Technology in dentistry

New Technologies In Dentistry

We live in a time when technology is advancing faster than most of us can keep up. Take our iPhones for instance. They have only been on the market for ten and a half years, and even then…the early models look like bricks compared to the highly sophisticated devices we have in our pockets now.

And to think we sent the first spaceships into orbit with less technology than is in wrist watches today! In the medical setting we have also seen hug leaps in technology in the past few decades. From cancer treatments that use a patient’s own cells to fight tumors to lasers in dentistry that whiten teeth, we live in the best time for medical advancements.

Keep reading as we highlight some of the biggest innovations in dentistry over the past decades!

Highlighting cool technologies in dentistry

Throwing it way back, the discovery of fluoride and the invention of modern toothpaste in the last century revolutionized and changed the course of oral care. Our not-too-distant relatives commonly lost all their teeth in early adulthood and suffered greatly from oral health problems due to the lack of proper hygiene products. The combination of fluoride and modern toothpaste change the course of oral health.

While the idea of dental implants is not new (in fact they date back to 600 A.D.), innovation over the last several decades has brought this ancient idea into the future. Over the last 30 years, dentists and researchers have learned more about how implants can integrate with the jawbone. Today, many experts point to the discovery that titanium can physically bond with living bone tissue as the catalyst to the modernization of dental implants. Modern implants use titanium to form an artificial root of the tooth. Once surgically implanted into the jawbone, the titanium bonds with the jawbone and heals much quicker than previous iterations. This technology brings comfort, aid in eating and confidence to millions of Americans every year.

Another dental technology that has changed the landscape is teeth whitening. Once again, the idea has been around for decades; however, modern technology has allowed patients to have office-quality whitening service at home. Tray whitening has allowed people to complete the treatment at home and new laser-based technology has allowed for quick in-office procedures that give same-day results. In addition to these, over-the-counter products have also become more accessible to the masses.

 

Onto the future…

In addition to the technologies that are currently dominating the marketplace, there are always new things right around the corner. As dentists, we are always excited to discover new technologies that can make appointments easier for patients and keep their teeth healthy! Ultrasound technology is one budding innovation that allows dentists the option of radiation-free imaging and 3D images of the teeth. There is still work to be done here since the images are not always very crisp. However, there are always new breakthroughs in ultrasound technology and we hope it will eventually be a viable alternative.

3D printing has taken the world (and dentistry world) by storm. A new proprietary method opened by Carbon boasts printing speeds more than 100 times faster than your traditional 3D printer. This technology has already begun to be harnessed by using 3D printers to make dentures! This technology will allow dentists to do things more accurately, faster and cheaper than traditional methods. This all results in more benefits for the patient!

Finally, virtual reality is no longer just for video games. Thanks to its proliferation in the market, virtual reality training is beginning to change the way dentists are trained in dental school and continuing education classes. These systems allow dentists to hone their skills and experiment all without the presence of an actual patient. In addition to the dentists benefitting, some offices are allowing their most anxious patients to wear virtual reality headsets during exams to calm nerves and provide an escape.

Technology is every changing and here at Dr. Ku’s are always keeping our eyes out for new products that can make your trip to the dentist even better!

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Tips For Summer 2018 Travel

With summer vacations right around the corner, you might already have vacations planned that require a trip to the airport.  

 

Exciting! 

 

While getting to your destination is great, the process can be long, tiring and frustrating…especially if you have kids in tow or are having to conquer the labyrinth that is DFW Airport! To ensure that we enter the summer stress-free and each make it to our vacation destinations in one piece, we’ve provided our Tips and Tricks on how to make air travel easy! 

 

Packing 

 

Depending on the duration and destination, our packing advice is going to vary slightly. If you’re heading out of town on a short trip (i.e., less than two weeks), pack light and consider shipping toiletry items to your destination via Amazon or another big-box retailer. This could include wipes, diapers, sunscreen, snacks, or even sippy cups—things that your children rely on daily, but you don’t want to take up room in your bags. Remember, it’s important to be agile at the airport, and that requires less stuff! 

 

If you are taking a long, luxurious trip that will have you out of town for weeks at a time, still pack light. You will not want to be lugging around huge suitcases for weeks on end. If you are gone for a while, scope off where you’re going and the options for buying additional necessities when you get there. For instance, if you need extra shirts for your kids, is there a Gap Kids (or the foreign equivalent)? Having this knowledge will help you pare back your belongings. Also, look for accommodations with washing machines, like on Airbnb. This will help you pack less and re-wear more! 

 

Finally, don’t forget to double bag all your liquids. You don’t want shampoo spilling all over a week’s worth of clean clothes! 

 

Navigating the airport 

 

This can be daunting, especially with strollers, car seats and all those bags (however, if you followed our packing instructions then it won’t be that many)! So for starters, check in ahead of time. Then, if you are traveling with another adult, have them drop you at the curb with all the bags or clunkier items. The other adult will park the car and solely handle the children. You will be able to divide and conquer and get those bags checked before the cutoff time. 

 

Once in the airport try to be as nimble as possible. This means checking everything you can. After you pass through security, keep your kids moving. This will help them get out all their wiggles before the flight. 

 

On the plane 

 

Be like a boy scout and come prepared with one of each of the bare necessities. This means snacks, extras clothes, diapers, activities and a little bit of grace for yourself and your family. No matter how many times your kids cried, or the number of lollipops you had to feed them to keep them quiet, it’s ok. Th plane ride is just something you have to get through! 

 

…Enjoy your vacation 

 

Celebrate once you get there, because you did it! Enjoy your vacation and cherish all the moments with you family or friends, because soon you’ll have to pack up and do the whole airport thing all over again. With these easy tips, we hope to make getting to your destination less stressful and, if possible, thoroughly enjoyable! 

 

We are always looking for new tips and tricks for traveling—especially with kids! So let us know what works best for you and your family!  

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Pharma Spending Gone Bipolar: Generics At One End, Specialty Drugs on the Other

While the use of medicines continues to rise in the U.S., spending grew by only 0.6% in 2017 after accounting for discounts and rebates. In retail and mail-order channels, net spending fell by 2.1%.

Prescription drug spending on branded products grew nearly $5 billion less than in 2016; generic drug spending fell by $5.5 billion, according to Medicine Use and Spending in the U.S., a report from the IQVIA Institute for Health Data Science. The report reviews medicines spending in 2017 looking forward to 2022.

