Which Medicare initiatives use quality measures?

In December, CMS listed its quality measures that it is considering for incorporation into some of their value-based payment programs and quality reporting programs. However, which Medicare quality reporting and payment initiatives use quality measures?  A full list is below.

1. Ambulatory Surgical Center Quality Reporting Program (ASCQR)
2. End-Stage Renal Disease Quality Incentive Program (ESRD QIP)
3. Home Health Quality Reporting Program (HH QRP)
4. Hospice Quality Reporting Program (HQRP)
5. Hospital-Acquired Condition Reduction Program (HACRP)
6. Hospital Inpatient Quality Reporting Program (HIQR)
7. Hospital Outpatient Quality Reporting Program (HOQR)
8. Hospital Readmissions Reduction Program (HRRP)
9. Hospital Value-Based Purchasing Program (HVBP)
10.  Inpatient Psychiatric Facility Quality Reporting Program (IPFQR)
11.  Inpatient Rehabilitation Facility Quality Reporting Program (IRF QRP)
12.  Long-Term Care Hospital Quality Reporting Program (LTCH QRP)
13.  Medicare and Medicaid EHR Incentive Program for Eligible Hospitals (EHs) and Critical Access Hospitals (CAHs)
14. Medicare Shared Savings Program (MSSP)
15. Merit-based Incentive Payment System (MIPS)
16. Prospective Payment System (PPS)-Exempt Cancer Hospital Quality Reporting Program (PCHQR)
17. Skilled Nursing Facility Quality Reporting Program (SNF QRP)
18. Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP)

One can readily see how these quality-based programs, while well-intentioned could be problematic for providers.   A hospital that is part of an ACO that provides inpatient, outpatient and psychiatric and rehabilitatoin facilities would be subject to quality reporting for HACRP, HIQR, HOQR, HRRP, HVBP, IPFQR, IRF QRP, and MSSP.  That is a lot of quality reporting.

Another question you may have are whether these measures are any good.  Most measures are NQF endorsed.  Further, a number of other of government agencies have provided input on these measures.  A full list of agencies providing input is below.

1. Office of the Assistant Secretary for Health (OASH)
2. Office of the National Coordinator for Health Information Technology (ONC)
3. National Institutes of Health (NIH)
4. Agency for Healthcare Research and Quality (AHRQ)
5. Health Resources and Services Administration (HRSA)
6. Centers for Disease Control and Prevention (CDC)
7. Substance Abuse and Mental Health Services Administration (SAMHSA)
8. Office of the Assistant Secretary for Planning and Evaluation (ASPE)
9. Indian Health Service (IHS)

In short, getting from volume to value-based payment, ultimately depends on being able to accurately measure quality.  Measuring quality is a lot easier to do in theory than in practice.

 

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Building Trust and Truth in Patient Social Networks

We are only just past the dawn of the second machine age, where digitization is enabling artificial intelligence. “Our new tools are destroying both trust and truth, creating a hunger for community and authenticity. We crave actual physical connection to neighbours, colleagues, and fellow townspeople, even if digitally facilitated.” 

Anne-Marie Slaughter wrote this in a column I read this morning in the Financial Times titled, “Our struggle with technology to protect trust and truth.”

Trust and truth underpin health engagement, we learned in the first Edelman Health Engagement Barometer launched ten years ago. Those were the early days of the formation of patient social networks [Patients Like me was founded in 2004, and WEGO Health and Stupid Cancer in 2007]. Those communities have matured and a decade later, led to the New England Journal of Medicine‘s Catalyst community assessing how social networks can improve patient health. The Insights Report from this study is available here.

Social networks are useful in health care delivery, virtually all healthcare stakeholders agreed. The biggest opportunities from the Council’s point of view are for managing chronic diseases and promoting healthy behaviors, followed by providing a platform for emotional support.

For context in interpreting these findings, note that the Catalyst panel is comprised of health care executives, clinical leaders and clinicians — with no patient or consumer input.

“Awareness is growing that social networks in health care…can help people improve health behaviors. Peer networks can provide information and community to patients who otherwise might struggle alone with a new or existing disease,” Dr. Kevin Volpp of University of Pennsylvania and Dr. Namita Mohta of Brigham and Women’s Hospital co-write in the report.

What’s driving health care providers to tap into social networks, Volpp and Mohta believe, is the growing financial risk assumed by health systems. Social networks give providers-at-risk the opportunity to scale care to larger patient populations, identifying disease-specific patient support groups and caregiver support groups as very powerful platforms for that scaling.

One practical benefit of patient social communities is that they may be a more “stable channel” for connecting with patients, given that consumers often switch cell numbers versus changing their social media identities on, say, Facebook.

Two-thirds of healthcare providers prefer face-to-face group sessions as the top choice for communication — that is, in-person social networks — versus 50% who say social media sites (like Facebook) are most useful for communication. One-half of providers also believe that face-to-face, one-on-one sessions with social network members are most useful for communicating.

How impactful might social networks be on different aspects of health care? The biggest impacts, Catalyst members say, will be on patient engagement, quality of care, and provider engagement. Over one-half of providers believe social networks, once mature, would also impact the cost of care in a moderate or major way.

Health Populi’s Hot Points:  Jack Barrette, CEO and Founder of WEGO Health, published a paper earlier this month on the impact of Facebook’s news feed changes on patient social networks.

Having analyzed the new Facebook approach, his bottom line is: “Leverage the truly authentic voice of the patient. User-generated content that features trusted Patient Influencers and their real stories will likely increase Facebook engagement rates and be prioritized in audience news feeds.” 

So we return to Anne-Marie Slaughter’s final insight, three paragraphs from the conclusion of her column: that recovering a belief in truth might happen through direct engagement with “purveyors of news and stories, through the creation, ironically, of Facebook groups.”

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Q-TWiST: One approach for measuring quality-adjust survival gains in cancer

Defining which cancer treatments are the “best” is not as easy as you think.  At first glance, treatments that produce the largest survival gains should be considered best.  Most cancer treatments come with serious side effects.  Thus, new treatments that better improve survival may also increase the risk of adverse events (although in some cases–like the case of immuno-oncology treatments–adverse events appear less frequently than standard of care).

How can we evaluate the tradeoff’s between life extension and quality of life?   On standard approach for cost-effectiveness analysis is using quality-adjusted life years (QALYs).  This approach measures gains in survival improvements but does not value all survival equally.  One year survival where patients are in perfect health is valued at 1.0, a 1 year survival gain in less than perfect health is valued at less than 1.0.  For instance, an additional QALY of 0.5 would imply that the person was indifferent between living half a year at perfect health and living for 1 year at this level of less than perfect health.

