8 Things CFOs Must Know About Health Reform

Whether a Chief Financial Officer is running the fiscal operations of a hospital system, an insurance company or a company that simply employs individuals with health coverage, the decision-making process for sustainability is changing at a rapid pace. However, after years of hearing about reformation in the health system, broad, sweeping and revolutionary changes are finally happening. Major shifts are also occurring in the population, as well as technological advances that will disrupt the entire premise of a four-walled institution for care and the very model we use for health delivery.

Health care in the US is a business – a multi-billion dollar business – and understanding the financial implications of health reform will make or break every CFO. Knowing that health access, demand, quality and payment changes are inevitable there is an immediate need for CFOs across the ecosystems to embrace and plan for transformation.

1. You have too many beds.
   While many hospital leaders won’t accept this at face value due to lengthy wait times, surgical demands and desire to shift beds, the truth is there are too many beds in a lot of hospitals. Between transferals to the outpatient setting and telemedicine, the need for expensive inpatient beds is declining. Additionally, hospital leadership are increasingly finding that they face problems with state authorities when they apply to move beds. Most recently at the University of Chicago, where 338 beds were being used for a 304-person utilization pattern, the state rejected a University application to move surgical beds.
2. Food, housing and transportation of patients is your problem.
   As Americans begin to define and attempt to tackle community and population-based care, the access individuals have to quality food, affordable housing and efficient transit matter.  No one living in a food desert will have the same health outcomes as someone living next door to a Whole Foods, just as an individual with a new car will always be more consistent in making appointments and picking up prescriptions than someone who has to access three public transit buses for the same activities. Real patient engagement and activation begins with understanding the environment of each patient.
3. Your patient demographics are shifting, and so too should your leaderships. As the US continues to brown, hospital leadership must be representative of the population to understand and meet need. At a recent Modern Healthcare Top 25 Minority Executives session, an awardee remarked that the United States is now a country of minorities, and “our leadership as minorities is our future for health outcomes.” With this in mind, it is inevitable and paramount to success that the leadership of any organization resembles and represents those it serves, so it makes the financial investments and decisions that influence the community.
4. More bodies in beds will never work again.
   Value-based purchasing means that a warm body in a bed not only drives costs higher for the payer, but that the longer a patient remains in the hospital – or the more often they return – the more penalties that accrue. Therefore, the goal should not be for more bodies, but for cost-effective bodies. Depending on the community serviced, this can mean desire for more Masters Athletes, specialized services or elective services. Additionally, as we shift to a world where technology enables more clinical procedures and recovery to be done in the outpatient setting, or at home, and expensive inpatient procedures decrease in volume and reimbursements, hoping to fill beds is futile.
5. Alignment with physicians is nonnegotiable.
   No leader can effectively attain a goal without buy in from those who carry out the work.  However, it is important to be aware that “physician alignment” is a term that causes almost all physicians to turn and walk the other direction out of fear that this indicates buying their autonomy and dictating their day-to-day, moment-to-moment ability to practice. According to Healthcare Financial News the implications of physician behavior are so important in 2014 that more revenue than ever will be spent recruiting physicians who see the world the same way you do, which is not very different from how corporation CFOs think about their employee hires.
6. As consumers take on more and more pay responsibility, unexpected payment shifts will keep occurring.
   Many experts estimate that defined contribution, health insurance exchanges and the growing individual health insurance market means that patients will become more informed about spending their health care dollars, and therefore, more unwilling to spend. The future of reimbursements and pricing strategies is presently a puzzle wrapped in an enigma because of extreme uncertainty. However, it is general knowledge that Medicare and Medicaid reimbursements are going to continue decreasing, with the American Hospital Association and Moody’s already estimating an, “unequivocally negative” outlook for hospitals on the reimbursement fronts.
7. Technology and data utilization can save you money.
   While the learning curve with new technology can be excruciating and the meaningful utilization of collected information seems daunting, everything from workflow to health activities and employee/patient engagement can be monitored – and altered in real time – using new technology. Moreover, the more information that is known today, the better predictive analytics and behavioral change that can be made tomorrow. However, as the amount of technology available to leadership continues to grow exponentially, the purchasing of new tech will be a balancing act between what is a passing fad versus what is sustainable and transferable.
8. Your EHR is going to cost you. Big time.
   Now this seems obvious to most hospital CFOs, as they have already seen the initial price tags that come with implementing a “holistic” electronic system. However, the most costly elements may not yet be realized. As mergers and acquisitions continue, technology advances and EHR capabilities increase, the need to refresh systems will continue.  At present there is not one system that meets end-to-end patient or provider needs, leaving the ecosystem open for further disruption, which inherently includes more interoperability, more upgrades, more plugins and more costs.

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10 Things Hospital Leadership Need To Know About Social Media And Marketing

Building any brand can be difficult, but in the US, hospital identity and branding are paramount to success within a community. By listening to patients, getting feedback on wants and needs, engaging individuals and creating new incentives, a better reputation, greater trust and improved health outcomes can all be achieved.

Below are 10 things hospital leadership should keep in mind when thinking about marketing and strategy in 2014 and beyond. 

