Single payer debate heats up: Don’t say I didn’t warn you

smilies-1732509_1280

Why is single payer popping up now?

The Affordable Care Act (aka Obamacare) was a sincere attempt by Democrats to write a bipartisan bill that would attract the support of moderate Republicans. It preserved the employer-based system of private insurance, added market-based approaches such as the insurance exchanges, and enforced personal responsibility through the individual mandate. The Republican leadership made a political decision to attack the bill rather than to support it, and the GOP-led Congress and now a GOP-led Administration have tried their best to undermine the law by spreading misinformation (death panels, government takeovers), defunding key aspects such as the risk corridors, and creating uncertainty (e.g., not committing to funding cost-sharing reductions). States have done their part by suing over the law’s constitutionality.

I’ve warned since 2014 that if Obamacare fails or is repealed it will make single payer more likely. (See If Obamacare fails are we on to single payer? and One more way Obamacare may lead to single payer and Goodbye Obamacare? More like hello single payer!)

Suddenly the political ground is shifting as leading Democrats embrace single payer. The Washington Post (The dam is breaking on Democrats’ embrace of single-payer) reports that there are four co-sponsors of a single-payer bill in the Senate. Max Baucus, former chairman of the Senate Finance Committee and an Obamacare architect, has also come out in favor –something that was unfathomable until recently.

There a few reasons this is happening right now:

  • After seven years of shouting “repeal and replace” Republicans have revealed that they actually don’t have a plan for addressing problems in the healthcare system and that their real intention is to cut Medicaid and throw millions off of coverage
  • President Trump has called Republicans on their subterfuge, so now everyone is aware that there never was a plan
  • Experience with the Affordable Care Act has changed the conversation. For example, no one wants to go back to worrying about whether pre-existing conditions will keep them from getting coverage or that they’ll hit an annual or lifetime cap on benefits

Most importantly from a political standpoint, Democrats realize that the complexity of the ACA –which was needed in order to keep it a moderate bill that built on the complexity of the existing system– has worked against them. I’m a healthcare expert and I don’t understand every aspect of Obamacare. How can the average citizen be expected to do so?

“Medicare for All” is a simple and powerful rallying cry. Everyone knows what Medicare is. Those who have Medicare like it and want to keep it. There is no stigma attached to it. Unlike the ACA, a Medicare for All bill could be simple and elegant. And it wouldn’t require an individual mandate to function.

The health wonk in me says that Medicaid would actually be a much better vehicle for universal coverage than Medicare. (See Could Medicaid for all be the answer?) It would do a better job of bending the cost curve and addressing drug pricing, and would give the states more freedom to innovate. But it might be less appealing politically.

Those who want to preserve capitalism and private innovation in healthcare –and I put myself in that category– should embrace the Affordable Care Act and look for ways to improve it. The alternative is to fight a rear guard action against single payer.


By healthcare business consultant David E. Williams, president of Health Business Group.

 

Natural Language Processing: Podcast with Wired Informatics

murali_hires

Murali Minnah, co-founder and chief strategy officer of Wired Informatics

Natural language processing (NLP) is a fascinating segment of Artificial Intelligence that draws on a variety of emerging scientific fields.   Wired Informatics is developing and commercializing NLP within the healthcare industry.

I met co-founder and chief strategy officer, Murali Minnah last year and we have been exploring  applications for NLP within Health Business Group’s client base. I admire the company and its approach, so asked Murali to share his insights in this podcast:

  • (0:11) You are involved with a lot of the hot buzzwords: big data, natural language processing, and machine learning. What do those words actually mean to you?
  • (4:59) Are there aspects of healthcare that lend themselves well to natural language processing?
  • (7:18) How well does NLP actually work today? What’s the trajectory for its development?
  • (8:42) How do you work with a technology that is good and improving but not perfect? In healthcare it seems we’d be concerned about something that isn’t perfectly accurate.
  • (10:59) If you do get to 100 percent accuracy, how do you contend with problems in the underlying data?
  • (12:50) You mentioned operational use cases as the first places to start. What are some of the most compelling use cases today and down the road?
  • (15:35) Where is your company getting traction? What use cases? What customers?

By healthcare business consultant David E. Williams, president of Health Business Group.

Hospice: Another sad sector of the opioid crisis

drug-pusher-1907827_640

Help yourself?

A person addicted to drugs might do anything to get their hands on the next dose. Whether that means ‘borrowing’ painkillers from a relative who had their wisdom teeth extracted, breaking into cars to grab small bills and coins, or stealing their mother’s jewelry –all things I’ve seen myself– there are no real limits. So I was saddened but not surprised to read Dying At Home In An Opioid Crisis: Hospices Grapple With Stolen Meds, which highlights the trouble dying patients face in keeping hold of their painkillers.

The Kaiser Health News examples are only anecdotal, but the combination of high quantities of opioids and homebound patients unable to fend for themselves is an ideal setting for diversion. The problem is two-fold: theft of drugs while the patient is alive, and diversion once the patient passes away. Since many patients die within days or weeks of beginning hospice, the second problem is a major one.

The examples offered in the article are heartbreaking:

  • In Mobile, Ala., a hospice nurse found a man at home in tears, holding his abdomen, complaining of pain at the top of a 10-point scale. The patient was dying of cancer, and his neighbors were stealing his opioid painkillers, day after day.

  • In Monroe, Mich., parents kept “losing” medications for a child dying at home of brain cancer, including a bottle of the painkiller methadone.