Another approach for measuring the “quality” of any survival improvements is measuring time spent without symptoms of disease or toxicity of treatment (TWiST).  In a paper by Gelber et al. (1996), the authors use a 3 step method to measure Q-TWiST of postoperative radiation therapy alone or radiation therapy plus fluorouracil-based chemotherapy among patients with poor prognosis, resectable rectal cancer.  These steps include:

1. Defining quality-of-life-oriented end points
2. Partitioning overall survival time
3. Comparing the treatment groups with respect to quality-adjusted survival

In the first step in the Gelber paper, they define TWiST as time period without: any adverse event during or soon after chemotherapy or radiation treatment, any subsequent delayed adverse event after treatment, or any disease relapse.  Next, the authors needed to allocate, what time should be considered as in suboptimal health when these adverse events occur.  In the Gelber paper, they assume that all time during treatment, time when adverse events were reported plus some additional time in case follow-up reporting was not completed (e.g., 2 extra days for nausea, 10 extra days for any other adverse event).  All time during relapse was considered suboptimal.

Based on these assumptions, the authors could calculate a quality-adjusted survival relative to TWiST (Q-TWiST) as follows:
Q-TWiST =TWiST + (u_tox × TOX) + (u_rel × REL)

Where TOX represents time spent addressing symptoms of adverse events and REL represents the survival time following a diagnosis of relapse.  The parameters u_tox and u_rel are the utilities when patients have toxic adverse events and disease relapse respectively. By assumption, time spent in TWiST is assumed to have a utility level of 1.o (i.e., full health)

For each of the two treatments considered–radiation alone vs. radiation + chemotherapy–the authors estimated Kaplan—Meier curves for time in TOX and disease-free survival in order to used to partition the overall survival time.  The authors then used these curves to estimate the amount of time spent in TWiST, TOX and REL.

Using this approach, the authors found that the combined radiation and chemotherapy treatment resulted in

more TWiST (6.1 months; 95% CI = 0.2-12.0 months) than patients who received adjuvant radiation therapy alone. Despite an increase in the amount of time that individuals spent with early and late toxic effects, the Q-TWiST analysis indicated that the combined therapy conferred significantly greater benefit for a wide range of patient preferences about living with the toxicity of treatment or the symptoms of overt disease.

Source:

• Gelber, Richard D., Aron Goldhirsch, Bernard F. Cole, Harry S. Wieand, Georgene Schroeder, and James E. Krook. “A quality-adjusted time without symptoms or toxicity (Q-TWiST) analysis of adjuvant radiation therapy and chemotherapy for resectable rectal cancer.” JNCI: Journal of the National Cancer Institute 88, no. 15 (1996): 1039-1045.

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The Natural Brushing Secret For Smiles and Smooches

Life these days calls for the multitasking. Whether you are parked waiting for a pickup and you quickly check your bank account or sending emails while in a waiting room, we are conditioned to maximize time and get as much done in a time efficient manner as possible. 

 

Have you ever thought about ways to clean your teeth while completing other tasks? What if we told you there are ways to naturally brush your teeth while you ate lunch or dinner? I’m sure your fist inclination is to say, “no way.” You’re supposed to brush your teeth after eating, right? Well of course, but there are foods that due to their crunchiness or fiber content act as a natural tooth brush. 

 

Raw fruits and vegetables are the most common example of food that scrub your teeth while you eat them, but what about meals? Is it possible to create dishes that boost oral health and fill your family’s bellies? We have a few suggestions below that will act both as a natural tooth brush as well offer a balanced an delicious meal.  

 

Veggie stir fry 

 

While Chinese take-out is a universal favorite, it is also full of sodium, sugar and other chemicals that can lead to tooth decay. The crunchiness of raw carrots and celery helps rid your teeth of build-up plaque. Instead of eating them raw, consider cutting them into thin strips and throwing them on the stove in a stir fry. This dish is great for when you need to clean out your refrigerator and get use up vegetables before the go bad. Throw everything in the pan together and cook with teriyaki or soy sauce. Pair the veggies with rice or noodles to complete the meal. This dish is a crowd favorite and will give your teeth a natural teeth brushing. 

 

Besides, who doesn’t invite an excuse to eat stir fry? 

 

Chicken salad 

 

Homemade chicken salad is a simple dish to make if you’re expecting a large number of guests for lunch. To increase its tooth brushing qualities, add fresh apple and almonds. The water in apples combined with their crunchiness increases saliva production which helps to wash plaque and food articles from the teeth. Almonds, a high fiber and high protein food, are low in sugar and will help fill you up. This dynamic duo of almonds and apples will help build stronger and healthier teeth. 

 

Pizza 

 

I am sure the addition of pizza to the list is somewhat confusing on a list of healthy food options. However, if you top it with crunchy peppers and spinach your can turn this meal around. The crispness of peppers coupled by leafy greens will increase salvia production and help wash away food particle stuck in your teeth. Spinach, as well as cheese, is packed with protein which helps increase the enamel. Stronger enamel means healthier teeth that are more resistant to bad bacteria.  

 

Edamame  

 

If you are looking for a mouth-friendly appetizer when at a restaurant (or at home!), opt for edamame. This south-east Asian dish is an immature soy bean that you commonly dip in a soy sauce. To pop the bean out of the middle of the shell, involved place the whole bean in your mouth and slipping it through your teeth. Don’t let the complexity scare you. The sliding of the bean through your teeth will help dislodge food particles stuck along the gum line. Try this international dish next time you’re out! 

 

By choosing the right dish, you can help build strong and healthy teeth. Crunchy, fibrous food act as a natural tooth brush, while protein and dairy rich options help strengthen the teeth and their enamel. While you may feel like you have brushed your teeth after these meals, it is important to remember they are not a substitute for the real thing!

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Volunteering is good for you

A feel good research study from Sumedha Gupta (2018):

Cognitive decline among the elderly imposes a large welfare and health care cost on the individual as well as society. Little however is known about factors that can mitigate cognitive decline. Using seven waves of the Health and Retirement Study and a fixed effects – instrumental variable methodology, this study estimates the effects of volunteering on old age cognitive decline. Although cognitive decline is an inevitable aspect of aging, our results suggest that volunteering participation significantly forestalls its progress among individuals aged 60 years and older.

Perhaps the old adage that giving is better than receiving is true after all.

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More Working Americans Enrolled in High-Deductible Health Plans in 2017

Over four in 10 U.S. workers were enrolled in a high-deductible health plan in the first 9 months of 2017, according to the latest research published by the National Center for Health Statistics, part of the Centers for Disease Control in the U.S. Department of Health and Human Services.

