaid in some states.

Essential benefits include at least 10 general categories such as emergency services, hospitalization, maternity and newborn care, prescription drugs, mental health and substance abuse, lab services, preventive and wellness  services and chronic disease management.

Categories: Access to Care

What’s Getting Lost in the Health Care Debate?

Health care has never been more highly politicized than today.

Last year, it was central to the third longest government shutdown in U.S. history. This week, it consumed a large chunk of President Obama’s State of the Union address. Every day, we are inundated by news of health exchange website defects, insurance policy cancellations, coverage that forces people to switch doctors, and a laundry list of other problems attributed to the Affordable Care Act. On the flip side, advocates complain of the problems that make the U.S. rank among the lowest in health system efficiency among advanced economies and hail the health care law as a ray of hope.

Jamie Elizabeth Rosen

Meanwhile, a new study from the U.S. Centers for Disease Control and Prevention (CDC) revealed that one in four American families struggled to pay medical bills in 2012. Pretty dismal.

But there’s something missing from this barrage of coverage. Incredible advances are being made in health care every day, providing Americans with innovative ways to stay healthy, treat illnesses when they arise, and save money on medical problems. Just this month, a new program was launched to help people on Medicare living with multiple sclerosis afford copays for treatment; the FDA for the first time approved a postnatal test that can help parents identify possible causes of their child’s developmental delay or intellectual disability; and a study published in the Lancet showed that it is possible to train children’s immune systems to become less sensitive to peanuts.

At Real World Health Care, we focus on what is working.

That’s why I am proud to take over this week as editor of Real World Health Care. While much of my professional focus has been on health internationally – advocating for the development of vaccines to prevent tuberculosis, policies that save mothers and infants from dying during childbirth, and the formation of emergency medical systems in places where people have nowhere to turn – I am compelled by the notion that more attention must be focused on solutions that are improving U.S. patient care today. By serving as a central clearinghouse for information about improvements to segments of the U.S. health care system, we hope that our readers and those journalists who get ideas from our blog will be inspired to expand innovations that are working in health care today.

Real World Health Care – only entering its 11th month – already has a reputation for covering solutions to enhance nutrition, prevent diseases, reform medical education, improve hospitals, support patients, fund research, increase treatment adherence, and reduce costs. The blog serves as a resource for policy makers, health systems, research universities, non-profit health organizations, leading biopharmaceutical companies, government agencies, and the nation’s leading health journalists among thousands of others interested in practical and well-researched health care success stories.

We need your help to continue to grow our success. Have an idea for a story or a guest blog? Email me at jrosen@WHITECOATstrategies.com. Want to take part in advancing solutions in health care? Sign up for updates and share stories that inspire you via Twitter at https://twitter.com/RWHCblog. Do you believe in our mission to expedite improvements to our health care system? Consider co-sponsoring the blog while gaining visibility for your organization. We are now followed by over 300 health industry leaders each week, and journalists turn to us for story ideas about the good news on what’s working in our health care system. For more information, email dsheon@WHITECOATstrategies.com.

I look forward to continuing to cut through the political vitriol around health care with inspiring stories of what is keeping Americans healthy and saving lives. Thank you for giving meaning to our work by using this blog as a resource for yours.

Categories: General

What You Can Do To Strengthen Health Care Delivery for MLK Day

Nathan Sheon Head Shot to Use

Nathan Sheon

The Rev. Dr. Martin Luther King Jr. (MLK) Day of Service will be recognized in communities across America on Monday, Jan. 20 as part of UnitedWe Serve – the President’s annual national call to service initiative. A powerful catalyst that organizes and promotes local volunteer programs to benefit diverse populations, it “empowers individuals, strengthens communities, bridges barriers, creates solutions to social problems, and moves us closer to Dr. King’s vision of a ‘Beloved Community.’”

Recognized as a “day on, not a day off” since 1994, the MLK Day of Service is the only federal holiday observed as a national day of service. The campaign’s programs address a wide range of issues that include poverty, education and access to food, in addition to sponsoring numerous initiatives that intersect with health care. This year, the MLK Day of Service aims to empower people to advocate for and educate their communities about how to live healthfully, from working out to making better eating choices and obtaining the latest information on implications of the Affordable Care Act (ACA).

Some of the ways you can help raise awareness about health interventions that will help your volunteering to last beyond one day, include:

  •  Organizing a local fitness event
  •  Informing people in your local community about how the new health care law effects them
  • Teaching a class on healthful cooking and eating
  •  Educating low- and middle-income families on opportunities to access affordable health care for their children

The MLK Day of Service website also includes a multitude of communications tools, such as:

But why serve on MLK Day and join the movement to help transform communities and improve health care delivery?

“Dr. King devoted his life to advancing equality, social justice, and economic opportunity for all, and taught us that everyone has a role to play in making America what it ought to be,” Robert Velasco II, acting CEO of the Corporation for National and Community Service, said in a statement. “Now more than ever, we need to take heed of Dr. King’s teachings and work together to achieve his dream. Volunteer service is a powerful way to strengthen economic opportunity. And when better to start than on the day we honor Dr. King?”

Organizers of the MLK Day of Service hope that by giving advocates and allies the tools and information to make their projects newsworthy, word of the initiative will spread – along with the success of new and innovative service projects. The event provides volunteers with the critical resources they need to establish grassroots campaigns and service projects that they believe will empower individuals and local communities to make more informed choices across the spectrum of health.

Now share your story. Are you participating in the MLK Day of Service, and if so, tell us why. Have you – or someone you know – volunteered in one or more programs? What impact did it have in your local community?