1. In 2013, it was estimated that 62% of emails were opened on a mobile device. Checking email is the top mobile activity among smartphone and tablet users. More people in the world own a mobile device than a toothbrush, so using email to inform patients about new services, community events and preventative care tactics is a must.
2. The brain processes visual data 60,000 times faster than text. Additionally, 90% of information transmitted to the brain is visual. Whether it’s growing your brand identity or improving medication adherence through visual instructions, images are key to interacting with, informing and empowering patients.
3. Surprisingly, Grandparents are the fastest growing demographic on Twitter.  Not only does this indicate that it is here to stay as a social media platform, but it’s a great place to target our aging population who consume the majority of our health services.
4. In 2014, more than 50% of Internet users, or 102.5 million people in the US, will redeem a digital coupon. There are many new partnerships with retail clinics, pharma companies and other service providers that can use coupon-like strategies for patient cost-savings and adherence.
5. The number of devices connected to the Internet now exceeds the number of humans on earth.  So don’t forget to market on multiple platforms and for many different devices. Top sites include Twitter, Facebook, Pinterest and Instagram.
6. Social media influences 93% of shoppers final purchase decisions. Further, 90% of consumers indicate that they trust peer recommendations. Therefore, previous patients are your greatest allies. Their reviews online matter more than you think.
7. More than 78% of US Internet users research products and services online, and every month, there are more than 10.3 billion Google searches, with most people clicking one of the top four links. What your top hits say about your organization, your providers and your quality of care can influence your bottom line.
8. Targeted, content marketing costs 62% less than traditional marketing, and, per dollar spent generates about 3 times as many leads. When creating a marketing strategy for a particular service line, service, or physician group, think about exactly who needs to see what ad and what information they will be looking for.
9. Consumers that receive email newsletters from companies spend 82% more with those companies. Think about what that says for brand loyalty following engagement, and about the ability of constant, relevant engagement. Patients are consumers, and like email, newsletters keep them informed.
10. 70% of people surveyed claim they would rather learn about a hospital or company through articles rather than direct advertisements. Therefore, not only are advertising campaigns important, but so are the patient experience testimonies, community reviews and Forbes articles that highlight the work being done inside and outside of your hospital.

 

Global Study Finds Majority Believe Traditional Hospitals Will Be Obsolete In The Near Future

A global study was released at the new year by the Intel Corporation indicating that around the world people’s health care wants and needs are principally focused on technology and personalization. The “Intel Health Innovation Barometer” found a consistent theme: customized care. At the intersection of health, care and technology, communities around the world consistently said they wanted to see their biological makeup and individual behaviors used to make receiving care more effective and efficient. This unsurprisingly was described by people through means such as telehealth, mobile health and the sharing of health information in real time. However, surprising methods of care were also common themes throughout the world such as ingestible monitoring systems and care that involves no utilization of hospitals.

Eric Dishman, Intel Fellow and Global General Manager of Health & Life Sciences at the company says the findings indicate that, “workflow, policy and culturally focused care are the most important ways we can improve health care.” Making care convenient, universally available and efficient through technological innovation is seen as more promising around the world than increasing the number of physicians or funding more academic research.

According to Senator Ron Wyden (D-Oregon), “People always talk about disruptors in terms of various kinds of practices in the American economy,” but “there’s nobody who’s done more disruption for the right reason than Eric Dishman.” With that kind of support to understand and advance the health care system, the Intel Health Innovation Barometer was conducted online by Penn Schoen Berland in Brazil, China, France, India, Indonesia, Italy, Japan and the United States. It was conducted among a representative sample of 12,000 adults aged 18 and older with a margin of error of +/- 0.89 percentage points.

Surprising Findings:

–       Traditional hospitals, according to 57% of people, will be obsolete in the future

–       Majority of people (84%) would be willing to share their personal health information to advance and lower costs in the health care system

–       More than 70% of people are receptive to using toilet sensors, prescription bottle sensors and swallowed health monitors

–       72% of those surveyed would be willing to see a doctor via video conference for non-urgent appointments

–       66% of people say they would prefer a care regimen that is designed specifically for them based on their genetic profile or biology

–       More than half of people (53%) would trust a test they personally administered as much or more than if that same test was performed by a doctor

–       About 30% of people would trust themselves to perform their own ultrasound

While wearable monitoring devices are commonly accepted in the US, global readiness for ingestible and sensory systems far exceeds that of Americans.  Acceptance of non-hospital care is also more appealing to those living outside the US. In remote areas of India, for example, extremely high percentages of people said that there is no need for traditional hospitalization.

Although in the US, a growing desire to care for the elderly at home gives hope to Eric Dishman that there could soon come a day that hospitals are obsolete. He cites changes in care seeking behaviors, policy and payment reform as incentives to move away from traditional hospitalization care. “The moment you signal pay for performance, people start thinking about how we misuse hospitals every single day,” says Dishman. That misuse of hospitalizations, and lack of formal hospitals in other countries, contributes greatly to the number of individuals worldwide who think the archaic system is not sustainable in the future.

Emerging Technologies For Innovation

Intel has been doing qualitative and quantitative research around the health care industry for many years. To date, the Intel Barometer is the most extensive survey it has conducted, and did reveal shifts in people’s increased desire to have access to emerging personal technology tools to become more active members of their care team.

Specifically, the Intel R&D teams are using ideology like Dishman’s to seek clarity and recognition of health advancements that unburden people from having to travel to a health care provider. “Care must occur at the home as the default model,” says Dishman. “It was also interesting,” he says of the survey, “to see people in emerging markets such as Brazil, China and India trusted themselves to use health monitoring technologies more than those in more technologically advanced economies like Japan and the United States.

Intel’s team of ethnographers used research in more than 1,000 homes and more than 250 hospitals across 20 countries to better understand the everyday lives of people, including those receiving and giving care.

The technologies that Intel’s survey received novel feedback on include items such as wearable and ingestible monitoring systems. While these hi-tech possibilities are new to all markets, the potential benefits could be felt across the entire health care arena as more thorough and patient-centered data is collected, driven by patient approval and demand.

Eric Dishman’s Personal Mission

In his pursuit of better health care technologies and home health care, Eric Dishman has been driven primarily from his in depth involvement with the health care system. As a student at the University of North Carolina, Dishman was told that he had months to live due to a rare kidney disease. Over twenty years later he has received a new kidney from a colleague at Intel thanks to sequencing his genes and finding that his diagnosis had been wrong his entire life.

Further, his grandmother’s progression of Alzheimer’s Disease drove his pursuit of innovation to keep her safe in her own home.  He found that keeping her health and dignity was a group effort. According to him, “Improving health care is a team effort, including patients and their families. Intel’s research shows that when people see benefits for them and their wider community, they are open to sharing sensitive information in an anonymous way.”

His approach seems to be gaining support based on the Health Innovation Barometer, which found that a higher percentage of people (47%) were willing to share their personal health records than their phone records (38%) or banking records (30%) to aid innovation.