The report details Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-September 2017.

About 28 million people were uninsured in the U.S. in 2017, about the same proportion as in 2016 — but nearly 20 million fewer than in 2010, as the line chart illustrates.

The proportion of people enrolled in publicly-sponsored health insurance fell slightly to 19.5 million Americans in 2017. Note that 42% of children 0-17 years of age were covered through public sources.

 

The highest levels of working-age uninsured people live in Texas, Georgia, Florida, North Carolina, and Virginia, shown in the second bar chart. Levels of the uninsured increased in most of the 11 states on the chart, except for health citizens in Florida, Michigan, Pennsylvania and New York state.

Note that the states where the rolls of uninsured people grew the most were led by Governors who chose not to expand Medicaid under the Affordable Care Act.

 

The third chart illustrates the growth in high-deductible health plans (HDHPs) with and without health savings accounts (HSAs). In the first nine months of 2017, 43.2% of working-age people (under 65 years of age) were enrolled in an HDHP: 18% in consumer-directed health plans (which are HDHPs bundled with an HSA) and 25% in an HDHP (which do not have an HSA with the plan).

Health Populi’s Hot Points: Just over 3% of employers believe that high-deductible health plans are the best concept for “converting passive patients into active healthcare consumers,” according to the recently-released 8th Annual Industry Pulse survey conducted by Change Healthcare. [I covered this study earlier this week in Health Populi here in an analysis of the state of patient/health engagement].

For over a decade, through my health economics lens, I’ve pointed out the self-rationing impacts that HDHPs have had on consumers’ health behaviors, such as postponing needed healthcare services, avoiding doctors’ appointments due to cost, skipping prescription fills, cutting pills, and other avoidance “choices.”

These behaviors can feel like short-term smart fiscal options, but in the long term they can have dreadful physical outcomes.

Bundling financial wellness into health/wellness is key, and there’s a lack of dot-connecting in so many health citizens enrolled in so-called consumer-directed health plans. Patients don’t feel much like consumers facing a high-deductible, and particularly when the healthcare services they need aren’t very shop-able.

There are more tools available for patients-consumers who choose to shop for services; just this week in my own town of Philadelphia, Clear Health Costs launched Philly Price Check through two local media outlets, The Philadelphia Inquirer and 6 ABC Action News, a healthcare cost comparison tool. Expect more like this important development in the coming months — the sooner they reach the minds and pocketbooks or health care consumers, the better, in the short-run.

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How Albertsons Grocery Stores and Rite Aid Can Help Remake Healthcare

Albertsons, the grocery group with popular brands like Acme, Safeway, and Vons, announced a merger with Rite Aid, the retail pharmacy chain. The deal has been discussed as Albertsons’ move to succeed in light of growing competition from Amazon and Whole Foods, the proposed CVS/Aetna merger, and Walgreens’ possible purchase of AmerisourceBergen (finalizing its acquisition of over 1,900 Rite Aid stores).

If played out well, the combination could become an important player in the evolving U.S. health/care ecosystem that brings a self-care front-door closer to consumers, patients and caregivers.

“The new company is expected to serve more than 40 million U.S. customers a week at around 4,900 locations, 4,350 pharmacy counters and 320 health clinics across the U.S.,” USA Today reported.

Albertsons’ geographic footprint has been heavily weighted on the western side of America, with some Mid-Atlantic reach through the Acme, Eastern and Shaws storefronts. Adding Rite Aid to this map would expand Albertsons’ physical reach to millions of more food, healthcare and wellness consumers.

Albertsons opened its first retail clinic in 2003 in Boise, Idaho, reported here in Supermarket News. “This is the first time we have accommodated a medical clinic within the structure of a store,” a company spokesperson said. Supermarket News opined that this opening was “unusual” in the supermarket industry at the time.

Retail clinics co-located in pharmacies and grocery stores are mainstream today. One key asset in Rite Aid are the chain’s RediClinics, operating in over 60 Rite Aid pharmacies and also in H-E-B grocery stores in Texas.

Rite Aid has a concentration of bricks-and-mortar stores east of the Mississippi, as the second map illustrates.

Note that Albertsons bought Plated, the subscription meal kit company, in 2017.

Health Populi’s Hot Points:  Yesterday in Washington, DC, at the Healthcare Costs Innovation Summit sponsored by West Health, Dr. Mark Smith, Professor of Medicine at UCSF and former President of California HealthCare Foundation, talked about the importance of self-care.

His remarks provided context and introduction to a panel on “The Power of the Patient” in helping address health care costs in America.

Dr. Smith provided evidence on the pivotal role consumers can play in co-designing and co-producing health and healthcare through self-care.

“As long as we talk about controlling costs in a system whose larger ecology produces diseases we want to treat, we won’t get too far” without supported people in self-care, Dr. Smith asserted. He presented evidence for the role of self care from various healthcare settings and geographies such as post-hospital discharge care with nurses and handymen in Baltimore, hypertension and self-monitoring in the U.K., and self-dialysis in Sweden….and in West Philadelphia.

Dr. Smith noted there’s a huge reservoir of untapped labor in patients.

The role of grocery stores, pharmacies and retail clinics will be part of this growing self-care support system in our communities…if we are to lower healthcare costs in America, improve quality, and reduce healthcare disparities. Albertsons and Rite Aid can be part of this movement.

A journalist writing for Fortune questioned whether Albertsons’ purchase of Rite Aid would prove to be a “lemon.” I believe it can be a Jewel (which is, coincidentally, one of Albertsons’ grocery store brands).

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Need data on health plan benefit design in the ACA exchanges?

The Robert Wood Johnson Foundation has a publicly available data source you can use to find this information.  Known as HIX Compare, the data contain descriptions of plans in the individual and small group markets across all 50 states.

HIX Compare is the only dataset with information on nearly every individual and small group marketplace plan offered from 2014-2018, and most off marketplace plans as well. HIX Compare contains information on plan characteristics, such as premiums and benefit design. HIX Compare is a machine readable file available in CSV and Stata formats.

Here is the HIX Compare data documentation.  The data have been used for a variety of purposes including measuring the effect of risk corridor programs on premiums, the presence of narrow networks, and many other studies.

Need data on health plan benefit design in the ACA exchanges? posted first on http://dentistfortworth.blogspot.com

The Fascinating History of Teeth Whitening

If you are looking to “remake yourself” this year, our recommendation is to start right here at Dr. Ku’s office! While spending hours in the gym and focusing on improving your nutrition will make you a healthier person in 2018, it’s important to feel good about all aspects of how you look. We want each of our patients to feel more confident in 2018, and to jumpstart that process it is important to focus on the beautification of your smile. 

