Untangled Health

Consumers Unite To Drive The Changes We Need

NC Senate : While the rest of the country profits from North Carolina’s success in Medicaid, you throw the baby out with the bathwater.

 

Heck! With health insurance we can afford a cup of coffee!

Heck! With health insurance we can afford a cup of coffee!

cmis_use

 

 

The graphic report (above right) comes from the CCNC data systems developed by the Community Care of North Carolina Program. It allows communities to identify and assist people in need of support or locate systemic problems such as high utilization rates in local emergency rooms. All of this stuff combined fits into the Medical Home Model that out senate suggests purging CCNC; Yet, as you will note below, this program is a locally managed;public-private joint venture that is used throughout the US to achieve cost reductions in health systems. Please read on:

Yet another testimony to the capability of a Medical Home framework to decrease cost and improve health outcomes was published in today’s NY Times.   Here are the data:

  • The payer: Care First Blue Cross Blue Shield
  • The population size: 1.1 Million!
  • The model: Medical Homes (Community Care of North Carolina an early adopter of this strategy)
  • The savings: $130 Million

The article goes on to explain that results have been mixed in Medical Home Evaluations, demonstrating a need to identify the components that are required to achieve such results.   However, The Patient Centered Primary Care Collaborative Chief Executive Marci Neilson noted that the studies are showing promise as Blue Cross Blue Shield of Michigan demonstrated a $155 Million savings in Emergency Room Visits and Hospitalization through their Medical Home Program last year.   So here’s what I have to say to the Senate: WAKE UP… the people providing the knowledge and structure to the programs now receiving accolades from the media cut their teeth in North Carolina through a fifteen year joint effort between public and private industry. Then, after receiving national recognition they were asked to teach other States the basics of the Medical Home that will reduce cost and improve health outcomes.

  1. Local control with State support
  2. Physician directed care
  3. ACCURATE DATA published frequently, reviewed frequently, converted to focused interventions
  4. Care Coordination and patient education from within the physicians practice
  5. Frequent regional meetings to review success and make adjustments to work-flow and design.

Here is an example from years ago in Greensboro (CCNC ORAL REHYDRATION PROGRAM)  

  • The local Community Care Network discovered that many emergency room admissions were attributed to children experiencing dehydration when they had GI Flu.
  • The CCNC Network (Partnership 4 Health) created an oral rehydration program where they reached out to the community of working mothers who would come home to a child experiencing diarrhea and vomiting.
  • As they engaged the family they taught the mothers to rehydrate their children using pedialyte.
  • They distrusted the rehydration kits to physician practices, public health departments and elsewhere.
  • The people started treating their children at home as opposed to the emergency room.
  • The Medicaid emergency department visit rate for GI distress fell and the tax-payers saved money.
  • All of this with happier children as the most important outcome in my opinion.

So what do you think NC Senate?   How about we keep what works!!! If you need further illustration there are a few thousand of us who would be pleased to teach you: Republicans, Democrats, and Independents alike. 

From the front lines in North Carolina’s debate over human equality

I am so sad to see the level of intentional prejudice in this State.

Here is todays local television coverage of the closure of a critical access hospital (CAH). CAH’s are placed in rural areas throughout the USA and exist strictly to provide life saving healthcare to sparsely populated areas (usually agricultural).

This event is blamed on a corporation “Vidant Health”

In reality, it is not the fault of a corporation; or the pharmaceutical industry, or publicly funded healthcare, or the insurance industry; or the doctors; or your dog.

This is a collapse of civilization. In NC, we have decided to stop caring for those in the lower socioeconomic classes. We have proven this through our elected officials. So the fault lies with us and every life that is lost in transit to hospitals 45 minutes away is our responsibility.

You see:

The Affordable Care Act found the money to expand Medicaid and provide coverage for those with incomes less than 200% of Federal Poverty Level (about $28,000). In doing this, the cost of insurance polices through exchanges decreases. This has been proven in States that accepted Medicaid expansion funding. North Carolina did not.

The money for expanding Medicaid is partially funded by eliminating the large disproportionate share payments to critical access hospitals. You see, they would now bill Medicaid.

Well, NC did not accept the money as a “Statement of our conservative believe in small government”.

Now the hospitals are closing.

Here are my comments to our State Health News today, and more will come of this situation as you watch it play out on the national front. You will note that the good people are here. They are just under-represented.