There were over 5.8 billion prescriptions dispensed in 2017, and generic drugs accounted 90% of them. 97 percent of the time, generic drugs were dispensed when possible. Consider that 97%: this means that nearly all the time a drug was dispensed, it was a generic product.

The first chart illustrates the downward price pressure that generics exerted on prescription drug spending in 2017 compared with spending growth among new brands. That’s the navy blue component in each bar, indicating the $5 bn drop in 2017). See the orange component: that’s “LOE,” or “loss of exclusivity,” which is the value of a branded drug on-patent that lost sales due to a generic equivalent entering the market. These are the forces countering the branded side of medicines for new products and existing brands on-patent. “Growth slowed in 2016 and declined by $5.5 billion in 2017 as greater competition in a number of markets drove down prices,” IQVIA explains.

Let’s not get too comfortable assuming overall growth will continue to fall. IQVIA recognizes that medicine spending is shifting “strongly” to specialty medicines away from traditional treatments.

It’s those specialty treatments that are the fast-growing portion of spending, driving some consumers’ out-of-pocket (OOP) costs up. In 2017, patients spent $57.8 billion OOP for prescription drugs: OOP costs include copayments, coinsurance, payments during the deductible phases of health insurance, or retail payments for drugs due to the lack of prescription drug insurance coverage. The second chart illustrates OOP spending for the 5.5 billion prescriptions filled in 2017:

• 3.4 million prescriptions cost patients over $500, adding up to $5.2 billion in OOP costs. That’s equal to an average of $1,502 per prescription, accounting for 0.1% of all filled prescriptions.
• 10.7 million prescriptions cost patients between $250 to $500, totaling $3.9 billion, on average $362 per prescription.
• 80% of prescriptions cost under $10, representing 22% of OOP costs.

Against the low-cost generic backdrop, we can expect the special drug portion of the medicines bill to gain greater share of spending to 2022. Spending on new brands for specialty medicines drove $9.8 billion of the $12.0 bn net growth in 2017. There were 42 new active substances launched in 2017, 32 of which were specialty therapies. These were in the areas of oncology, HIV, MS, and narrower therapies for Huntington’s disease, atopic dermatitis, and spinal muscular atrophy, among other conditions.

IQVIA Institute is the renamed IMS Institute.

Health Populi’s Hot Points:  As new-new drug therapies come on-stream, prescribers look to trusted information sources beyond the pharma manufacturer of the product for information on use of the new medicine. SERMO, the physician social network, launched its Drug Ratings program in May 2017. Some 800,000 physicians belong to SERMO, where peers discuss a range of topics including but not limited to diseases and conditions, medical and information technology, and with the Drug Ratings program, prescription drugs.

As of March 2018, there were over 3 million data points on over 600,000 drug ratings in the SERMO database, which the company terms “the FICO score for drugs.” These ratings cover over 2,100 pharmaceutical brands for which over 40,000 having submitted opinions.

SERMO’s poll of 2,900 physician members learned that:

• 83% of doctors say the opinion or feedback of a peer doctor has changed their perception of a drug
• 80% trust recommendations of doctors with real world experience with a drug, and
• 84% believe Drug Ratings will lead to better patient outcomes.

As value-based payment continues to grow among physicians and other prescribers, and among patients taking on high-deductibles and coinsurance for higher-cost specialty drugs, understanding details about prescription drug use from peers (both physician-to-physician and patient-to-patient) will become increasingly important. More patients are asking physicians for specifics at the point-of-prescribing about their own patient cost-shares for a specific prescription drug, as well as information on side-effects, toxicity, and other known real-world experiences gathered by doctors and patients. The SERMO Drug Ratings community is one signpost in this increasingly bipolar world of prescription drug prescribing and pricing.

 

 

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Your Fluoride FAQ

Have you ever stood in the toothpaste aisle at the grocery store and been totally overwhelmed by the options? 

 

What makes the choice hard for toothpaste is that there are so many ingredients included—and some of them with controversial news items, particularly fluoride. What is fluoride, and is it actually necessary? We know a lot of our patients are committed to “eating clean” and avoiding the use of overly-processed chemicals and ingredients. So, should you avoid using fluoride and opt for fluoride-free toothpaste, too? 

 

To dispel myths and ensure you are protecting your teeth with every brushing, we’ve compiled a list of Frequently Asked Questions we receive from our patients. If there is any question not listed, feel free to give our office a call today! 

 

Is fluoride natural? 

 

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 the ion was a scientific achievement in the first half of the 19th century, and its benefit were discovered to be so widespread that it was added to water and toothpaste in the 20th century. 

 

What does fluoride do for my teeth? 

 

Fluoride protects teeth by making tooth enamel stronger and more resistant to the bacteria that feed on their outer surfaces. Fluoride actually gets into your enamel, and once there it combines with the calcium and phosphate to create a stronger outer layer. 

 

Worn enamel can cause weak teeth that easily chip or break. Thanks to fluoride in toothpaste, teeth are stronger than ever, and there has been a significant decline in cavities since its introduction.  

 

Where do I find fluoride? 

 

Fluoride exists naturally and is in almost all water supplies in the U.S. That said, in many areas the fluoride levels are even further increased in water to help protect your teeth. Some experts believe that the rate of cavities has been cut by more than 25% fully due to the fluoridation of water! 

 

In addition to water, most toothpastes also contain fluoride. The combination of fluoridated water and toothpaste has saved both patients—and state governments who administer health benefits—millions of dollars! Healthier teeth mean more money in your pocket. 

 

For patients that are at a higher risk of developing cavities, your dentist can even provide an additional fluoride treatment. These professional treatments only take a few minutes and are much stronger than what’s available over the counter. If you have a history of cavities, talk to your dentist today about a fluoride treatment.  

 

Is fluoride safe for children? 

 

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

 

Some of my friends say fluoride is still dangerous, is it true? 

 

We have heard many stories of how fluoride can cause diseases and is “not beneficial.” However, the Centers for Disease Control and Prevention still recommends that community water systems add fluoride to their water. They also acknowledge its benefit on tooth decay. However, just with any substance—naturally occurring or not—it is important to use fluoride properly and in moderation. If you have concerns about your use, please call us today. 