 

Teeth whitening is an easy and painless way to get immediate results that has been proven to boost self-confidence. If you are ready to take the first step in your journey, call our office today for a consultation. Or, if you’re just curious about what tooth whitening entails, keep reading for a quick synopsis of its history and the procedure.  

 

Is tooth whitening a new thing? 

 

While you may assume tooth whitening is a newer phenomenon thanks to increased advertising, the truth is that the concept has been around since the time of the Egyptians. As you can imagine, ancient tooth whitening was primitive and used questionable (by our standards) ingredients. As civilizations progressed, white teeth became a symbol of power and wealth. By the 18th century, physicians used a combination of bleach and oxalic acid to artificially color teeth. While patients did experience whitened teeth, the toxic combination of ingredients also did irreversible damage. 

 

Modern tooth whitening  

 

Thankfully we’ve progressed significantly, and tooth whitening is no longer detrimental to the health of your teeth. What we’d consider the foundation for modern day tooth whitening—a thick gel called Opalescence carbamide peroxide—was patented in 1989. This creation spurred the market, and it soon became commonplace in dentist offices across the country. Its ease and popularity also created the at-home whitening market. From whitening strips to toothpastes and mouthwashes it is hard to find a product without a whitening quality. Products meant to be applied at home all have varying efficacies; however, technological advances have made them both easy to use and popular. 

 

Today, dentists have the option to choose between professional teeth whitening trays or laser teeth whitening. And don’t let the laser scare you. Unlike the movies where lasers normally blow up aliens or obliterate planets, the laser doesn’t actually do the whitening of your teeth. Instead, the laser works in conjunction with a paste that is applied to the teeth that is then heated up by the laser. Whitening trays are a more traditional approach and use peroxide to break down stains. Both treatment options brighten teeth, but come with different price tags and time commitments. It is important to discuss this with your dentist prior to making a decision.  

 

What does the future hold? 

 

The future of teeth whitening is bright. (That’s a little dental humor for you!) An increase in patient demand has pushed innovation and technology and made teeth whitening more accessible for everyone. As convenience continues to dominate the marketplace, expect to see more at-home products. If you choose to pursue at-home methods, it is important to remember some of the products are not regulated and therefore are much less potent than what you would receive in our office. If you are looking to drastically change the color of your teeth, it’s recommend to come to us for professional application.

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Consumer Health and Patient Engagement – Are We There Yet?

Along with artificial intelligence, patient engagement feels like the new black in health care right now. Perhaps that’s because we’re just two weeks out from the annual HIMSS Conference which will convene thousands of health IT wonks, users and developers (I am the former), but I’ve received several reports this week speaking to health engagement and technology that are worth some trend-weaving.

As my colleague-friends Gregg Masters of Health Innovation Media (@2healthguru) and John Moore of Chilmark Research (@john_chilmark)  challenged me on Twitter earlier this week: are we scaling sustained, real patient engagement and empowerment yet?

Let’s dive into the reports’ findings to divine an answer for Gregg and John.

Change Healthcare published the company’s 8th Annual Industry Pulse Report, which examines key challenges facing payors and other stakeholders this year. The report analyzes results of a survey of over 2,000 Change Healthcare customers (from academia, government, technology vendors, hospitals, providers, and health plans), conducted in October-November 2017.

Several findings address patient and health engagement in this study, including:

• The failure of high-deductibles’ “skin-in-the-game” theory to turn  patients into active health consumers
• The growth of health plans and providers integrating social determinants of health into health strategies and tactics for improving peoples’ health outcomes and engagement
• The migration of incentives from negative “sticks” to positive “carrots” along with more value-based benefit design in motivating consumer health behavior.

One of my favorite series of papers that inform my advisory work comes from PwC on the New Health Economy, this week publishing its report on Customer experience in the New Health Economy – the data cure. A highlight of their survey found that one-half of provider executives sees customer (patient, clinician) experience as a top strategic priority over the next 5 years, and most payer execs are investing in technology to improve member experience. Remember that health insurers rank very low on consumer experience compared with retailers and grocers.

PwC offers five pillars for healthcare stakeholders to build on to improve experience, including:

• Convenience
• Quality
• Support
• Personalization, and
• Communication.

Finally, CarePayment studied the skin-in-the-game motivation for engagement, finding that 61% of patients don’t have money saved for healthcare expenses, and two-thirds of people have avoided or delayed medical care in the last year due to expected costs.

An alarming anti-engagement statistic is that 44% of the 1,000 consumers surveyed said they would not get needed medical care, even if it put their health at-risk, knowing they would have out-of-pocket expenses of $500.

The 20/20 CarePayment survey team also noted in their press release that among people who did not seek healthcare, medical debt is a growing and common problem impacting + nearly 1 in 4 Americans under 65.

The CarePayment poll was conducted in November-December 2017.

Health Populi’s Hot Points:  So, Gregg and John, to your question: has patient empowerment and engagement scaled yet in U.S. healthcare?

Well, it depends on how we define the terms, and through what and whose lens. I do see green shoots of engagement among patients in the U.S., both for clinical activation and financial/shopping muscles.

A question in the Change Healthcare survey hints at one of the challenges in assessing and inspiring patient engagement: “What is the best approach for turning passive patients into active healthcare consumers?”

For many years, my discussions with patient activists on social media have informed me about some of the toxic language that prevents trusted conversations between people – patients, consumers, caregivers — and health care providers, plans, and pharma. Words like “adherence,” “compliance,” and in this question the verb, “turning,” are turn-offs for the very people legacy healthcare organizations want to engage.

Contemporary health engagement for patients in the U.S. is also complicated by the fact that patients are responsible for financing at least part of their healthcare — resulting in self-rationing among a large percentage of people who truly need to access care, the CarePayment survey points out. We’ve seen these behaviors based on other data sources, notably over the years via the Kaiser Family Foundation which I perennially cover — even back in 2012 before the advent of the Affordable Care Act.

As providers, payors and pharma allocate capital resources for technology to improve relationships with patients on the hardware side of the ledger, these healthcare organizations should also be mindful of other processes and mindsets facing consumer-patients — both in terms of helping people navigate the healthcare system, and at the same time, avoid the financial toxicity that can prevent them from seeking care in the first place.

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Is the physicians labor market recession proof?

According to a Health Economics paper by Alice Chen, Anthony Lo Sasso, and Michael R. Richards, the answer is ‘yes’.  According to their study:

We leverage a unique dataset on New York physicians to analyze if and how the Great Recession impacted the labor market of physicians who have completed their residency and fellowship training and are seeking their first job. We find that these physicians do not delay labor market entry and their job searches and other employment outcomes are unaffected by the business cycle. The collage of evidence demonstrates that new graduates were largely unfazed by the recent downturn, which sharply contrasts with other highly educated, high remunerating occupations.