If Dishman and Intel have their way, the new survey will move them to the head of the class by proving to health care leaders around the globe that massive disruption to the health care system is possible and supported by the large community. Smart devices that can connect patients and care givers in their home can lead to all kinds of health and policy change. Payment reform, independence and equal access might all be possible in the near future if individuals around the world are willing to use their own bodies and surroundings to educate and innovate the larger system.

 

NFL Players Host Concussion Summit Week Before Super Bowl, Despite Ongoing Litigation

Real innovation is often driven by those who think outside the box; those who take the obvious and make it an actionable reality. The week leading up to Super Bowl XLVIII, a group of entrepreneurs created a unique and transformative meeting of the minds. At the Coalition for Concussion Summit (#C4CT), Brewer Sports International and Amarantus BioScience Holdings, Inc. joined forces at the United Nations’ (UN) New York headquarters to bring scientists, biotech companies and professional athletes together, with the goal of building awareness and advancing scientific and medical opportunities for traumatic brain injury (TBI), chronic traumatic encephalopathy (CTE) and concussions. Add in the weight of immediate policy implications of the National Football League facing litigation for not properly informing or protecting players and Northwestern University’s football team attempting to unionize in hopes of improving athlete’s rights, and a perfect storm is created to demand change. Collectively, the week of the Super Bowl developed into an ideal time, location and platform for changing standards of health care and promoting developments in mental medical care that are patient-centric.

NFL Litigation

In the months preceding the 2014 Super Bowl, the NFL and the NFL Players Association (NFLPA) found themselves in a heated battle over the allegations that the NFL withheld information from the players about the depth and breadth of research indicating that concussions, memory loss and memory deterioration are linked. The NFL has since agreed to a $765 million settlement, which was recently denied by Judge Anita Brody who claims that the in the suit, “not all retired NFL football players who ultimately receive a qualifying diagnosis, or their related claimants, will be paid.”

While that decision is pending, more lawsuits are beginning to surface from individual players. Last Tuesday, former Detroit Lions running back Jahvid Best sued the NFL and helmet maker Riddell, claiming that concussion problems contributed to ending his career early

However, according to Robert Griffith, a 13-year veteran of the league, it doesn’t take a career-ending hit to significantly impact long-term functioning. “Guys suffer the same symptoms even after a few years in the league, including, sleep deprivation, depression, mood swings, addictions and self worth problems.”

The same week of the Super Bowl, the Northwestern University football team also dropped a bomb on the sports world, despite efforts from the National Collegiate Athletic Association (NCAA) to curb player concussions. The team wants to change the way university’s view, treat and educate student athletes, claiming more players’ rights are needed. This comes in tandem with a more than two-year long effort by several college players to sue the NCAA for failing to protect student athletes from concussions. An irony, pointed out by Chris Nowinski, author and former professional wrestler with World Wrestling Entertainment (WWE), who noted that “We have pitch counts for shoulders, even in high school, but we don’t have hit counts.”

Health Policy at the Forefront

When the NFL, the United States’ most powerful sports league, is on the hot seat for neglecting players’ mental and physical health, it is only a matter of time before public outrage requires policy change. Not only does the NFL itself have the ability to change health policy for the better, but the trickle down impact could save many young athletes around the country the trauma that current and past players have suffered.

Ultimately, a new standard of care is possible in the near future. Because, as Jermichael Finley told me, “100% or 50%, it doesn’t matter how one steps on the field. It isn’t if you get hurt, it’s when you’ll get hurt.” Further, as one conference goer attested, “We are speaking on the floor of the United Nations about brain trauma. This has never before been possible.”

With that in mind, researchers and clinicians such as Andrew Maas, MD, PhD, Robert Stern, PhD, Kim Heidenreich, PhD and Jay Clugston, MD came together with patients and biotech companies to discuss the current state of trauma, neuroscience, degenerative diseases, sports medicine and public policy.

Meeting Of The Minds

Despite the exorbitant power of the NFL, surprisingly little has been done to advance the conversation between athletes and the scientists who work diligently to understand and protect our brains. Until now.

As the nation’s best football players ascended upon New York and New Jersey, Brewer Sports International and Amarantus BioScience Holdings, Inc. gathered a room full of athletes and scientists to educate one another and discuss the real world of traumatic brain injury, concussions and memory loss.

“As a former NFL player, I am passionate about making strides to improve the health and safety of my fellow professional athletes, both former and current,” said Jack Brewer, CEO of Brewer Sports International. “Instead of pointing fingers, we have put together a world class panel of researchers to discuss TBI-induced neurodegeneration and CTE with those directly affected by and equally passionate about the cause as we strive to enhance awareness and work to find viable treatments.”

Gerald Commissiong, President and CEO of Amarantus reinforced the originality of the idea saying that, “The true innovation in #C4CT lies in bringing all of the stakeholders on the concussion issue into one forum. Conferences that are medical in nature almost always overlook key groups such as patients, caregivers and advocates. By allowing patients to be part of the process, we are creating a paradigm shift that we hope will galvanise the broader community into action.”

Brain Function

Despite Super Bowl caliber athletes having athletic abilities that are superior to most, the brains and vulnerabilities of these athletes are comparable to all others. The impact of one hard hit or one concussion can disrupt brain function forever. A point that resonates with Mixed Martial Arts (MMA) fighters as well. Just yesterday, boxing rivals met on Capitol Hill with Senators to support efforts of the Cleveland Clinic in studying brain health. They were backed by more than 400 of their peers who wanted to maintain their profession, but ensure that the future is brighter for other athletes.

Even veteran players such as Clinton Portis assert that he does not have regrets about his career but that he, “will not let my sons play contact football until at least high school,” due to the limited research that exists on TBI and concussions.

Those downstream effects, many at the summit contend, are highly linked to neurodegeneration, memory loss and long-term functioning. However, this is exceptionally hard to prove given how hard apples-to-apples comparisons are of brain damage and functioning. This association is further limited by the ability to compare impact enumeration and force due to the small sample size that are athletes.