  1. Very sad indeed. Within the last week the following has occurred in my personal world of chronic disease management: 1) the endocrinology group that fills the diabetes management subspecialty role for many Medicaid diabetics in the RTP area has stopped taking these patients and (according to my personal MD) they plan to discontinue services for existing patients on Medicaid. 2) The behavioral health group that treats many of the same diabetics for depression has dropped away from their care-team roll as they too are no longer accepting payment from Medicaid.

    Meanwhile, back in the grass roots of Johnston County we have been blessed by three Raleigh Retina Specialists who are willing to continue treating Medicaid patients. This includes visits, laser procedures, vitreal injections for macular edema etc. I begged them not to drop the Diabetes Eyesight Preservation program at Taylor Retina Center and their response was clear: Are you kidding Jeff, we will turn no-one away, this is a serious disease and far too many preventable vision related disability cases are missed.
    A Heart-Felt Hooray for the Good Guys.

    I wish the NC voters could understand the magnitude of dishonesty between legislators and their constituents. I have worked directly with past external review actuaries including Mercer when determining the return or loss associated with NC Managed Care through their CCNC program. The level of detail, down to the adjustment for illness burden and months of enrollment in Medicaid proved to me the sincerity and accuracy of the folks charged with program evaluation. Later (2006-2010) the program and its outcome data were modeled in many States around the country.

    Yet when attending a Medicaid public forum I witnessed a NC employee from the budget office explain away all cost efficiencies by pointing to differences in the percentage of the NC population that are children in contrast with other States. Such an illinformed if not ignorant piece of information to share with the GA. This comment was made as I sat next to a former legislator who is a surgeon. I described the inaccuracy to him and said they may want to get some help with interpreting the data reported on Medicaid estimates. After a few more minutes discussing evaluation methodologies he looked at me and admitted ” We really do not know what questions to ask”.
    I testify to the truth of this statement further acknowledge that it is mine alone.

Physicians retreat from accepting NC Medicaid Patients

cemetary at dusk

I suppose the NC Legislature will eventually accomplish their objective of reducing Medicaid expenditures for the chronically ill. Either individuals like myself who have diabetes and are unable to afford a $500.00 insurance premium through our two payer exchange will either die or move.

Please note: Within the last month, Raleigh Endocrine Associates the one and only local provider of diabetes specialty services in the region will no longer accept Medicaid patients. For now, the primary care doctors (of which there is a shortage and no plan to adopt new reimbursement strategies for high quality disease management outcomes ) will have to take on the Medicaid diabetics alone.

I spoke with a young man this morning. At 26 he was discovered to have type II diabetes when receiving  his admission exam for the local community college. It has been weeks since he was able to purchase his insulin. I just happened to meet his uncle on the plane two weeks ago and called the fellow today with information on methods to access medicines for the treatment of chronic illness. Seems like the least our legislature could do is provide adequate resources for maintenance medications: Even if only to keep ED visits down.

More on the land of Oz (North Carolina)

Heck! With health insurance we can afford a cup of coffee!

Heck! With health insurance we can afford a cup of coffee!

It is so unfortunate that the Senate has demonstrated such ignorance of the systems in NC that have provided frequently cited information on the cost benefit associated with Medical Homes.

I came here in 2001 to work with Community Care of NC following the sale of my company to Aetna Health. The technology we sold allowed Medicare Advantage Programs to identify, target and engage at-risk seniors through referral to primary care case management. It was clear at that time that the lessons learned from the world of HMO managed care had reached the end of their useful life as physicians had learned about the concepts of cost control through limiting redundant procedures and using evidence based guidelines in the 1980′s. The 1990′s brought us minimal returns in Disease Management which was the initial model deployed by Carolina Access’s efforts in Asthma and Diabetes population management activities. Those in the US that were on the cusp of ‘the next big thing’ were organizing for Primary Care Case Management through regional networks. I had spent 1999-2001 making presentations to the likes of Aetna, United Health Care, PACE and Empire Blue Cross to sell our intellectual property. If the commercial insurance industry understood the value of the marriage of technology with Medical Homes in 2001 it was a sure bet that our entire delivery system was on the verge of major payment reform.

Having had these successes in the private sector, my wife and I moved to NC after learning about the evolving Medicaid program which ultimately was titled Community Care of NC. We had a sincere desire to see a replication of a successful private industry venture through the public systems of care.