 

The advent of fluoride has been deemed one of the largest scientific advancements of the 20th century. It protects our teeth and has decreased cavities by over 25%. If you have any questions about your fluoride use or have any additional concerns, call our office today! 

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Quotation of the Day

“Lottery: A tax on people who are bad at math.”

• Ambrose Bierce, HT: The Browser.

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Food as Medicine Update: Danone Goes B-Corp, Once Upon a Farm Garners Garner, and Livongo Buys Retrofit

As the nation battles an obesity epidemic that adds $$ costs to U.S. national health spending, there are many opportunities to address this impactful social determinant of health to reduce health spending per person and to drive public and individual health. In this post, I examine a few very current events in the food-as-medicine marketspace.

Big Food as an industry gets a bad rap, as Big Tobacco and Big Oil have had. In the case of Big Food, the public health critique points to processed foods, those of high sugar content (especially when cleverly marketed to children), and sustainability. But there’s a new good news story in the world of Big Food that connects with health: Danone became a B Corp on 12 April.

“What’s a B Corp?” you ask? Companies that become Certified B Corporations are part of a global movement of people using business as a force for good (a phrase that is trademarked).

In the U.S., Ben & Jerry’s, Patagonia, King Arthur Flour Co., Cabot Creamery, and the Indigenous fashion brand are a handful of the over 2,400 companies that have undergone B Corps certification. This process reviews companies’ commitments to sustainability, social responsibility, and the environment. Danone joined this small circle of B Corps as the largest member among them, globally.

Danone recently divested its portfolio of any business that didn’t speak to health or some adjacency to wellness. In the U.S., consumers know Dannon best for yogurt, but the company globally serves up a lot more than cultures good for gut health. Several years ago, the parent Danone has doubled-down on the mission of making people healthier, and is strategically focused on sustainability, health and wellness. See the photo’s tagline: “One Planet, One Health.”

In the U.S., the company’s portfolio of brands includes Activia, DanActive, Danimals, Dannon, Horizon Organic, International Delight, Light & Fit, Oikos Greek yogurt, Silk plant-based foods and beverages, and more. Globally, Danone is very active across the continuum of health, from early life nutrition and to advanced medical nutrition.

This engaging video will answer more of your questions about B Corp’s.

Another food-health news story finds Jennifer Garner, the actress, joining forces as Chief Brand Officer and company co-founder at Once Upon A Farm, a baby food company co-founded by Annie’s Organics ex-CEO, John Foraker.

Once Upon A Farm works with partner farms on the U.S. west coast, positioning the baby-and-toddler foods as nutrient-dense without preservatives, concentrates or processed purees — “delivered fresh from farm to highchair,” their tagline asserts.

I was particularly interested to read Garner’s comments quoted at the 2018 Natural Products Expo West trade show: she said, “We can’t just talk about feeding the top 10% of kids, or 50% of kids. We have to talk about how to give that nutrition to the bottom half.” Foraker reinforced her sentiment, saying that, “We want to build a leading kids nutrition brand. We think we have an opportunity to increase the quality and healthfulness of food for all kids in the U.S.”

Here’s a video about how they “make homemade so you don’t have to.”

The third news item in this food-as-medicine update follows up last week’s post on Livongo Health’s expanded diabetes care program partnering with Cambia Health, coupled with the company’s influx of $105 million. We intuited the company would use the money to scale beyond diabetes and nationally beyond Cambia’s geography. Today, Livongo announced its acquisition of Retrofit, a weight management company that works with employers like Aon Hewitt, Dr. Pepper Snapple, and PSEG to help workers deal with weight management and disease prevention.

Sustaining weight loss is very difficult: after seven years’ worth of data, Retrofit has shown impressive outcomes: 96% of participants who start the program complete it; 88% lost weight; and, 78% have maintained that weight loss a year later.

Health Populi’s Hot Points:  One of the long-missing pieces of this food-health puzzle has been medical education. “He knew the dearth of nutrition training in medical schools was a problem that went far beyond his experience. Five years ago, he left his university-based cardiology practice in Chicago to launch the Gaples Institute for Integrative Cardiology in Deerfield, Illinois, a nonprofit that aims to improve nutrition and lifestyle education for health care professionals,” a column published in last week’s JAMA points out, with “He” being Dr. Stephen Devries, executive director of the Institute and associate professor at Northwestern University Feinberg School of Medicine.

Dr. Devries is optimistic about incentives aligning to encouraging more nutrition in both the med school curriculum and continuing medical education through online courses his group is developing, and other tactics you can read about in the JAMA article. He writes, “When it comes to the financial incentives, fortunately, those are beginning to shift. We’re moving toward a value-over-volume sort of reimbursement, which is going to look at outcomes as opposed to the number of procedures that we do. And what makes more sense than to work to prevent disease and to mitigate the severity of disease with a very low-cost intervention like diet and lifestyle?”

To that end, the New England Journal of Medicine published “Prescribing Food as a Specialty Drug” last week, featuring the Fresh Food Farmacy pioneered by Geisinger Health System.

The Geisinger team wrote that, “We focused on food because research suggests that food insecurity, or lack of access to nutritionally adequate food, is one of the most important risk factors for developing type 2 diabetes. Food-insecure adults are two to three times more likely to have diabetes than adults who are food secure,” exacerbated by low-incomes driving people to turn to inexpensive, accessible food rich in calories and poor in nutrients — risk factors for diabetes.

After screening for patients who are at food-risk for diabetes, the team serves up food prescriptions as well as identifying additional services to help bolster outcomes, including other social determinants of health like transportation, family care, and other services that will help people co-create health. The Geisinger team points out that a value-based payment environment fosters this kind of program.

The proof is in the outcomes-pudding shown here.

What all these programs bake into their value propositions is a commitment to helping people co-create health through engagement, nutrition, empowerment, and empathy.

They are all examples of how tools — including food itself — can be well-designed and put into peoples’ hands to improve health, wellness, and vitality.

We come full circle and return to the B Corps Declaration of Interdependence, which reads:

“We envision a new sector of the economy which harnesses the power of private enterprise to create public benefit.

This sector is comprised of a new type of corporation – the B Corporation – which is purpose-driven, and creates benefit for all stakeholders, not just shareholders.