  • In Clinton, Mo., a woman at home on hospice began vomiting from anxiety from a tense family conflict: Her son had to physically fight off her daughter, who was stealing her medications. Her son implored the hospice to move his mom to a nursing home to escape the situation.

Some hospices are trying to do something about the problem, but it’s not easy. After all, their primary goal is to ease the pain of dying patients. It’s not really their job to keep track of and control everyone else. Some of the ideas being tried include:

  • Screening families for a history of drug addiction
  • Limiting the amount of meds delivered at any one time
  • Drafting agreements with families about consequences for drugs that disappear
  • Encouraging the destruction and disposal of drugs after the patient dies

None of these approaches is likely to succeed on its own. The country will have to address the broader opioid crisis in order to bring this part of it under control. However, there are a couple additional steps that could be taken now:

  • A few states let hospice employees destroy drugs once a patient dies. That should be expanded nationwide and made mandatory. There is no conflict here with the patient’s needs
  • Some patients, who would otherwise be eligible for home hospice, should be moved to facilities such as nursing homes, where controls can be tighter. (Much as I hate to argue against home care this needs to be part of the discussion)

By healthcare business consultant David E. Williams, president of Health Business Group.

mHealth Israel founder Levy Shapiro shares plans for conference in Jerusalem

 

Image 8-18-17 at 6.22 PM

Innovative Israeli technology companies have a huge impact around the world. Now, more of the country’s entrepreneurs are turning to connected health. mHealth Israel is at the center of this surge. Its upcoming mHealth Israel conference on September 14 will be the culmination of a nationwide week of activities.

I had planned to speak at the conference, but sadly won’t make it to Jerusalem this time around.

Levy shared his perspectives on mHealth in Israel and provided background on the upcoming mHealth conference.

  • (0:13) What’s the state of digital health in Israel? How does it differ from markets in the US and Europe?
  • (1:58) Israel is a small market and doesn’t trade much with its neighbors. Are most of these companies focused locally or are they looking at external markets?
  • (3:09) Describe the ecosystem. What is the typical interaction between the startup companies, hospitals and larger companies?
  • (7:10) What are some of the major themes you are seeing in health startups this year? Is it a change from the last couple years?
  • (9:38) What is mHealth Israel?
  • (11:30) You are running an Israel startup competition over the summer. What is it? When are the entries due?
  • (12:40) What are the highlights of mHealth week?
  • (14:02) Who are some of the speakers at the upcoming conference?

By healthcare business consultant David E. Williams, president of Health Business Group.

Health Wonk Review is up at Health System Ed Blog

The Summer Lull edition of the Health Wonk Review is posted at Health System Ed. Here you’ll find a leisurely edition with plenty of explanation and context for a summer read.

Host Peggy Salvatore has featured my post on free markets in healthcare, and for that I thank her.

Advances in care management: podcast interview with AxisPoint CEO Dr. Ron Geraty

Ron Geraty

Dr. Ron Geraty, CEO of AxisPoint Health

AxisPoint Health is part of the new breed of care management companies, leveraging new data sources and digital techniques that go beyond the traditional paradigm of nurse call centers focused on a handful of common chronic conditions. Industry veteran, Dr. Ron Geraty (former CEO of Alere) took the reins of the company a couple years back.

In this podcast interview, Ron and I discuss the evolution of care management, the role of digital, and what the future will bring.

  1. (0:11) What’s the current state of care management in the US?
  2. (2:27) How is care management being done differently across populations: commercial, Medicare, Medicaid, dual eligibles?
  3. (5:36) Care management traditionally focuses on 5 common chronic conditions. Has it made a significant difference in those areas?
  4. (8:26) What attracted you to AxisPoint? How is it different from other population health management companies?
  5. (13:08) Who are the customers? Who is drawn to your approach and why?
  6. (15:26) You work with the most vulnerable populations. Do you attempt to influence the social and behavioral determinants of health?
  7. (19:18) What’s at stake for AxisPoint in the debate about healthcare in Washington, DC, especially since you are serving populations that have been a major focus of the ACA?
  8. (22:33) How will digital tools be leveraged for vulnerable populations? Will you still have feet on the street?

By healthcare business consultant David E. Williams, president of Health Business Group.

How to cure patient cancellations. Podcast with QueueDr CEO Patrick Randolph

druid-1415032_640

I can wait –if necessary.

It takes an average of 24 days for a new patient to get an appointment with a doctor, up 30 percent since 2014. In Boston, it’s 52 days! Physician schedules are full, and yet a significant percentage of appointments are canceled or patients just don’t show up –costing doctors billions in revenue and depriving needy patients of appointments.

These two things are related: with such a long wait the patient may either be cured on her own, go to the ED, die, or just forget about the visit.

Patrick Rudolph saw an opportunity to do something about this problem and started QueueDr to simply and automatically offer patients a chance to fill those open slots. You can listen to him explain in our podcast:

  1. (0:10) What problem are you addressing?
  2. (0:58) Why do you think the problem is getting worse?
  3. (2:25) Bad technology is a problem. What do you mean that your technology doesn’t require anything of the user?
  4. (3:44) What does it look like from the patient standpoint?
  5. (4:54) One of your customers says your product works “too well.” What is he talking about?
  6. (5:58) Do you think this cancellation issue is a standalone solution or should it be a feature in a broader system?
  7. (8:01) You’re not the first one to address scheduling and cancellation as a challenge. How do you compare with other approaches?
  8. (9:46) How would QueueDr work with a policy like charging patients who don’t show up or introducing an open access schedule?
  9. (11:58) Where will the company be five years from now?

By healthcare business consultant David E. Williams, president of Health Business Group.