Although being a physician may be getting less enjoyable with more paperwork, more pressure on earnings, and more oversight by regulators and managers, it does appear that physicians do enjoy high levels of job security.

Source:

• Chen, Alice, Anthony Lo Sasso, and Michael R. Richards. “Graduating into a downturn: Are physicians recession proof?” Health economics 27, no. 1 (2018): 223-235.

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Olympic Snowboarders Go for the Gold…Mouthguard!

Plenty of people were cheering at the Winter Olympics in PyeongChang, South Korea this week when U.S. snowboarders Chloe Kim and Areille Gold captured the Gold and Bronze medals in the women's halfpipe event. Kim's routine was virtually flawless, while Gold's come-from-behind third run was a thrill. It was also great to see Gold putting in her mouthguard before every ride.

How important is that mouthguard? The 21-year-old athlete from Steamboat Springs, Colorado recently said it's one of the three things she never leaves behind for a competition. (The others are headphones and a water bottle.) What's more, as viewers could clearly see, the mouthguard she wore for the half-pipe runs had something special about it: It was colored bright gold.

Maybe that color was a tribute to her own name—or to her Olympic dreams. Either way, it's a reminder to fans everywhere that while winter sports like skiing, riding and sledding are great exercise and lots of fun, they also have the potential to cause injury, including damage to the teeth, face and mouth. So just like a helmet, a mouthguard should be part of every skier and rider's gear.

What's the best kind of mouthguard? It's the one you feel comfortable wearing all the time. A custom-made mouthguard offers the greatest comfort and the best protection against injury. Your family dentist can provide one that's made from an exact model of your mouth, so it fits just right. And the cost of a custom-made mouthguard is less than the cost of treating even a relatively minor dental injury when you include the time lost from work or school.

Even seasoned pros aren't immune from accidents—as another competitor at the halfpipe event proved. Australian snowboarder Emily Arthur had problems landing a jump in her third run, and fell face-first into the packed snow. When she got up her face was bleeding, and she complained of sore teeth. Fortunately she received prompt attention, and later joined her family to watch the day's remaining events.

Whether you're shredding the local slopes or throwing down huge tricks at the Olympics, remember that injuries can happen to anyone at any time. That's why it's vital to wear protective gear like a helmet and a custom-made mouthguard whenever you're on the snow.

Olympic Snowboarders Go for the Gold…Mouthguard! posted first on http://dentistfortworth.blogspot.com

Olympian Adam Rippon’s Smile & Skating Equally Dazzling

Let's say you've got a big night coming up. Maybe it's an event you've always hoped would be really special. You have great moves, a killer attitude, and a custom-made outfit. What else do you need? How about a fantastic smile!

Adam Rippon, the 28-year-old figure skater who lives in Los Angeles, California, knows how important a great smile is. His "big night" came at the 2018 Winter Olympics in PyeongChang, South Korea, where he made his Olympic debut in front of the whole world. "This is a moment I've been waiting for my entire life," he said. So before hitting the ice, he had teeth whitening treatments to make sure his smile would be as dazzling as his jumps and spins.

Teeth whitening is one of the most popular cosmetic dental treatments. It's best to have whitening done under the careful supervision of a dentist, who can help ensure its safety and effectiveness. Your dentist will begin your treatment with a thorough exam to detect any problems, and will then recommend the most appropriate whitening methods for your individual situation.

In-office whitening is the fastest way to get brighter teeth. Using the most concentrated bleach solutions combined with proper safeguards, your teeth can be lightened by up to ten shades in a single visit. It's a quick and effective way to get results that will really get noticed. However, if you're not in a hurry, similar results can be achieved with take-home kits from the dental office. These custom-made kits have plastic trays made to fit your mouth comfortably, and bleaching gels that are safe for home use as directed. In just weeks you'll see a lighter, brighter smile.

Plenty of TV stars, media personalities and sports icons have teeth whitening treatments done routinely. But you don't have to be a celebrity to get whitening—countless regular folks do it every year. And if you have a special event coming up, it might be just what you need to make an unforgettable impression.

Rippon's performance captivated the worldwide audience and boosted Team USA's medal count; he also became the number one trending topic on Twitter. But whether you're playing to an audience of billions—or just one—one thing's for sure: a brilliant smile always gets attention.

Olympian Adam Rippon’s Smile & Skating Equally Dazzling posted first on http://dentistfortworth.blogspot.com

HWR Going for the Gold Edition

The latest edition of the Health Wonk Review–the Going for the Gold Edition— has been posted at HealthInsurance.org.  Thanks to Steve Anderson for hosting.  Check it out!

HWR Going for the Gold Edition posted first on http://dentistfortworth.blogspot.com

Bayes vs. Fisher

An interesting People of Science video compares the approaches of two titans of statistics, Ronald A. Fisher and Thomas Bayes.

Bayes vs. Fisher posted first on http://dentistfortworth.blogspot.com

Unique Valentine’s Day Ideas!

We are a country divided: those who think Valentine’s Days is a real holiday, and those that think it was the creation of capitalistic card and candy companies…Those that love to be showered in flowers and those that think it is all a ruse and insincere. The set that loves to go out and be among the throngs of couples, and those that think restaurants purposefully increase their prices and serve the worst wine on February 14. 

 

Well, we understand. However, since the tradition of a Valentine has been around in some form since the Roman Empire, it doesn’t look like it will be abolished anytime soon. February 14 rolls around each year, and for your reading pleasure we’ve come up with a list of nontraditional activities for you to do with your Valentine, or with friends and family. 

 

And for the haters: this list will not contain any reference to a prix fixe menu!  

 

Get down and dirty 

 

Put the little black dress back in the closet and opt for a pair of jeans and tennis shoes instead! The “sweet nothings” you will be whispering to your significant other will be along the lines of “see you at the finish line”. Bring out your competitive side with a trip to the go-kart track. K1 Speed boasts a professional track with cars that go fast! The experts here will fully outfit you for the ride so you look like a professional driver. Who needs roses when winners get trophies? 

 

Pop the cork 

 

For those who want to drink wine, but not be bothered by a stuffy restaurant, try out one of the many sip and paint options across the metroplex. From Painting with a Twist to Art in the Vine the concept is all the same: drink wine and paint. The best part of these classes is that your art actually looks good. Maybe it’s the instructors or maybe it’s the wine, but whatever the reason your creation will be wall worthy. 