As members of this emerging sector, and as entrepreneurs and investors in B Corporations,

We hold these truths to be self-evident:

That we must be the change we seek in the world;

That all business ought to be conducted as if people and place mattered;

That, through their products, practices and profits, businesses should aspire to do no harm and to benefit all;

To do so requires that we act with the understanding that we are teach dependent upon another and thus responsible for each other and future generations.”

Dealing with chronic conditions like obesity and overweight truly takes a health village of interdependent organizations driving public benefit in partnership with patients. We can all learn from B Corp’s Declaration as we continue to do our work to make healthcare better and help people be healthy, being the change we seek.

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How Walmart Could Bolster Healthcare in the Community

Walmart has been a health/care destination for many years. The company that defined Big Box stores in their infancy grew in healthcare, health and wellness over the past two decades, pioneering the $4 generic prescription back in 2006. Today, that low-cost generic Rx is ubiquitous in the retail pharmacy.

A decade later, can Walmart re-imagine primary care the way the company did low-cost medicines? Walmart is enhancing about 500 of 3500 stores, and health will be part of the interior redecorating.

Walmart has had ambitious plans in healthcare since those $4 Rx’s were introduced. Here’s a New York Times article from 2014 discussing the company’s vision for expanding primary care.

This announcement comes on the heels of the company’s announced intentions to acquire Humana and PillPack. Walmart will spend $11 billion to remodel some 500 stores around the U.S., including the addition of private rooms adjacent to the stores’ pharmacies. Here’s one description about the chain’s plans to use $200 mm to expand in Florida (THINK: the state will be home to 4,5 million people age 65 and over in 2020, potential candidates for Humana’s Medicare programs. [Just sayin’]). Florida and Texas will see the most Walmart remodels among 82 stores, along with 14 new store openings. In addition, California, Ohio, Virginia, New Jersey, and Minnesota will receive the bulk of the remaining funds, with plans in other geographies, as well, Business Insider reported.

In addition to the Humana deal, Walmart also recently announced intentions to acquire PillPack, a pharmacy packaging firm with the mission of helping patients stay adherence to medications — a big challenge for U.S. healthcare that costs nearly $300 billion worth of safety risks, medical errors, and ill health in America each year. In context, a prescription drug “blockbuster” is typically defined as having global sales of $1 billion annually.

Walmart talked about the company’s growing commitment to helping consumers manage diabetes in a press release here.

Health Populi’s Hot Points: I recently spoke at a meeting in Bentonville about Walmart as a front-door to health for the new patient-as-payor. From the pharmacy to health-and-beauty (THINK: headaches,  vitamins and supplements, and good skin care), the grocery (for food-as-medicine and healthy eating for families), vision and oral care (often overlooked since the Great Recession of 2008), the urgent care Clinic at Walmartand primary care doctor access in the Care Clinic, and Walmart’s “biggest health fairs” convened throughout the year.

As Walmart looks to add Humana’s health insurance business to its expanding health/care portfolio, the company is building a vertically integrated offering with many on-ramps and front doors to health and wellness. Adding PillPack would enhance the pharmacy’s value to help drive adherence and better patient outcomes.

Along with CVS + Aetna, Amazon + “everything” omnichannel in health and medicine, and Apple in electronic health records, we’re in the midst of Fortune 100 companies placing bets for building out the U.S. health ecosystem for the third decade of the 21st century. It will take this village, collaborating with legacy health care organizations, baking in consumer-centered design and financial pragmatism, to bring the various visions to practical life for the millions of real people who shop at Walmart every day.

 

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April Fort Worth Events To Check Out!

The spring weather is finally here and it beckons us out of our winter hibernation. While we in Fort Worth, Texas know our winter temperatures aren’t the worst in the county, we still prefer the warm weather over the Texas cold. 

 

Thanks to the warmer weather, we can finally start planning events outside and soaking in that natural vitamin D. If you’re looking for things to do in the Fort Worth area to get out of the house, then we have you covered! From concerts to cattle and everything in between, we have picked out our favorite upcoming events in Fort Worth in the coming months. Get out your calendar, because there are lots of things you won’t want to miss! 

 

Family-friendly 

 

Do your kids have cabin fever as bad as you do, or worse? We all know Fort Worth is a family-friendly city, but here are a few upcoming events that will be sure to thrill the littlest ones. 

 

• A Day out with Thomas: Join your favorite trains Thomas and Percy and trusty conductor Sr. Tophamm Hat for a meet and greet and train ride! Here your kids will be able to meet their favorite characters and learn more about the railroad. Bring your camera for the photo ops! 

 

• 2018 Strider Cup: This tot-friendly bike race is great for your little athletes under six. With some races geared for those two and under, even the youngest members of the family can have fun. Organizers hope this race will help spark a love of biking for all participants! 

 

• Beauty and the Beast: The Casa Mañana Theater is soon to be hosting the classic, The Beauty and the Beast. For any Bell fans, you can also include a tea with characters from the show. Create young theater lovers with a night out at this show! 

 

Festivals 

 

If you’re looking to get out and spend time with friends, this is a great time of year to visit a festival. Here are some of our favorites: 

 

• Mayfest: This huge, four-day party is held every year on the first weekend in May at Trinity Park. This event features live music, festival food, carnival rides, performing arts, pet adoptions, more than 60 Art and Gift Market vendors, free children’s activities, special attractions…the list goes on and on! This event benefits The Junior League of Fort Worth, Inc., Streams & Valleys, Inc., and The City of Fort Worth Park and Recreation Department. 

 

• El Feurte/Taco Fest 2018: As the largest Cinco de Mayo event in Fort Worth, you can guarantee the competition is fierce for the best taco. Come and celebrate diverse cultures through music, food, and live entertainment.  

 

• Main Street Fort Worth Arts Festival: Texas’s largest arts festival will find its home for the 33rd time in Fort Worth at the end of April. Featuring award-winning artists and art in all mediums, this event has been ranked the 4th best art festival in the United States. 

 

Other favorites 

 

Finally, here’s a quick list of a few more of our favorite things to be on the lookout for in Fort Worth in the coming months: 

 

• A Night of Artisans and Chefs  
• Bike-N-BBQ Tour
• First Fridays and the Modern
• Stockyard Championship Rodeo  

 

There is so much to do this spring in Fort Worth that it will be hard to fit it all in. We’ll keep updating our list as events pop up, so let us know if you see something interesting! 