Events such as the Coalition for Concussions Summit are becoming imperative to change health policy. When organizations, individuals, researchers and policymakers cannot fight the battle alone, it takes a meeting of the minds to advance a message. Hopefully, assembling key stakeholders to address health care problems will become a norm to improve health and care in the US.

 

Mental Health Loses Funding As Government Continues Shutdown

In the months leading up to World Mental Health Day, DC has been shaken by a series of violent events that ended with innocent lives lost and our country’s mental health services called into question. During this same time period, Washington, DC has been consumed by a government shutdown, with lawmakers and policymakers trying to determine how to rein in our country’s financial burdens and overspending. Unfortunately, as federal and state governments look to cut budgets at every turn, mental and behavioral health services are often on the chopping block first. Financial cuts, compounded with US stigma often applied to mental health troubles and disparate access to services across the county, mean that those who need services most are often those left without proper care.

August though October brought DC into the spotlight for many reasons, the saddest of which is the violence that was covered by mass media as two shootings occurred. In one case, Aaron Alexis, a 34-year-old, perpetrated a mass shooting that left 12 people dead, in Washington’s Navy Yard. Previous to the shooting, it was reported that Mr. Alexis was treated at the VA for mental health issues including sleep disorders and paranoia, but had not lost clearance.

Miriam Carey, also 34, reportedly had an unhealthy obsession with the White House when she drove her car into the White House gates and led police on a chase around DC before being killed. Although she had no reported psychosis or supposed violent intent, it was noted in the months leading up to the incident she believed that the President had beenstalking her and might have suffered from postpartum depression. When killed by authorities on Pennsylvania Avenue, she had her 18-month-old child in the car.

Budget Cuts

Although societal stigma and knowledge of where to access behavioral and mental services are often barriers to care, budget cuts continue to make seeking care more difficult. Whether this be through decreases in available services, lack of providers due to poor reimbursements or less preventative actions in communities, the impact of mental health funding shortages is great. According to the National Alliance on Mental Illness, “increasingly, emergency rooms, homeless shelters and jails are struggling with the effects of people falling through the cracks due to lack of needed mental health services and supports.”

In the last five years, significant budget cuts have befallen mental health programs and services. From 2009 to 2011, states cut mental health budgets by a combined $4 billion- the largest single combined reduction to mental health spending since de-institutionalization in the 1970s. In Chicago alone, state budget cuts combined with reductions in county and city mental health services led to shutting six of the city’s 12 mental health clinics. These closures, along with other public and private center closures in Chicago, have eliminated vitally needed services, especially on the south and west sides where they are indispensable.

Threats of sequestration in 2013 had a significant impact on people’s ability to access mental health services and programs, including children’s mental health services, suicide prevention programs, homeless outreach programs, substance abuse treatment programs, housing and employment assistance, health research, and virtually every type of public mental health support. The Substance Abuse and Mental Health Services Administration(SAMHSA) claimed it alone would be cutting $168 million from its 2013 spending, including areduction of $83.1 million in grants for substance abuse treatment programs.

Consequences

Despite the need to balance budget and make all health care services more efficient, many argue that society has better long-term outcomes if more federal and state dollars are allocated to mental and behavioral health care. This includes preventative services as well as mental health testing and treatment.

Because individuals with untreated mental illness often find themselves in emergency rooms, homeless shelters and prisons, the societal cost of prevention and treatment may be exponentially less than funding those other outlets and catchment areas. This is especially true in the case of children, who face cycling in and out of the system throughout their lives if left untreated.

These costs can be exceptionally large over the lifetime given that the National Institute of Mental Health (NIMH) estimates that two-thirds of children with lifetime mental health problems never receive treatment. This takes substantial emotional and financial tolls on individuals and families, as well as the broader society. However, programs that address the mental health needs and provide services for youth show better outcomes in health and education that carry over the lifetime. For example, in the University of Chicago’s Crime Lab, therapy is being used to curb youth violence, especially amongst those with behavioral and mental health care needs.

Additionally staining on the mental health care system is that during times of recession and budget cuts the caseload for mental health actually increases. It has been estimated that during this most recent recession, the caseload of community mental health services alone has increased almost 50 percent. This increase has most notably been seen in the Native American community, where suicide prevention is an essential part of the cultural health care demands.

Everyone Benefits

The NIMH contends that one in 17 people suffer from a “seriously debilitating mental illness,” we as a society are accountable for ensuring that those in need have resources for care. Not only does access to quality mental and behavioral health care ensure that individuals are being properly treated, but that America as a whole saves money and resources caring for those in need in other, more expensive settings. It may further prevent violent acts like those in DC from happing.

On this World Mental Health day think about the ways in which access to and support of mental and behavioral health care can be improved in your community.

 

President Obama Fails To Explain Tech Glitches And Solutions In ACA Speech

Monday at 11:30am EST, President Obama spoke in the Rose Garden about the recent troubles with health insurance exchange enrollment and websites. With a team of young people standing behind him and Janice Baker at his side, the first person in the state of Delaware to successfully enroll in the exchange, President Obama said he was speaking to every American wanting to get affordable health insurance. He claimed that in the last three weeks, despite the horrific technological problems with the websites, that “half a million consumers across the country have submitted application through federal and state marketplaces.” He further touted that the “federal site alone has been visited 20,000,000 times” in the last three weeks. Unfortunately for those American’s who are really interested in signing up on the exchange sites, he glossed over the depth and breadth of the current troubles, giving a speech that sounded more like a State of the Union address with small-business examples and reading letters written to the White House.

President Obama also alleged that no one wants to see the exchange sites improve more than the federal government, noting that, “the website has been to slow, and people have been getting stuck during the process.” He also said that it is the mission of the administration to make them “more better,” with visible cringing from the audience, but claimed failures were due to response rates. He said the public response was “overwhelming, which has aggravated the underlying problems.”

However, he failed to go any further to explain what those other underlying problems were or when specifically they will be fixed. He did say that while HHS and contractors such as CGI Federal are working out the “kinks,” American’s should be patient. He claimed that “if the product is good, [American people] are willing to be patient,” suggesting that there will not be a delay for the individual mandate.