 

No skating on thin ice 

 

We’ve had enough cold weather in the metroplex so why would you want to skate around frozen water?! Ditch the blades for wheels and head to Skate Town for a night of roller skating. The last time most of us were at a skating rink was for a birthday part that concluded with the kid of honor in the money booth. Now that we are older, the falls hurt a little more, but at least your date will pick you up this time!  

 

Fall in love  

 

All relationships have their ups and downs, but if you really want to test it then try indoor skydiving. iFLY allows you to have the skydiving experience without actually jumping out of a plane! Safe inside a wind tunnel you will experience the feeling of free falling while gently hovering above the ground. Parachutes are not required for this experience! 

 

Don’t reject Valentine’s Day due to preconceived notions of what you should do or what the movies led you to believe was the “right” way to go about it. Take advantage of these locations around Fort Worth to have both a fun and adventurous night!  

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The $4 Trillion Health Economy of 2020

In 2020, national health expenditures (NHE) in the United States will exceed $4 trillion to cover $334.5 million Americans. That equates to 18.4% of the Gross Domestic Product (GDP) and $12,230.40 of health spending per person.

I sat in on a press call today with researchers from the Office of the Actuary working in the Centers for Medicare and Medicaid Services (CMS) to review the annual forecast of the NHE, published in Health Affairs in a statistically-dense eleven page article titled, National Health Expenditure Projections, 2017-2026: Despite Uncertainty, Fundamentals Primarily Drive Spending Growth.

What are those “fundamentals” pushing up healthcare spending? Three factors will drive healthcare costs to 2026: prices for medical goods and services, changes in income growth, and shifting enrollment from private health insurance to Medicare — driven by the aging of Boomers.

Focusing in on the health insurance line item, 44% will be covered by private/commercial payors and 51% by Medicare and Medicaid (the remaining 5% of insurance costs will lie with other third-party payors and programs).

The annual growth rate of medical spending will be 5.5% per year, 2017-26, expected to hit $5.7 trillion in 2026 when healthcare spending will be $1 in every $5 in the American economy (approaching 20%). That 5.5% is also 1% faster than expected GDP growth.

The second table details medical spending by category: hospital care, professional services (doctors, dentists, and other professionals), residential and personal care, home care, long-term care, and the retail sales of medical products: namely, prescription drugs, durable medical equipment, and disposable supplies. The three largest line items of NHE in  2020 will be:

• Hospitals = $1,326 trillion = 38% of NHE
• Professional services = $1,075 trillion = 31% of NHE
• Prescription drugs = $404 trillion = 11.6% of NHE.

Together, these three categories will comprise just over 80% of health spending in 2020.

Health Populi’s Hot Points:  Prices of services and goods continue to be a key cost driver in American healthcare, which is old but continuing news that the CMS forecast assumes in its financial model.

Altarum Institute informed a story in Bloomberg news yesterday on the end of a long-run of low-cost increases in U.S. healthcare. The third chart on “price hikes slow” illustrates the low-growth medical cost story since the start of the Recession.

If that slow-growth cost scenario is over and the U.S. faces the next few years of 5.5% growth rates, reflected in today’s CMS forecast, we face personal health care price inflation that will exceed general price inflation in the U.S. economy.

The CMS team added a “special topics” section at the end of the forecast report with an analysis of prescription drug rebates and specialty drug price impacts, and a discussion about the effect of high-deductible health plans (HDHPs) on national health spending.

Over one-quarter of American workers were enrolled in HDHPs in 2017, Kaiser Family Foundation found in their annual employer health benefit survey. Consumers’ enrollment in HDHPs has been found to lower their demand (use, utilization) of health care services and goods (such as prescription drug fills or continuation). This self-rationing behavior has resulted in a deceleration in private health insurance spending growth for hospital care and physician services, the CMS team points out.

Through the eyes of the American patient, now health consumer, affordability continues to rank ahead of quality or access for health care based on TransAmerica’s research into healthcare consumers in a time of uncertainty. Underpinning affordability concerns is 70% of consumers’ confession that they do not currently save for healthcare expenses.

Savings rates have hit a low in 2018 for Americans, consumer debt continues to creep up, and health care prices will drive medical spending over the next several years. The U.S. consumer will continue to face medical cost affordability challenges and will be at-risk of further self-rationing care if health plan sponsors — in both commercial plans funded by employers and public sector plans at the Federal and State level — do not artfully alter health plan benefit designs that nudge consumers-as-patients — to spend health dollars when they should — and patients-as-consumers, to understand what value-based healthcare means for their household in their healthcare communities.

This will impact patients’ financial relationships with hospitals and physicians, who will need to pay growing attention to revenue cycle management in even more risk-managing and creative ways. Someone in my social circle told me earlier today that they will be starting up a GoFundMe page soon to help them cover costs for an unexpected cancer diagnosis. We must never lose sight of the patients underneath numbers like $4 trillion of health spending, and what our ROI is on that spending through both public and individual health lenses.

 

 

 

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#Engage4Health: How Patients Are Morphing Into Healthcare Consumers, for #HIMSS18

This blog appears today as part of a #HIMSS18 primer series for attendees, and the industry at large, to discuss major health IT issues that will help move health and healthcare delivery forward in 2018 – and beyond. I’m grateful to HIMSS to be one of 20 Social Media Ambassadors appointed for this year’s conference, which convenes in Las Vegas at the Sands Expo Center from March 5 to 9th, 2018. 

Prioritizing the patient-as-consumer through my health economic lens, the biggest priorities will be:

• Engaging patients in self-care and driving health and health plan literacy to better manage constrained access and payments
• Dealing with healthcare provider burnout due to bureaucratic tasks and high-expectation patient demands
• Delivering right-sized care based on the most current clinical evidence to all patients, regardless of personal or financial factor

Healthcare providers are the front-line stakeholders who, increasingly, are taking on payment and incentives to help manage individual patient and communities’ health. More hospitals are physicians’ employers, and so bear the responsibility of supporting doctors and nurses in working to their highest and best use – especially empowering professionals in their patient care missions. The just-released Medscape National Physician Burnout and Depression report for 2018 reveals that 42 percent of doctors feel burned out – largely due to bureaucratic and administrative tasks.

However, adopting and implementing poorly designed electronic health records (EHRs) has diminished the time available to clinicians to lay hands and eyes on patients – essentially, limiting their ability to do the jobs they were trained, hired and personally driven to do. This is a case of unintended consequences: the important research of Dr. Christine Sinsky and colleagues has shown that so much health IT has sub-optimized care processes, workflows and the important relationships between clinician and patient that both parties want to have.