Categories: Access to Care

President Obama Urges “Millenials” to Sign up for Coverage under Affordable Care Act

In recent days the Obama Administration has been intensifying outreach efforts to increase the number of young people who enroll for insurance coverage under the Affordable Care Act (ACA) before the March 31, 2014 deadline.

Paul DeMiglio

Paul DeMiglio

During a speech in Boston on Oct. 30, President Obama pushed back against criticism of ACA – which he signed into law in March 2010 – by seeking to draw parallels to the Massachusetts’ health care insurance law (“Romneycare”) that then-Governor Mitt Romney signed into law four years earlier.

“And if it was hard doing it just in one state, it’s harder to do it in all 50 states, especially when the governors of a bunch of states and half of the Congress aren’t trying to help. Yes, it’s hard, but it’s worth it. It is the right thing to do, and we are going to keep moving forward. We are going to keep working to improve the law, just like you did here in Massachusetts.”

Governor Romney, on the other hand, rejected the comparison, describing the “Obamacare” rollout as a “frustrating embarrassment” that has failed to learn “the lessons of Massachusetts’ health care.”

However, the two laws did face similar challenges at the start of their implementation, especially among young people. Romneycare saw an extremely low registration rate among younger demographics until the deadline. Likewise – although the White House set a goal of getting 2.7 million 18-34 year olds signed up through HealthCare.gov by the end of March – a recent study by the Commonwealth Fund revealed that only one in five people who visited the federal or state enrollment sites were 18-29.

A Dec. 4 article in The New York Times makes the case that many young people are likely to follow enrollment patterns that were similar to those in Massachusetts in 2006 – by pushing it off until the deadline hits.

“The experience of Massachusetts under Gov. Mitt Romney showed that most people, especially young people, acted only when they approached a deadline,” write Jonathan Weisman and Michael Shear, “and with the federal law, the deadline to have insurance or pay a penalty is months away.”

According to an Oct. 30 article in Business Insider, two former Massachusetts officials who played major roles in creating and rolling out the Massachusetts health law — Jonathan Gruber and Jon Kingsdale – say successful implementation of massive health care changes can come slowly at first:

“In Massachusetts, the officials said, only .03% of the share of Massachusetts residents who eventually enrolled for health insurance signed up in the first month the law went into effect. In the final month of enrollment, before the mandate to purchase insurance kicked in, more than 20% of the final tally signed up.”

Last week President Obama renewed strategies to increase enrollment rates by actively engaging young people, who are widely seen as critical to the financial stability of Obamacare. Addressing 160 participants from across the country at the Dec. 4 Youth Summit, the President urged “Millenials” – including DJs, entrepreneurs and organizational heads – to talk up Obamacare and get their peers to sign up on HealthCare.gov.

The Washington Post is reporting signs that enrollment among younger Americans is beginning to pick up, with a three-day total of about 56,000 from Dec. 1-3 – more than twice the number of online signups on HealthCare.gov during the entire month of October.

Now tell us what you think. Can Romneycare serve as an effective model for implementation of Obamacare, especially with respect to generating more signups among younger population demographics? What, if any, provisions from that law are applicable to rolling out the ACA? Have you tried to enroll on HealthCare.gov and were you successful?

Categories: Access to Care

Not Your Mother’s Big Pharma

In a September 29 article in Adweek, Joan Voight demonstrates how the Affordable Care Act (ACA) is expected to create new opportunities for pharmaceutical stakeholders to play a more active, personalized role in managing patient care through interactive web-based tools. Three aspects of the ACA will change the way treatment decisions are made and reinvent how patients and Big Pharma interact.

Paul DeMiglio

Paul DeMiglio

Fill the Primary Care Gap
Although providers will be overwhelmed by an expected uptick in newly insured patients, pharmaceutical companies can help reduce the strain while strengthening relationships with consumers in the process. MerckEngage — an online educational and marketing program that has attracted 8.2 million visits since its launch in 2010 — is one example of just how this can play out. Among some of the resources the website gives members access to include:

  • Free personal health tracking
  • Daily planners
  • Food and exercise tips
  • E-mail messages
  • Content updates

Doctors who sign up will receive alerts to track their patients’ activity, and starting this year the program also features mobile versions for patients and providers alike.

Provide Solutions to Adherence Challenges
A key goal of the ACA — to prevent sick patients from developing more serious conditions and needing more care — emphasizes the importance of increasing medication adherence. This need presents a valuable opportunity for pharma to personalize treatment and communicate in ways that resonate effectively with target audiences.

AstraZeneca is collaborating with Exco InTouch to help patients and doctors track and manage chronic conditions through mobile and web-based tools:

“The first app addresses chronic obstructive pulmonary disease. Patients enrolled in the program collect, transmit and review their own clinical data, while their doctors use real-time information to personalize each patient’s care, adjust meds and possibly prevent hospitalization. The patients’ identifiable data is only seen by patients themselves and their healthcare providers, says AstraZeneca,” the report notes.

Develop Innovative Bundles
Implementation of ACA will also change the way prescriptions are made, with insurance companies and accountable care organizations (ACOs) choosing what to prescribe instead of individual doctors. This can serve as an opportunity for pharma to build support among ACOs by creating and branding a package of services for patients and providers that spans behavior modification, education, tracking and dispensing of drugs.

Eli Lilly’s online diabetes program that helps patients and families manage the disease, Lilly Diabetes, was critical to paving the way for this marketing approach, according to the article:

“In Lilly’s case the tools include a meal planner, a self-care diary, a carbohydrate tabulator and even an emergency guide in case of hurricanes or earthquakes.”

Now we want to hear from you. Do you agree with the article? What are the long-term implications of pharmaceutical companies having access to more data about consumers in this new era of digital outreach? What might be the potential advantages and disadvantages?