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Which inflation index should I use?

Many studies use data on health care costs from multiple time periods.  To make costs comparable over time, researchers often use an inflation index to translate previous years costs to current dollars.  The first question is, what inflation indices are available to make this adjustment.  A paper by Dunn et al. (2018) reviews the potential indexes and makes some suggestions.

Overall Inflation

• Gross domestic product (GDP) implicit price deflator.  Created by the Bureau of Economic Advisors (BEA), this adjust based on inflation in the overall economy.
• Consumer Price Index (CPI).  Created prepared by the Bureau of Labor Statistics (BLS) and the Personal Consumption Expenditures, this metric looks at the prices of goods and services consumed by household.  The CPI for urban consumers (CPI-U) measures changes in prices for a bundle of over 200 products and services.  CPI price change estimates are generally higher than PCE, likely because CPI is a Laspeyres index.
• Personal Consumptions Expenditure (PCE) price index. Prepared by BEA, it also measures changes in goods and services consumed by households.  Whereas the CPI is a Laspeyres index, PCE is a Fischer index. The approach uses an identical method to the GDP deflator, but PCE excludes expenditures made by businesses, governments, and foreigners. “About one-quarter of PCE included in the PCE is excluded from the CPI, notably personal health care expenditures by employers and governments (e.g., Medicaid and Medicare Part A).”

Medical Inflation.

• Personal Health Care (PHC) deflator.  Calculated by CMS, it is a Fischer index that includes spending on hospital, physician and clinical, dental, other professional, home health care, nursing care, and other health, residential, and personal care services, as well as sales of retail medical products, for example, over-the-counter drugs.  The approach uses sector specific producer price indices.
• PCE health-by-function (PCE health) price index. Created by the BEA, it is its index for health care consumption.  Like PHC, it uses both the producer and consumer price indices to estimate changes in health care prices. The results are similar to the findings in the National Health Expenditure Accounts (NHEA).
• Medical Care CPI (MCPI).  Like the CPI, it is a Laspeyres index, but it only measure the cost patients pay out-of-pocket.
• National Health Expenditures (NHE) index.  Created by CMS, it measures changes in health spending not only by consumers but also spending on government administration, net administrative and other costs of private and public health insurance plans, government public health activities, noncommercial biomedical research (commercial research is already implicitly included in PHC spending), and expenditures by health care establishments on structures and equipment.
• Producer Price Index (PPI).  Produced by BLS, some of the PPI components measure changes in inflation for specific health care service types (e.g., hospital or physician services).

The authors also briefly touch on disease based price indices which–rather than measure the cost specific goods or services–measure changes in the overall cost of treating specific diseases.

So which index should you use?  The authors recommend the following:

• To adjust health expenditures in terms of purchasing power, use the GDP implicit price deflator or overall PCE measure. The PCE measure is suitable for personal consumption. The GDP deflator is more appropriate for the societal perspective.
• To adjust overall consumer out-of-pocket spending in terms of consumer purchasing power or out-of-pocket burden relative to income, the CPI-U can be used.
• To convert average expenditures to care for a specific disease for price changes from 1 year to a different year, either the PHC deflator or the PCE health index can be used. Because of exclusions of some payers in its weights, the MCPI may not be appropriate to adjust all-payer expenditures or payments by employers, Medicaid, and Medicare Part A for medical inflation.
• To convert average consumer out-of-pocket health care expenditures from 1 year to a different year, the MCPI can be used.
• To adjust estimates of costs of inpatient services from different years, the PPI for inpatient services appears currently to be the best option.

And now you know how best to adjust for inflation depending on your specific research question.

Which inflation index should I use? posted first on http://dentistfortworth.blogspot.com

The Health of A Nation – Being Healthy In America Depends on Where You Live

In the US, when it comes to life and death, it’s good to live in Hawaii, Utah, Minnesota, North Dakota, and Iowa — the top five states with the greatest life expectancy and healthy life expectancy at birth in 2016.

For health and longevity, sorry to see the lowest five ranked states are Washington DC which ranks last, along with Mississippi, Louisiana, South Carolina, and Alabama.

This sober geography-is-health-destiny update was published this week in JAMA, The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States.

The first chart illustrates states down the left column and across the top, the 20 diseases that most likely kill Americans: ischemic heart disease, lung cancer, road injuries, self-harm, cerebrovascular disease, COPD, drug use disorders, Alzheimer disease and other dementias, colon and rectum cancer, interpersonal violence, lower respiratory tract infections, diabetes, congenital birth defects, neonatal preterm birth complications, chronic kidney disease, breast cancer, pancreatic cancer, cardiomyopathy, cirrhosis and chronic liver diseases due to alcohol use, and endocrine, metabolic, blood and immune disorders.

In this chart, green is good for health, signifying lower rates of years of life lost to the disease compared to the mean US rate. Red means the rate of years of life lost is significantly higher than the US mean.

There’s lots of red on the bottom, among the following ten states from the bottom up, Mississippi, West Virginia, Alabama, Louisiana, Oklahoma, Arkansas, Kentucky, Tennessee, South Carolina, and New Mexico,

Green dominates, from the top down to tenth, in Minnesota, California, Connecticut, Hawaii, New York, Massachusetts, Washington, New Jersey, Colorado, and Vermont.

What’s underneath these health outcomes are state and local differences in factors that make health: first, access to quality health care services, complemented by environmental factors and lifestyle behaviors — those social determinants that influence our health more than our genetic code at birth.

The top 20 causes of life-years lost listed above show that lifestyle and environment have so much to do with mortality and quality of life: tobacco use, dietary risks, high body mass index, alcohol and drug use, air pollution, activity all shape individual and public health — the heaviest disease burdens in heart disease, diabetes, and lifestyle-influenced cancers (most notably lung). Then note road injuries, self-harm, drug use disorders, and interpersonal violence — deaths related to safe driving, mental health, physical and personal pain.

The second chart covers years lived with disability — the quality of life stuff, like pain which dominates the list via low back, migraine, and neck. Depression and mental/behavioral health conditions also feature prominently in years lived with disability.