Most physicians entered the profession, Medscape found, to form such relationships. The time tug of war between too many bureaucratic tasks coupled with lack of time to nurture patient relationships contributes to clinician stress and the added fourth leg of the Quadruple Aim – the Triple Aim with the addition of addressing provider burnout and drop-out.

Still, clinicians need to hone their webside manner, listening and empathy skills. Patients are more adherent to medication regimens when people feel more respected in the clinical encounter and achieve better outcomes when managing chronic conditions like diabetes.

Payor, insurer and employer stakeholders can better align healthcare outcomes with health-making by more artfully designing health plans than nudge people to take better care of themselves, fund services that can address chronic healthcare conditions, and arm people with tools to share in decision- and health-making.

Patients/consumers also bear responsibility in helping make a better healthcare system. See that roughly equal proportions of patients themselves say they along with healthcare providers are responsible for improving health. The chasm between “say” they’re responsible and acting on that promise can be addressed through provider supports – both analog (read: empathy and humanity) and digital (via useful tools clinicians vet and curate for effectiveness and user-centered design).

Barriers and Opportunities for Progress

People have become Amazon-primed, benchmarking consumer expectations at a level beyond what the healthcare industry has typically delivered. Healthcare must adopt UX/UI that underpin technologies solving real patients’ and providers’ problems to streamline life- and work-flows.

There’s also a trust deficit between some patients and providers. But trust is a precursor to health engagement, so trust can be a barrier to patients and providers working together to improve healthcare. In addition to the EHR/screen-time challenge, there’s also a data/health information concern: patients expect health providers to be good data stewards, protecting personal health information.

Most consumers say visiting healthcare providers is where privacy and security is most important, the Ponemon Institute found. The frequency of cybersecurity breaches in health systems is a risk factor eroding patient trust. To that end, it is interesting to note that Amazon is seeking a privacy professional experienced with HIPAA.

Finally, healthcare costs are top-of-mind for patients in the U.S. Financial toxicity is a growing concern among oncologists treating patients with cancer, for example. Doctors and patients want to discuss healthcare costs and have greater transparency available for healthcare products and services.

Technology solutions can be designed to address each of these three barriers (consumer service expectations, trust and data security, and financial transparency).

What to Look for at #HIMSS18

It is exciting to see so many panels and speakers addressing the patient and consumer as the “noun” in healthcare this year at HIMSS18. Here are some of the sessions I recommend that, together, will address many of the issues I’ve discussed in this post.

• Connected Patient Forum | #Engage4Health + #HIMSS18
• Innovation Symposium Closing Keynote – Health Happens Everywhere | #Aim2Innovate + #HIMSS18
• Patient Engagement – It Takes a Village | #Engage4Health + #HIMSS18
• Creating Delightful Consumer Experiences: What Can We Learn From Other Industries? | #Engage4Health + #HIMSS18
• Patients as Consumers: How Leading Providers are Digitally Transforming Patient Consults | #Engage4Health + #HIMSS18
• A New Era: The CMO’s Role at the Healthcare Consumerism Table | #Engage4Health + #HIMSS18
• Connected Care: VA, Virtual Health and the Patient Experience | #Engage4Health + #HIMSS18
• Tailored Conversations for Consumer Activation | #Engage4Health + #HIMSS18

Follow and continue this conversation via the following hashtags and communities: #HIMSS18, #Engage4Health, #Aim2Innovate

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But What IS Fluoride?

If you’re anything like us, sometimes going to the store to pick out toothpaste can be a little overwhelming. Between the different flavors, gel vs. paste, and whitening agents, it’s hard to find any uniformity between products. However, if you take a closer look you’ll notice that almost all toothpastes on the shelves contain fluoride. In fact, if you’re reading this blog, toothpaste has contained fluoride your entire life. 

 

If fluoride is such a prevalent ingredient in a daily product everyone uses, why don’t we know much about it beyond its advertised benefits? To help you become a more educated consumer, we’re going to break down the history and benefits of fluoride toothpaste.  

 

What IS fluoride? 

 

Fluoride is a naturally-occurring chemical ion found in rocks, soil, and water; however, it does not exist on its own in nature. To harness its benefits, it must be created though a scientific process. Harnessing this ion was a scientific achievement, and its benefit so widespread that it was added to water and toothpaste in the 20th century. Fluoride protects your teeth by making them stronger and more resident to the bacteria that feed on their outer surfaces. Thanks to fluoride in toothpaste, there has been a significant decline in cavities over half a dozen generations. 

 

While fluoride is generally lauded as a great accomplishment in public health, some concerns remain about what is the proper amount of fluoride for kids. Overconsumption of fluoride in young children can lead to fluorosis. This condition is caused prior to age eight and is a result of getting too much fluoride when the teeth are forming in the gums. It’s estimated less than one in four people have this purely cosmetic condition. 

 

In 2007, the Centers for Disease Control and Prevention (CDC) noticed an increase in the number of fluorosis cases among children. They speculated this was due to the amount in the water combined with fluoride toothpaste. To address this concern, the recommended amount of fluoride in water was reduced. While this new recommendation has brought awareness to the fluorosis, it’s important for parents to be vigilant and monitor the amount of fluoride introduced to their children—without forgetting the core benefits of fluoride use. 

 

What’s the “fluoride footprint?” 

 

While we are bombarded by the presence of fluoride in the market and—whether or not you know it—in your own home, you might be most familiar with fluoride treatments at the dentist’s office. After reading the potential adverse effects, you might be thinking these treatments aren’t necessary, or even a waste of money. However, that’s simply not true. Fluoride treatments are beneficial at any age—especially at a you age. While young children are more susceptible to cavities, older people are more likely to experience cracked teeth and gum disease. Fluoride strengthens the teeth and acts as a bonding agent to prevent bad bacteria from infiltrating the gum line and causing root diseases. Root decay is a leading cause of pain in the middle-aged. In addition to being painful, it is more serious than tooth decay. Fluoride helps to prevent this dental disease.

 

The discovery of fluoride and its inclusion in tap water, toothpaste, and mouthwash has led to a drastic decline in the number of cavities and other oral health diseases. Just like with any supplement, it’s important to understand how to properly use it and how to prevent harm from overuse.

 

Fluoride is such an important factor in keeping your mouth healthy that we encourage you to continue to use it and to ask us about professional fluoride treatments! If you have any concerns about its intended use or how to protect your child against fluorosis, please call our office today!

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Health care in Peru

Located in South America, Peru is almost twice the size of Texas and has 31 million people.  About one third of these live along the coast, largely in Lima.  About half of the population–largely Amerinidan population–live in the Andean highlands, with the rest spread on the eastern slopes of the Andes and the adjoining rainforest.  About 45% of the population is aged 24 or younger.  Peru is a middle income country, with GDP per capita of $13,300, which ranks 118/224 countries in the world.