Nevertheless, he followed this by assuring the public that unlike Black Friday sales, the insurance plans will not run out like purchasing a new PlayStation – adding to the list of items the administration has compared exchange sites to, including iPhones and travel websites.

Despite his promises of improvements and putting the “best and brightest” on the job, CNN and other sites have insisted that the inherent technological and platform problems with Healthcare.gov will not be resolved anytime soon. This begs the question, that if the federal government is now searching for the best and brightest to correct the estimated 5,000-5,000,000+ lines of coding that need to be fixed on the federal site alone, who was working on the original platforms?

As he continued his speech, the President reminded the American public that although the websites for enrollment are not as, “quick, consistent or efficient as we want,” that the exchange sites are far more than “just a website.” He noted that many pieces of the Affordable Care Act (ACA) are already in place and being utilized by millions of Americans. He addressed pre-existing conditions, youth under the age of 26 and several other provisions that are already being rolled out by federal law, and the successes they have seen there.

He noted more examples of ACA triumph in Oregon, where he maintained that the exchange, “has cut the number of uninsured people by 10% in three week,” which is about “56,000 more Americans” with health insurance coverage.

During the speech, President Obama also tried to clarify the exchanges or marketplaces by describing them to the public as becoming part of a “big group plan… that bargains on your behalf for the best deal in health care.” He said that by doing so, insurance companies have created new products and options that strengthen market forces, leading to better deals.

He went on to say that without a doubt, “prices have come down,” further claiming that “when you add the next tax credits (those not yet implemented)… then the prices come down even further.”

The President rounded out his talk by noting the Republican party’s opposition to the ACA and how willing they were to “shut down the global economy” to fight against the ACA. A move, he claimed, that shows just how unwilling Republicans are to negotiate on legislation intended to, “free families from the pervasive fear that one illness one injury will cost you everything.”

While that may be the goal of the Affordable Care Act, the underlying technological and coding problems may prove to make that impossible.

 

Lasting Effects: Health Impact On First Responders

September 14

The days after September 11^th, 2001, the city of New York was enveloped in a blanket of ash. Rescue workers spent hours, days, even months without rest sorting through rubble and dust, exposing themselves to all kinds of physical dangers. These images are well documented in newspapers, television images and museums. But the haunting images from the aftermath, including the one of firemen I keep in my kitchen, do not tell the ongoing story of the men and women who risked their lives, physical health and mental health to dig the magnificent city out of the ash.

Despite the immediate coverage of heroism for the country’s rescue workers, very few have taken time in the last 12 years to fully research the physical and mental toll taken on those individuals that risked their lives on September 12^thand the following days. According to the City’s Department of Mental and Physical Hygiene “thousands of individuals—including rescue, recovery and cleanup workers and people who lived, worked or went to school in Lower Manhattan on September 11^th—have developed chronic, and often co-occurring, mental and physical health conditions.”

Understanding The Impact

Most of what is known about the issues affecting thousands of domestic and international rescuers has been collected by the New York City HealthDepartment’s World Trade Center Health Registry. This Registry, which allows health professionals to track and investigate illnesses and recovery related to September 11^th also helps create guidelines that can save lives and reduce injuries in future disasters.Dr. Robert Gillio, who is significantly responsible for its creation claims that, “The Registry was not part of any preplanning. Nor was the care of the New York Police Department (NYPD) or construction volunteers. I got a panicked call from someone that knew I had developed a middle school lab kit enabled laptop with curricula for how to measure heart and lung function and learn how to protect them. It was something I created for my four daughters to make health and science education more interesting.”

Following that creation, Dr. Gillio says, “When I joined up with a team of volunteers screening NYPD officers, this early telemedicine app was used to create health records. We had the presence of mind to realize the vast differences in the levels of exposure and decided to create questionnaires for what is called risk stratification.”

From that point forward the Registry has providedguidelines for domestic and international health care providers to care for those who volunteered in the aftermath of September 11^th by creating flow charts, tracking systems and symptom coordination for individuals who may be experiencing conditions related to World Trade Center exposures. The database has collected information on more than 70,000 people over a decade and includes not just the official heroes of September 2001, the NYPD and the Fire Department of New York (FDNY), but also the volunteer and paid professionals that tended to health care at the site, search and rescue teams, demolition and hauling teams, those who cleaned apartments and residents that moved back into the neighborhoods.

First Responders

All of these individuals took health-related risks, risks that are hard for many of us to understand, but none more so than the first responders. I certainly would not be one to run straight into the face of danger, despite that being in my genes. Growing up in a family of firemen meant that we came to terms early on that loved ones would risk their lives to save others. However, the honor and pride these men have shown throughout our lives often leaves us in fear. My admiration for my Father’s inherent need to help others gave way at times to fears of losing my hero to saving the lives of others buried in ashes. When asked why he chose to become a fireman, my dad, Rodney Fender, humbly said, “It’s just who I am. I want to help people.” He went on to describe the feeling that overcame him as a fireman, the one to rush into danger, saying his logical reaction to the call was, “How the hell do I get in there, and how do I get them out safely.” His immediate response has never been to think about himself above others.

When asked about this innate desire to risk oneself, it became clear that my father, like many rescuers simply react in a way that brings out the best in human nature. A mentality of our heroes following September 11^th, who were still there working through the ash and rubble, was best summed up by my grandfather, Michael Fender, also a fireman who said, “It’s just your job as a person to help other people.” He went on to explain that first responders have a mindset like his, “You do what you can, when you can, how you can. That’s just how we work.”

Lifelong Effects

September 11^th was a day that changed American lives forever, one that shook our faith in humanity to its core. Like all US Citizens, mental health and safety were altered in significant ways during that time of fear. For the rescue workers though, the risks of danger did not end with the last plane crash or the decision to go to war. For the first responders, volunteers and health care professionals and researchers, September 12^th marked another day to face physical and mental health risks to save the lives of others.