How to deal with these challenges? The researchers recommend three strategies: first, address key modifiable risks like diet, tobacco, alcohol and drug use, activity, and obesity; then improve access to quality of care in specific areas to address chronic kidney disease and substance use disorders; and, address social determinants of health. The authors have calculated a 74% of overall variation of life expectancy based on socioeconomic and race/ethnicity factors combined with behavioral and metabolic risk and healthcare factors.

Health Populi’s Hot Points:  Public health is personal health at the ZIP code level. Here’s a map of life expectancy in my town of Philadelphia, illustrating that if you live in Philadelphia northeast of Temple University, you are likely to live 20 fewer years than residents who live in Olde City near the Liberty Bell and Independence Hall.

Independence Hall is where the Founding Fathers convened to get to a consensus about Life, Liberty, Pursuits of Happiness, and all Men being Created Equal. Do Americans today believe these concepts extend to health and healthcare?

The evidence in terms of outcomes and the burden of disease by US state demonstrates, “no,” we do not.

While health care services (both in terms of access and quality) can address some of the variation between health/life have’s and have-not’s in America, those complicated and multivariate social determinants profoundly influence American lives. “To increase the likelihood of prevention to succeed, it has to be a priority for all stakeholders — physicians, nurses, hospital systems, policy makers, health insurance companies, patients and their families, and advocacy groups.”

To succeed, strategies from bake in the notion of accountability broadly beyond “care” to address risk reduction in partnership with patients and communities, the report asserts in its conclusion.

And so back to Independence Hall and the Founders: as Benjamin Franklin said at the time, “You have a Republic…if you can keep it.” The chasm between health have’s and have-not’s threatens the unity, health and wellbeing of the nation.

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Patient-Centered Formularies: Steps In The Right Direction, But Challenges Remain

That is the title of my latest blog post in Health Affairs with co-author Mark Linthicum.  The premise is as follows:

CVS recently announced its new Transform Rheumatoid Arthritis Care initiative, which aims to reshape coverage of rheumatoid arthritis care through “value-based management strategies including outcomes based contracts and a new indication-based formulary for autoimmune conditions.” The CVS announcement comes amid an ongoing movement to tie formulary design to measures of treatment value, including initiatives such as value-based insurance design (VBID). The Center for Medicare and Medicaid Innovation even partnered with 13 Medicare Advantage plans to implement its VBID Model.

As payers take important steps toward value-based care, the broader debate around how value should be assessed points to the importance of different stakeholders’ perspectives on the tools, methods, and sources of data. A number of organizations have created formal value assessment frameworks, each with a different perspective on what value means. These frameworks highlight the need for value-based coverage decisions to account for underlying differences in the patients affected. To truly link benefit decisions such as formulary design to value, formularies must incorporate the factors that determine value from patients’ perspectives, while also accounting for diversity in covered populations.

The rest of the post examines the feasibility of making formularies patient-centered. Please do read the whole thing.   The piece would be interesting for those focused on patient-centered care.  For economists, the article even uses the results from the Arrow Impossibility Theorem to help inform the challenge of formulary design.

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Livongo and Cambia Allying to Address Chronic Disease Burden and Scale Solutions to Consumers

Chronic diseases are what kill most people in the world. In the U.S., the chronic disease burden takes a massive toll on both public health and mortality, accounting for 7 in 10 deaths in America each year. That personal health toll comes at a high price and proportion of national health expenditures.

A new alliance between Livongo and Cambia Health seeks to address that challenge, beginning with diabetes and scaling to other chronic conditions.

Livongo has proven out the Livongo for Diabetes program, which has demonstrated positive outcomes in terms of patient satisfaction and cost-savings. The plan with Cambia is to scale this approach to consumer-empowerment and delight and healthcare cost-curve vending across a range of chronic diseases.

Cambia will first extend the diabetes program to members of Regence Blue Cross and Blue Shield in Idaho, Oregon, Utah, and Washington. The collaboration will then target hypertension and behavioral health beyond the plan’s core geographic market.

“We see great potential in collaborating with Livongo to transform the experience Americans have in health and in sickness,” Mark Ganz, President and Chief Executive Officer of Cambia Health Solutions, is quoted in the press release on the announcement. “Livongo is a kindred spirit on our journey to make health care more person-focused and economically sustainable. Both companies are committed to a human-centered design approach and seamless experiences for individuals and their families.”

That human-centered design approach is evident in Livongo’s net promoter scores gifted by consumers. Note the member satisfaction bar chart, illustrating that Livongo scores nearly as high as Netflix. The average health plan fetches a low +12 points, with Livongo scoring five times greater engagement. I noted the dismal consumer experience ratings of health plans earlier this week covering the 2018 Temkin Experience Ratings report here. Livongo ranks with some of the highest-praised consumer-facing industries, like supermarkets and fast food. This bolsters patient engagement and stickiness — key for self-care in chronic disease management.

Health Populi’s Hot Points:  Health care costs in the U.S. threaten the long-term financial viability of the nation, with chronic disease consuming the largest share of health spending in America. Addressing chronic disease and its costs is akin to bolstering national security and economic stability in the not-too-distant future.

Note the third graphic, illustrating the growing costs of healthcare in America relative to other spending line items in the Federal budget. Health care is crowding out other priorities, like education, environment, and transportation infrastructure — all key to a healthy future for citizens — morphing into health citizens.

Patients must take on more self-care in their community — where we live, work, play, pray, and learn — to avoid costly settings for care. The Livongo/Cambia alliance can help patients, now health consumers, take on more responsibility and well-designed tools for self-care, partnering to move the needle on public and individual health outcomes and healthcare costs. Patients, that most underutilized resource in the health system, are part of the solution to reaching the Holy Grail of the Quadruple Aim.

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Nudging Patients to Use EHRs: Moving Toward a Tipping Point for Consumer Health IT

Half of U.S. patients were offered online access to their health records by providers or insurers, and one-half of them accessed the EHR at least once in the last year.  One in four of those offered online EHR access looked at them more than 3 times.

It takes a good nudge from a provider to motivate a patient to access online medical records, found by ONC in their latest research into consumers’ use of EHRs detailed in Individuals’ use of online medical records and technology for health needs, the ONC Data Brief No. 40, published April 2018.

he concept of patients accessing EHRs is a health behavior change challenge: 63% of physicians whose providers encouraged them to look at the EHR did so; only 38% of patients with providers that did not encourage EHR access looked at their records.