Since I was from the ‘evil private sector ‘I often heard ridicule from folks working in public programs here in NC. However; the willingness of these people to adopt information technologies that would increase their understanding of the Medicaid population and facilitate the design of delivery systems to tackle specific risks for the State of NC and separate regionally-managed community centered action plans for twelve regional networks was undoubtedly supported by the experts and General Assembly alike. Since that time it has become clear to all who work in the field of population health and disease management that the involvement of local providers, patients, payers and institutions in the creation of these programs is critical to the success in terms of both return on investment and quality of care.

So here we are: Those of us fortunate enough to work with these teams learned many lessons. When I left CCNC in 2006 I worked nationally, implementing similar programs across multiple states. I frequently heard how impressed various leaders in healthcare were with North Carolina’s success at improving the health of persons with diabetes and asthma as well as making a significant dent in the inflation rate in NC Medicaid when compared with other States.

So why would the Senate disband a working solution. I witnessed the reports from various budget experts at the public forums held last spring and noted a general lack of proper methodology when reporting cost data. For example: There was no evidence of proper control group selection and illness burden adjustment. When I stated to a former Senate member who happened to be a surgeon the errors in the reports used by the committee to compare cost benefit he agreed with me and stated “We really are not sure what questions to ask”: Yet the citizens of NC place their trust in this group to reform Medicaid.

Of course, when the public was asked for input, the decision was made to keep the existing program. Obviously many became clearer on the benefits. Then, out of left field comes enough controversy and distrust to once again, throw out the baby with the bath water.

Now that I am retired the muzzle of political correctness is no longer relevant. So here is some more feedback that is based on actual happenings in my life since working in NC.

I returned two weeks ago from the Patient Centered Primary Care Collaborative, a 10 year old group spawned from the private sector in response to the escalating costs of care in this country along with the fact that we are rated far down the line in healthcare outcomes when compared with at least seven other industrialized nations; few of whom conform to what we like to think of as traditional socialist thinking. I hold a co-chair position with this group and have gratitude for hearing the current thinking of the ‘best and brightest’   a club of economists and CEOs which I certainly do not qualify for membership.

During the conference a lead executive in a fortune 100 company along with several others from other organizations respected by all who read the Wall Street Journal told me that he had been asked to consult with the Governor’s office after the GA changed its mind about Medicaid outsourcing. He asked me what I thought and I gave him feedback on my personal observations of the successes achieved by Community Care of NC and told him a story about a similar plan assembled in Chicago in 2007 where I had a consulting contract. The Chicago plan failed since the commercial HMO and technology vendor had not developed succinct written requirements. I recall the meetings as if they were yesterday: Especially the frustration I exhibited in public when I found out that the HMO had not connected with the Medicaid primary care providers in Chicago prior to submitting their proposal. So here I had evidence of a public –private partnership success story in NC and private failure in Chicago.

My business friends that had reviewed the politics and business cases in NC for our Governor had all recommended that the State keep CCNC and the Accountable Care Organization models that had been promised only two months ago. Unfortunately their actual comment to me was: “Sorry Jeff, we do not understand the logic, the drivers appear to be something other than cost and quality. Perhaps it is time for you to leave.

What more can I say. The Senate’s budget is counter-intuitive yet those who are emotionally trapped by their opinions concerning the ACA seem unwilling to discuss the details as to why it makes no sense.

Does the GA realize that the Triad had a huge problem with mothers using the emergency room when their children became dehydrated from GI influenza and that the local CCNC network assembled a clinic to educate mothers to master the task of orally rehydrating their kids when they were sick which brought down the ER visit rate to almost nil?  How do they think an HMO will be able to address local needs with such specific detail and provide educational resources?

I have had diabetes for 48 years. I remember when Blue Cross sent my refrigerator magnets to remind me to have tests performed and monitor my blood-sugar. I have no idea how much my employer paid for that Disease Management Service but I do know that I had to argue for my insulin pump in 1984: The one tool that I attribute my lifespan to today.

I will close with this:

For the last six months I have been working with some private practice ophthalmologists who are willing to treat Medicaid diabetics. Many specialists will not treat Medicaid patients due to the lower reimbursement but these folks are a dream team. I assembled a program description and took it to the NC Medicaid Medical Home leadership to get their feedback. They were very pleased to see local people getting involved with creating specialty networks that would treat their patients. Why? Well we have a problem with diabetics becoming blind if they are on Medicaid due to inadequate access to specialty care. So here I was offering a bundled service at ½ the commercial rate charged by the hospital next door.