The image of an ash covered park in New York City with firemen working tirelessly in the background has been in my kitchen for many years, and serves as a daily reminder to the resiliency of this country, its citizens, and especially its heroes. Although their images are almost invisible in that photograph due to the devastation surrounding them, they are there, digging the city out of the rubble and piecing the lives of others back together.

In a similar vein, Dr. Gillio sat down soon after the attacks to write Lessons Learned at Ground Zero, an essay to, “Help explain to my daughters why mom and dad were away at Ground Zero when planes were falling out of the sky near us in PA. That book found its way to the White House and lead to a request for participation in a series of discussions there regarding the role of the average person or local organization in disaster preparedness, response and recovery. Those lessons in 2001 changed my career from one that treated preventable disease to one that finds ways to discover who is at risk and to intervene to prevent a chronic disease or acute injury and to empower the individual to be the health hero for themselves and their community.”

His message, and that of my father and grandfather, is correct. The terrorist attacks in 2001 changed American life forever. But as health care experts, providers, researchers, policymakers and first responders, it is our duty to take the lessons we learned from those horrific days, weeks and months to build a better system of care. Our job is to use our skills and passions to improve our communities as a whole and prevent, as well as care for, one another as best we can.

For more information, the 2009 World Trade Center Health Registry Report and Findings can be found here: WTCHR.

 

Say Hi To Oscar: The New Company that May Change Health Insurance

In five weeks from now, the Patient Protection and Affordable Care Act (ACA) mandates the opening of health insurance exchanges around the country. At that time New Yorkers will be introduced to an innovative way of thinking about health care: Oscar. Three friends, and technology entrepreneurs, teamed up to do something that has been inconceivable to date—create a start-up health insurance company to take on conventional health insurers on the NY exchange. Oscar co-founders, Josh Kushner, Kevin Nazemi and Mario Schlosser, plan to change the health insurance industry through technological interfaces, telemedicine and real transparency. Their goal is to redesign insurance to be geared toward the user experience, to make patients seek out their insurer before their doctor.

Americans do not usually think of health insurance as an intimate part of the care process. When sick, individuals do not call their insurance company for care or support. The health insurance industry is considered confusing, at best. The ACA however, presents an opportunity for the reformation of health insurance as we know it, not because of its disappearance, but by making it an integral part of receiving quality care. According to one co-founder, “We want consumers to feel like they have a doctor in the family.” That family doctor he speaks of is Oscar.

Oscar will have one plan in each of the ACAs metal-tiered categories, and additional plan options for the Bronze and Silver tiers. Although Oscar will have some of the familiar pillars of the health care industry like co-pays and deductibles for in-person visits, it introduces new elements like free telemedicine, free generic drugs and online price comparisons. Oscar health insurance will pioneer “a consumer experience, not a processor of claims,” explained Nazemi, with the goal of simply guiding individuals through the complex health system in an integrative and safe way.

Customer Service: What Oscar Can Do For You

Through user experience, customer service and innovative care options, Oscar will attempt to expand the role of the health insurance company to a health services provider. Oscar is being developed not just to cover medical costs, but to be the primary place to get the medical assistance a patient needs at any time.

When Oscar opens on the New York insurance exchange on October 1^st, there will be a focus on function, ease of use and design. When a patient logs into HiOscar.com, he or she will want to keep using it like a new iPhone or laptop, or so the creators hope.

For frequent conditions or issues, patients will be able to find treatments right on the website and have 24/7 access to a physician through their unique partnership with the telemedicine company, TeleDoc. Additionally, the creators claim there will be no need to discuss prescription refills in-person with an expensive physician when a user can have “one-click refills” through a health records feed that resembles a Twitter timeline.

Oscar will also offer services at many hospitals and retail locations such as New York CVS CareMark. The partnership that Oscar and CVS have is so strong that CVS is building sites for Oscar. These added locations will serve as one method of addressing the physician deserts that exist in the state. The company also contends that Value Options is a strategic partner with the goal of making mental and behavioral health care more accessible for the newly insured.

Not everything will be brand new though. Oscar will offer several types of plans like traditional insurance companies, but the approach is slightly different. As Schlosser explains, “packages will be bundled like AT&T, which consumers are now accustomed to.” The intention is to eliminate many of the arcane rules of the insurance industry, which often frustrate patients and erode the customer service experience.

Schlosser tells a story of him, his wife and baby going to CVS in the fall of 2012 to get flu shots in New York City. Schlosser gets his shot, but when his wife goes for hers, she is rejected. The pharmacist explains that Mario’s insurance only covered one shot per 24 hours. Schlosser, who at the time was already working with Kushner and Nazemi on Oscar, explained that Oscar is designed specifically not to have such “Byzantine rules.”

Telemedicine: The Doctor Will See You Now

When describing key functions of their new company, Nazemi and Schlosser emphasize that telemedicine will be the method by which many of their objectives are accomplished. Although telemedicine has been around for a while, it has not been wildly popular with patients to date. Oscar hopes to change that feeling with new incentives, 24-hour online services and a sleek design.

The founders of Oscar claim that consumers will have access to a doctor by phone within 20 minutes of a request, with no co-pay. Perhaps the concept is not revolutionary, but if it works, the behavioral changes associated with seeking care could be seismic. Currently, not many patients log onto insurance carrier webpages before seeing a doctor, unless they are seeing if the doctor is in-network. Oscar, however, wants patients to start their care with the insurer, not just use it for payment submission.

Oscar also plans to have incentive programs such as the “10 for 10,” where patients will receive $10 for answering 10 questions about their health and preferences. The answers from those questions will then be used to establish proactive health care, as well as help the Oscar team make continual upgrades based on user preferences. For example, answers to the “10 for 10” might help create an outreach program for Diabetes patients where a registered nurse would come to the home, or the answers might inform web developers on how utilization could change in the future.

For added flexibility, Oscar asserts it will employ registered nurses and nurse practitioners to provide in-home follow-up services for patients if needed. In the case of new mothers, weekly visits to the home can be arranged if that is preferred over online interaction. Schlosser described his vision of this component as “integrating backwards,” where patients and providers interact in the settings they choose at the times they agree upon.