So why don’t patients use online health records yet? 59% of those who do not say they just “don’t have a need” to use their online medical record.

Among those patients who do access their EHR, the most important data sought were lab test results (for 92% of those who accessed their EHR), current list of medications (79%), summaries of their office visit (76%), and a list of health/medical problems 70%. One-half of patients wanted to see their clinical notes, a growing demand that’s being nurtured by the OpenNotes project.

In terms of consumer health workflows, accessing the EHR is about “tests and tasks:” 85% looked to view test results, and 62% wanted to perform a health-related task like requesting prescription refills and making appointments online. (See the Hot Points, below, for how these patient life-flows are being met by innovative providers both inside and outside the healthcare system).

Health Populi’s Hot Points:  Designing for patient experience, that is user/consumer experience (UX/CX), is a key to inspiring people to engage in their health, which I wrote about yesterday here in Health Populi. I divulged that my favorite supermarket chain is Wegmans (who is not a client of THINK-Health). This morning in my inbox, I received news from the grocer (with whose emails I opt-in) shown in this graphic that I can receive text alerts from the pharmacy. The message: “Your prescription on your schedule!” [their exclamation point, not mine]

This reminded me of Dignity Health’s consumer-facing campaign marrying “online appointment scheduling” with their hashtag, #HelloHumankindness. These tech-enabled health tools allow patients to behave like the consumers they are in the rest of their lives, with good design, accessibility, and streamlined workflow designed into the tools. Oh, and did I mention empathy? That is, “your” prescription on “your” schedule, and “human kindness.”

It’s not enough to build an app or portal with all the facts, m’aam; design for the user’s values and value.

I leave you with one proviso which could be a barrier to patients engaging with digitized health information: in the wake of Facebook/Cambridge Analytica, there is a wake-up call for consumers to become more mindful about the security of their personal data online. On March 29, 2018, Under Armour’s announcement that about 150 million users of My Fitness Pal had their personal information breached in March is a specific consumer health wake-up call. My Fitness Pal is the most popular food tracking app on the market: I’ve been told by the founders that it could be the largest longitudinal health record of consumers, food, and weight loss in a single database.

The ONC study revealed that while a growing group of patients access their electronic health records, 1 in 4 patients did not do so due to privacy and security concerns. Baking in privacy by design must be the go-to strategy for health IT developers to bolster patient trust in their electronic health records. Finally, a re-imagination of what HIPAA should be in the era of Apple/Google/Facebook growth in health records is in order.

Verizon released its latest breach report, illustrating the continued and growing vulnerabilities of healthcare data. I clipped the detail from the report here, indicating the prime motive for breaching healthcare data was financial, and that risks are even greater via internal bad actors than external ones. Patients have plenty of reason to be concerned; the healthcare industry must work harder to build trust, policies and procedures, and secure tech into health data programs.

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Is It A “Thing” To Gift Dentist Services?

We all have someone in our lives that is great at giving gifts. Whether it’s the perfect birthday gift or just a “little something” to show they care, it’s obvious they have that special talent in picking out the right thing. 

 

For the rest of us who sift through pages on Amazon looking for something—or just anything—to give, we understand and can even commiserate with you. Thankfully, the holidays are still many months away, so you still have time to think creatively. 

 

Gifts that are experiences such as horseback riding lessons or a hot air balloon ride have risen (ha!) in popularity due to an increase in conscience consumerism. What’s more, giving gifts that help better someone’s life such as gym membership or food delivery certificates have also seen a surge in popularity. 

 

If you’re looking to reduce just giving “stuff,” then it might be time to consider out-of-the-box ideas like giving money towards Invisalign or tooth whitening treatments for those who have said they would want it. Since these gifts are on the personal side, though, allow us to walk you through when and how this type of gift is appropriate.  

 

Is this even a “thing?” 

 

Of course gifts toward dental services is a thing! However, it is important to know your audience when you choose to give teeth whitening treatments or contribute to orthodontic work. We recommend giving these gifts to close friends and family who have publicly expressed their desire for one of these services. This will eliminate any awkwardness for the person who receives the gift, and not contribute to any unintended insinuations of what you think about their appearance. 

 

In some instances, it might be prudent to speak to the person before purchasing the gift. Since the gift of a dental procedure can be expensive, knowing both what is needed and desired most (as well as the preferred provider if you choose to get a certificate) can be helpful in the process.  

 

Is this gift insulting? 

 

There is always the potential for the person who receives the gift to question your motives and end up feeling bad. However, that is why we suggest talking to the person prior to offering. For many people, a bad smile or unhealthy teeth might have prevented them from advancing in their careers or have resulted in a decrease in self-esteem. While some may see the offer of dental services as an attack on their physical appearance, many people would be honored to have the opportunity to have a bright, healthy smile. 

 

What are the benefits? 

 

The benefits to giving a gift like this are really endless. A good smile contributes to more professional and personal opportunities. Studies have shown that a good smile makes you seem more trustworthy and can lead to more job opportunities or growth in your field. As your confidence grows you will also smile more, strengthen connections, and advance professionally. In addition, both Invisalign and tooth whitening are noninvasive, so there’s no time required to recover, and results can be seen quickly. 

 

Giving the gift of dentistry is a great option for those closest to you. Talk to the person before making any purchases; but remember, this is one gift that is guaranteed to keep on giving. 

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What Would Healthcare Feel Like If It Acted Like Supermarkets – the 2018 Temkin Experience Ratings

U.S. consumers rank supermarkets, fast food chains, retailers, and banks as their top performing industries for experience according to the 2018 Temkin Experience Ratings.

Peoples’ experience with health plans rank at the bottom of the roster, on par with rental cars and TV/Internet service providers.

If there is any good news for health plans in this year’s Temkin Experience Ratings compared to the 2017 results, it’s at the margin of “very poor” performance: last year, health plans has the worst performance of any industry (with the bar to the furthest point on the left as “low scoring”). This year, it appears that auto dealers and airlines have fared worst on the very poor end of the customer experience spectrum.

Among the 14 health plans Temkin considered, Tricare earned the top place for customer experience in the industry. This top-ranked health plan was rated 184 out of 318 companies across the 20 industries in the overall study. Blue Cross Blue Shield of New Jersey ranked second among the plans. While BCBS of Florida had the greatest improvement over 2017, CIGNA dropped the most.