Life expectancy in Peru is 74 years, which ranks 126 out of 224 countries.  Health care spending is 5.5% of GDP (128/224 countries), far below the United States’ 17.1% of GDP.  There are 1.12 physicians per 1000 people and 1.5 hospital beds per 1,000 individuals.  The World Health Organization recommends 2.3 health workers per 1,000 people so this figure is far below that recommendation.  However, access to physicians and hospitals is highly variable depending on where you live, particularly across rural regions.

Before 2007, health care spending was largely financed by the government (54% of health expenditures) or patients paid out-of-pocket (40%).  Over 60% of the population had no health insurance coverage.  As stated in Neelsen and Donnell:

From 2002, poor children (<18 years) and poor pregnant women were exempted from paying user fees for basic healthcare at National Health Service (NHS) facilities.5  Providers were reimbursed through the tax-financed Seguro Integral de Salud (SIS), which covered 16% of the population in 2006. This programme also covered basic emergency care for poor uninsured adults with life-threatening or potentially permanently damaging conditions.

Despite the perceived generosity of the National Health Service at his time, the budget only allowed for spending of $18 per person. Further, often times claims exceeded Peru’s budget and in these cases regional governments simply refused to pay these bills.

In 2007, the Peruvian government passed the Seguro Integral de Salud (SIS), which provided 6 million Peruvian adults (21% of the population) access to free basic health care.  Previous user fees were eliminated and coverage was intended to be more comprehensive. Budget shortfalls, however, have made accessing some services difficult, especially inpatient treatment.

Both before and after the reform, workers in the formal economy were covered by El Seguro Social en Salud (EsSalud).  This program was financed by a 9% payroll tax.  Worker retain this benefit during retirement as well as for up to 1 year of unemployment.

Sources:

• Neelsen, Sven, and Owen O’donnell. “Progressive universalism? The impact of targeted coverage on health care access and expenditures in Peru.” Health economics (2017).
• World Health Organization. 2013. “A Universal Truth: No Health without a Workforce.” 2013-2-
  24].
• CIA World Factbook: Peru.

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How to become a centaur

Interesting article on how human intelligence and artificial intelligence can be seen as complements rather than substitutes.  Human+AI combinations have been shown to perform better than human or AI alone.  Why?

AIs are best at choosing answers. Humans are best at choosing questions.

The advent of AI is not a zero sum game.  The symbiotic relationship between humans and AI may lead to great advances in the coming decade in technology, medicine and a wide variety or fields.

How to become a centaur posted first on http://dentistfortworth.blogspot.com

AI, Robots and the Future of Health Care

Interesting video from Wired on how artificial intelligence (AI) software may help improve patient care in the future.

AI, Robots and the Future of Health Care posted first on http://dentistfortworth.blogspot.com

Getting Real About Social Determinants of Health

New research points out that real people live real lives, and our assumptions about social determinants of health (SDOH) may need to be better informed by those real lives. I read three reports in the past week sobering up my bullish #SDOH ethos dealing with food deserts, transportation, and health service access — three key social determinants of health.

To remind you about the social determinants, here’s a graphic from Kaiser Family Foundation that summarizes the key pillars of SDOH.

Assumption 1: Food deserts in and of themselves diminish peoples’ healthy nutrition lifestyles. Low-income households who are exposed to the same food-buying opportunities as higher-income households reduce nutritional inequality by only 9%, based on research from the NBER. Geography of Poverty and Nutrition: Food Deserts and Food Choices Across the United States found that nutritional disparities have more to do with peoples’ demand for healthier foods than the nature of the supermarket supply in their neighborhoods. NBER concluded that education, nutritional knowledge, and regional food preferences are strong influences in consumers’ food selection on the demand side, versus a supply side of greener, fresher or more nutritious choices. The Study also found that consumers who move to areas where other people tend to eat more healthy foods do not change their own eating patterns.

Assumption 2: Providing transportation to/from health care services will bolster patients’ appointment-making.  About 3.6 million U.S. adults miss medical appointments each year due to transportation challenges, many of whom earn lower incomes. A study in JAMA Internal Medicine learned that providing shared transportation through, for example, Lyft or Uber, does not in itself increase appointment show-ups. Patients’ missed-appointment rates were roughly equal between those offered a ride service and those who were not: 36.5% versus 36.7%.

Assumption 3: Peoples’ access to health care services boosts outcomes. Just because a patient has access to health services doesn’t mean their outcomes will improve. In the Effect of High-Deductible Insurance on High-Acuity Outcomes in Diabetes, researchers found that overall, patients’ use of health services declined and led to 3.8% lower costs. However, among patients that lived in low-income neighborhoods, “large concerning” high-acuity emergency department visits and inpatient hospital days significantly increased. The study was published in the January 2018 issue of Diabetes Care, the journal of the American Diabetes Association.

In each of these studies, making the typical SDOH assumptions providing a single solution didn’t yield the intended outcome.

Health Populi’s Hot Points:  These studies point to our ongoing need to be ruthlessly focused on user-centered design — in this case, patient- and consumer-centered design, based on and respecting peoples’ values.

Take the example of patients with diabetes and high-deductible health plans. New research from Roche, partnering with Alexa Von Tobel of LearnVest, a personal financial planning firm, found that Americans with diabetes are more concerned about their financial future than people without the condition. To cover the costs of their diabetes care, nearly 1 in 2 people with diabetes accrued credit card debt (22%), borrowed money from family or friends (21%), and/or withdrew money from a retirement or savings account (19%).

In this case, people managing diabetes are not only at-risk for managing the many daily work-flow components of their condition, such as mindful nutrition and blood glucose testing: they’re also at financial-risk with its own stresses and household challenges.

The authors of the transportation study sum up the SDOH challenge as follows: “We need to be thoughtful about how we design and test new programs that address social barriers to health care….While we want hospitals and health systems to address patients’ social challenges that impact health — we need to rigorously evaluate new programs to make them successful. In this case, addressing transportation alongside other barriers could make a difference or doing a better job identifying who needs the services.”

Those “other barriers” can include financial — a top consumer health issue with which regular Health Populi readers will be well aware — along with cultural preferences, job and work commitments (limiting time to seek care inside of “regular” operating hours), and institutional barriers such as racial and ethnic factors that prevent some people trusting healthcare institutions.

When doing the important work with social determinants, let’s make sure we address and embrace the wholeness and richness of people. To that end, here’s a helpful report to help us on our journey toward whole-person care.

 

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