According to the creators, in addition to the partnership with TeleDoc, Oscar has already amassed some form of relationship with more than 83 hospitals in New York, hoping to make the telehealth to in-person relationship seamless.

Just How Transparent?

Transparency, the newest buzzword associated with the ACA, plays a dual role in the Oscar story. The availability of data drove Oscar’s operation and consumer focus, and has been an integral part of their ability to test their interface with government feedback. Schlosser describes tracking and analyzing years of medical claim data for entire episodes of care to help assess how technology and telemedicine may better treat patients. His go-to example relates to how many people use expensive physician time and technology for simple ailments like headaches, where large percentages of costs go to small percentages of patients.

Data analysis like Schlosser describes are only the beginning. As more medical data becomes available under the ACA, more and more relevant analyses will be conducted. The Oscar team is counting on this improved data to help them meet patient needs on the platform as well as potentially predict future health demands. Like their past Instagram endeavor, the group hopes to make data the backbone of sharing information.

Oscar’s creators were quick to stress that design and functionality are also deeply rooted in transparency. Schlosser explains that the interface will allow consumers to see price differences based on location, facility and desired services.

On Oscar, a user will supposedly be able to look up prices for doctors across the street from one another or shop for MRI pricing by facility. Schlosser boasts that patients will be able to view “heat maps of services and providers.” The question, however, of whether patients will actually log on to compare prices remains unanswered. Human behavior indicates that unless cost savings are passed on to the consumer, there is very little incentive to look for or care about alternatives.

Media Experts As Marketers

Oscar’s founders plan to target all uninsured in their market area. Based on Oscar’s innovative approach to insurance, and the creator’s unique backgrounds in social media, the marketing endeavor will surely be novel. Nazemi says that the approach to courting the uninsured will “include traditional and nontraditional forms of media,” with the ultimate goal being, “to win over every consumer.” This winning of the consumer, or patient, will include all of the feedback mechanisms and personal interaction that allow for real time updates to the company.

Although Oscar will be targeting the entire uninsured population in their New York market, it is likely that the young, healthy and social media savvy will be the easiest to penetrate with marketing materials. This population, however, has been of the greatest concern for the constructors of the ACA, and the reason the individual mandate exists. As time progresses we will see how Oscar uses its flexibility to attract and maintain a young and healthy population that is the least likely to pay for insurance.

Currently, the Oscar site is merely a welcome page and a list of open positions within the company. But, on October 1^st, the site will be fully functioning, possibly putting other sites and insurers to shame. It is certain, given its creative employee background, that the feel and design of Oscar will be more user friendly than the state-based or federal sites.

According to Schlosser, the idea for consumer usage is to have a site where, “like Google, you can come use Oscar. You can type in your issue and we will help you find the best solution.” He explained that the entire experience will be interactive.

When asked about their role or faith in the success of the ACA, the team commented that, “the ACA is a catalyst for what we’re doing.” And the creators hope that Oscar will become a catalyst for the rest of the health insurance industry to be more transparent. They claim Oscar will set the stage for new expectations and behaviors by consumers, and that people already know they deserve more from their health care system.

Whatever the success of Oscar in the early stages of the exchange market in New York, one thing is for certain; Oscar has the potential to cause much needed disruption to health insurance and health care.

You can say hello to Oscar at HiOscar.com

 

Near Absence Of Government In Health Reform: Lessons From Nepal

In the US, many health care woes are blamed on the federal or state government. Whether there is too little oversight and lack of transparency or too much interference and regulation, it seems that policy and politics often end up getting blamed for health care system troubles. But what happens when one lives in a country with no functioning government? As one of the poorest countries in the world, with little to no government structure, Nepal has learned that health-related needs depend on local communities as well as international aid. Despite the vast differences between our countries, we have a lot to learn from one another about the underserved, health and decreasing disparities in access and outcomes.

Even with Nepal’s reliance on foreign assistance and continual poor health rankings, the US could learn a lot about a return to local or “community care.” Those in developing countries like Nepal have no alternatives. With poor infrastructure, unpredictable electricity and heat, and mountainous geographic barriers, the people of Nepal depend on local leaders and village health providers to care for the country’s millions of people. While Americans grapple with government involvement in the health sector, the Nepalese are now well versed in the pros and cons of no government organization.

In contrast, the Nepalese are looking to their allies from the States to help facilitate safe and fair democratic elections by the end of 2013.

In Nepal, the Constituent Assembly functioned in place of Parliament for many years, until its dissolution in May of 2012, often leaving health decisions and progress at a standstill. The developing country, which sits in the Himalayas and is home to eight of the world’s ten tallest mountain ranges, ranks 157 on the World Health Organization’s overall 2013 human development index. Moreover, Nepal has recently emerged from a decade-long armed insurgency creating an environment of insecurity and conflict that has only intensified poverty.

At present, the average Nepali spends only 5% of their annual income on health-related needs. According to the US State Department, “Nepal is one of the poorest countries in the world … The country faces several medium- and long-term development challenges, including strained capacity in government, civil society and the private sector to drive the development agenda, high vulnerability to climate change and a massive youth bulge.” Although surprisingly, despite economic troubles, Nepal has used its international aid partners and community-based health structure to become one of very few countries in the world on target to meet several Millennium Development Goals (MDGs).

The immobility of government has lead to geographical pockets where resources are almost nonexistent and dependency on foreign aid is great. Both the State Department and the US Agency for International Development (USAID) are working diligently in the capitol of Kathmandu to create sustainable health care programs that foster education, improve health outcomes and promote financial independence. However, it is difficult to see vast improvements in health outcomes and health equality without an active role by the people’s own government.

One of the added difficulties for health advancement is the country’s overwhelming number of natural disasters. Nepal is one of the most disaster-prone countries on earth. Annually, people experience floods, landslides, droughts, epidemics and persistent seismic activity. Due to these extreme difficulties, in tandem with direct health efforts USAID has created programs unique to Nepal, like the Program for Enhancement of Emergency Response (PEER) which aims at improving education on how to appropriately carry out activities such as search and rescue efforts in collapsed buildings and reduce health risks during disasters.