Health Populi’s Hot Points:  As an avid user of Temkin’s study each year, the research always prompts me to ask through the Health Populi lens: what would healthcare look and feel like if the best-performing supermarkets, retailers, and banks re-imagined the industry?

Consider Wegmans, which is my own favorite grocery store; I am fortunate to live within 15 minutes’ drive of four Wegmans stores in suburban Philadelphia, so I am spoiled by an embarrassment of foodie customer experience riches in my backyard. Spoiled, because for me, that experience has become a very high benchmark to which I compare other retail-facing experiences. Trader Joe’s and Aldi are also high on my list, for different reasons: eclectic, interesting food and high-value-for-money. These three stores ranked high on Temkin’s list, all in the top 15 overall.

For banking, it’s my TD Bank, which operates Sunday hours, has relatively lower fees, and a team-spirit mood when you enter the lobby.

So what would healthcare look and feel like if Wegmans and TD had their way with the industry?

Top-line, these companies’ service designs bake consumer respect into the mix: facets of that respect include good value, trained staff with positive attitudes, beautiful physical environments, and strong ties to local communities.

Furthermore, grocers and banks are playing growing roles in healthcare itself. Most consumers are seeking wellness and nutrition through food purchases, and financial wellness is bound up in overall perceptions of health. As patients take on more consumer workflows, we continue to seek solutions in our communities, and with organizations that can help us streamline our health and wellbeing. Most of the industry segments that have higher rankings in the Temkin study are already working adjacent to health/care. Industry can partner with them: consider telehealth at the grocery store, HSA fund management with a bank, medical tourism and wellness channeled through a favorite hotel chain, or prescription drugs delivered by, say, Amazon and the U.S. Postal Service.

On this note, it is timely that Temkin calls this the “Year of Humanity.” Here’s their video explaining this ethos based on three pillars: embrace diversity, extend compassion, and express appreciation.

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Can California afford a single payer system?

There have been a number of moves to try to move California towards a single payer system.  A single-payer bill, Senate Bill 562, was offered up last year.  Some Silicon Valley tech workers are trying to move voters towards a single payer system as well. The question is, can we afford it?

This is the question put forward by Richard Scheffler and co-authors in a recent Health Affairs blog.  They propose 7 initiatives that would save enough money to finance health care for all Californians.  Let’s take each of these in turn.

1. Increased use of global budgets/integrated care systems.  The key here is not the integrated care systems–as some can be more expensive and others less–but rather the issue of global budgets.  If you cap costs for each health system or pay a flat rate per person, clearly this is a great way to save costs.  This approach, however, is problematic in that often times adoption of innovative but expensive medications are delayed.  Also, if there were universal, but privately provided health insurance, insurers could try to design plans to avoid the sickest patients or intentionally provide low quality care to sick patients.  This is really the only point that matter–would people trade off increasing the number of people insured, with reduced access to medications among the insured, potentially longer wait times for care, and more ‘rationing’.  This is not an easy trade-off to make.
2. Increased use of palliative care.  This will be difficult to implement.  While I am supportive of palliative care, many patients in the U.S. prefer medical interventions.  Educating patients on the benefits of palliative care are useful, but are Americans really going to change behavior over night?  Or will this end up denying very sick, chronically ill patients they care they request.  Further, the cost savings here are small, only about 5% of the costs savings from initiative #1.
3. Increased use of patient-centered medical homes (PCMHs). There is some evidence that PCMH’s improve health and save money.  The question, is how much money?  The answer likely is not much.  One study found that PCMH’s saved about $10 per patient per month.  A systematic literature review found that PCMH’s reduced ED visits, but had not change on hospitalizations or overall cost.  I would suspect that elite PCMHs are able to improve quality and reduce cost but for the average PCMH this is not the case.
4. increased rates of physical activity.  Fantastic idea.  Low cost from the payer perspective. It is somewhat costly–in time, but not necessarily money–from the patients perspective.  However, there have been so many initiatives to imporve physicial activity, it is not clear that any promised behavioral change towards more healthy habits would happen in practice.
5. Increased use of nurse practitioners and physician assistants.  This is a good idea.  This approach would sacrifice quality for cost. However, if NPs and PAs can supplement physicians and provide patients with more time, it could be quality enhancing.
6. Reductions in healthcare associated infections.  Clearly a good idea, but the question is through what mechanism would this occur (that has not yet been tried) that would result in significant cost savings.
7. Reductions in pre-term births.  To repeat #6, this is clearly a good idea, but the question is through what mechanism would this occur (that has not yet been tried) that would result in significant cost savings.

In short, while the proposal has some wise recommendations, these recommendations are largely known by providers so the key is implementation.  In practice, affording a single payer system likely would come down to a grand bargain where Californians would need to be willing to trade their current health insurance system for one where expenditures operate under a global budget.  Done right, global budgets could improve efficiency and expand access to all.  Done wrong, the sickest patients my have reduced access to care, physician wait times may increase, and patient choice may dwindle.

There is a whole separate issue of how single payer would operate.  Would the state pay private insurers to implement this?  Would the California Medicaid program administer all health insurance in California? How much regulation of prices and scope of work would California have.   These questions would need to be resolved as well, but are solvable.  The fundamental issue is whether Californians would accept more “rationing” by their health insurance to expand coverage.  Only time will tell on this issue.

Can California afford a single payer system? posted first on http://dentistfortworth.blogspot.com

Investment, information and death

An interesting piece on death and mourning in modern compared to more traditional cultures from the Oxford University Press (OUP) blog.

Human relationships require huge investments and generate massive benefits, and we are not willing to let go of them unless we have unequivocal evidence that the person is dead…It is now generally accepted in the clinical literature that long-term outcomes are better for those who view the body of a loved one, as doing so is thought to help people come to terms with the death. Naturalistic data suggests that even in traumatic circumstances, viewing the body of a loved one may increase anxiety and distress in the short term, but is associated with less distress in the longer term. Conversely, not seeing the body is associated with more difficult, prolonged grief. Health care professionals often observe that spending time both viewing and touching the body of a deceased loved one is conducive to better outcomes. Grief is one of the most intensely stressful experiences faced by humans and modern practices may be retarding the process.

I particularly like the analogy of relationships as an investment.  If you are interested, this article shares some other burial practices from around the world.

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