In addition to USAID, there are several local and international organizations that concentrate on improving health in Nepal and meeting MDGs. One specific organization that has focused on health and care in rural areas for more than 20 years is Himalayan Healthcare, a non-profit organization that specializes in creating viable programs in regions where health posts go unstaffed and undersupplied by the local government. “Rural Nepal, almost universally, has mostly rudimentary health care services which are inadequate but still go a long way if caring village health providers are available,” says Anil Parajuli, Himalayan Healthcare’s co-founder and Nepal-based Program Coordinator.

Like many community health centers in the US, serving both rural and urban communities, the Himalayan Healthcare model is not based on one’s ability to pay. Their mission is to treat anyone regardless of his or her gender, sex, caste, profession, or ability to pay. The President of the Himalayan Healthcare’s Board, Dr. Robert McKersie, believes that the US and Nepal have a lot to learn from one another. He claims that what makes a community center successful in either country is, “having input from the local stakeholders from day number one. Before this can happen the providers have to be accepted by, and have legitimacy with, the stakeholders.”

Dr. McKersie contends this acceptance does not always come easily. “Many of these communities (both Nepalese and underserved communities in the States) have historically been used or misled by ‘outsiders’. The buy in process for us was health care. After Himalayan Healthcare proved itself, we were ‘invited’ to help with what became the other two tenets of our community development model, namely education and income generation.” He goes on to say that, “organizations in the States that have done good community medicine know this model of having the community members have a stake in their healthcare.”

With so many differences, yet so many similarities in our underserved populations, it is no wonder health care providers in the US and Nepal view one another as a source of knowledge and inspiration.

At present, the next scheduled elections in Nepal have been set for November 2013.

 

Health Inequality And Modern Day Slavery

“They never took me to the doctor when I was ill.” These are the words spoken by Merieme Mint Hamadi when asked about her life as a slave. Merieme, one of an estimated half a million people in Mauritania who are enslaved, lives in some of the world’s worst conditions. Her country, which has a population estimated to rival Chicago, was the last country in the world to make slavery a crime. However, since that 2007 law was passed – almost 150 years since Abraham Lincoln issued the Emancipation Proclamation in the US – only one person has been successfully prosecuted for owning another human in Mauritania. The health and human rights violations that exist there today have led to the UN ranking Mauritania at 155 out of 187 countries on its 2013 inequality-adjusted Human Development Index.

The UN estimated that in 2012 for every 100,000 live births in the country, 510 women die from pregnancy, with significant disparities between the death rates of Black slaves and Arab owners. Of even greater concern is that due to female slaves being forced to have children with owners, an estimated 71.3 births per 1,000 live births are to adolescents who suffer extreme mental and physical abuse. In John Sutter’s captivating CNN coverage of oppression, Slavery’s Last Stronghold, he reports that, “In Mauritania, the shackles of slavery are mental as well as physical.” He goes on to describe the political and societal methods through which the lighter-skinned Arabs maintain their ownership of the dark-skinned peoples.

Kevin Bales, an expert on modern day slavery, wrote in his book Disposable People that even if someone of bondage attempts to leave an owner, “for most, freedom means starvation.” He claims that because slaves are, “immediately recognizable by color, clothing and speech” they will not be given shelter or proper care by others. Further, Mr. Bales asserts that on the streets of Mauritania, “ there are already a good number of beggars, many of them disabled, to remind slaves of where they almost certainly end up” if they were to leave their masters.

“Mauritania is a country with scarce resources – including access to medical care. The health needs of slave owners come first in Mauritania; the health needs of slaves come last. Slave children are chronically malnourished. Slave women are frequently victims of sexual assault by their owners and the devastating health problems that result.” says Sean Tenner, Co-Founder of the Abolition Institute, an organization focused on ending Mauritanian slavery and a veteran of numerous public health campaigns.

Despite the country’s open system of ownership, to date, the US has not taken a stance against the practice. The country, located on the western fringe of the Sahara, is not densely populated, and therefore practices of the owners are not easily monitored by the government. Further, the country’s ruling elite makes no attempt to fight slavery, as they claim to the UN that slavery does not exist.

However, what is most surprising in 2013 is not the lack of Mauritanian action against their own traditions, but the lack of American recognition and action. At a time when the US tries to face its own challenges with inequality, health, human rights and foreign policy, it is saddening to know we also neglect others.

Mauritania is also deeply divided by access to basic human rights such as health. In 2000, it was estimated that only 37% of the country had access to safe drinking water and 33% to adequate sanitation. Life expectancy has hovered around 57 for both sexes for many years, but with great disparities between the slaves and owners.

The US has done nothing to date but overlook the unlivable health conditions and human rights violations in the region for those that are born into bondage.

In the United States however, one group is taking action to make Americans aware of the atrocities faced by the Mauritanian slaves, and the health and human rights violations that exist. The Abolition Institute, founded in Chicago by Mr. Tenner and former Mauritanian slaves, was recently formed to end the practice of slavery in Mauritania, and bring freedom to those suffering under the inhumane circumstances of maltreatment, malnourishment and abuse.

The organization does everything from educating the public on the religious aspects of modern day slavery to informing about the living conditions and health of slaves through noting disparate practices such as “gavaging” in Mauritania, where women of Arab decent try to gain weight to show that they are wealthy elite and not poor slaves with emaciated frames.

However, the devastating effects of slavery run much deeper than the physical effects. The extreme consequences the effects of slavery have on mental health know no bounds.

In Slavery’s Last Stronghold, a leader of an abolition group tells Sutter that many similarities exist between modern slavery in Mauritania and that in the United States before the Civil War, but that the one fundamental difference between the two in his mind is the use of physical restraint. “Chains are for the slave who has just become a slave, who has . . . just been brought across the Atlantic,” Boubacar said. “But the multigeneration slave, the slave descending from many generations, he is a slave even in his own head. And he is totally submissive. He is ready to sacrifice himself, even, for his master. And, unfortunately, it’s this type of slavery that we have today” — the slavery “American plantation owners dreamed of.”