Unfortunately, I have had to place the project on hold. One of our major criteria for inclusion in the retina service for diabetics is that they are tethered to a Medical Home. As of a few weeks ago I can no longer assume we will have a relationship with a Medical Home enterprise.

A note to the NC Legislature on Compassion

 

 peace 2 you

 

A letter to the NC General Assembly

 

 

 

We seem to be evolving into a nation of binary people. Binary in the sense of our emotional, tactical and strategic response to our surroundings: On one end we have the Concerned and on the other we have the Unconcerned.

 

Of course you realize I say this in jest, but what if I was right? Are you willing to risk your comfort and explore a possible reality with me?

Please place your religious ideals aside for a few minutes and read on:

 

Hypothesis:

 

  • There is no God
  • No-one will inherit the earth, we have no idea what the future holds.
  • Human beings randomly crawled from the primordial soup some billions of years ago and have evolved to the most intelligent form of life on the planet. When I speak of intelligence I mean cognitive ability and nothing else.

 

 

 

Since we became self-aware we have been unable to escape our internal reality: That we are born alone and will die alone. All of the space in-between (a brief 70 +- years) is filled with experiences arising from the environment around us. We learn –or not that our actions influence our environment and well-being; receive –or not, instructions on how to behave in society and together: “Trudge the road of destiny”.

 

Non-sense you say: “we trudge the road together”!

 

Two weeks ago, as I flew home from a medical conference in Denver, this essay was tumbling around in my mind. I was not sure of the words, but I felt an overwhelming drive to write something about how I currently perceive my world: The one where I wake in Raleigh North Carolina each day, aching from diabetic neuropathy, reflexive sympathetic dystrophy and drained by my hepatitis C, a condition undoubtedly resulting from poor lifestyle choices in the 1970’s.

 

I am observing the adults in my Country of origin become firmly rooted in social belief systems. It appears they are evenly divided between the concerned and unconcerned. At the same time, few fall completely into one group as they seem to be willing to sacrifice their beliefs when under personal threat. The ruggedly independent who celebrate life, liberty and the pursuit of happiness in the absence of stringent regulation will sacrifice their black and white thinking to help a nephew or niece who has become dependent on drugs or alcohol. Those who consider themselves intolerant of in-equality and weep over those experiencing disparity in health-care or lack of opportunity will often appear to live up to their values until they too fear losing something of greater importance.

 

I have a friend who calls this: “Integrity in the moment”.

 

Since we are tolerant of a change in our own life circumstances to the point of willingness to think in numerous shades of gray when it comes to self-interest and the safety of our loved ones; how is It we cannot apply this flexibility to everyone?

 

My father asked me if I had ever sacrificed. His opinion at the age of 86 was that his was the last generation to truly be willing to have such willingness. He and his friends in WWII who walked from one end of the Philippines to the next risked their lives daily. I always thought this was for God and Country until I learned much-later that my Dad joined the Army –in his words “to find chicks”.

 

So what I consider the truth today is that few human beings are willing to strictly abide by their convictions. Yet, in my opinion; to ease the pain of ‘oneness’ we find some common characteristics that we share with others and join that group: Until we become threatened that is.

 

So, for all of you Republicans, Democrats, Tea Par-tiers; Independents; Christians, Jews, Muslims, Atheists, Agnostics, or (insert category here): Are you willing to try something new?

 

How about belonging to one group:

Human Beings.

 

 

How about owning some truth:

  • We are a fickle species.
  • We are capable of changing our behaviors and attitudes.
  • We are not God if there is one.
  • We believe in knowledge.
  • We believe that knowledge is best obtained through scientific methodology
  • We would like to live forever, never be hungry, never be lonely, and always be loved and recognized as an individual.
  • When we put our defenses down we realize that each one of us will die and we might experience times when if not dead, we will wish were dead.

 

Now, stop here for a moment. Yes I know you have an important business meeting but please stop for a moment and read on.

 

  • If you own these truths you might feel a bit uncomfortable right-now: Perhaps afraid for yourself, perhaps sad for others who might suffer. In fact, all of a sudden you realize that We All Suffer.
  • What separates you from those who you call entitled. What separates you from the arrogant wealthy movie star; very, very little; perhaps nothing at all?

 

 

So on the flight home from Denver, I met a guy who said his nephew had been living a year in North Carolina. He said he had just got a factory job but could not afford his medicine. He said he was a diabetic who did not have his insulin.

 

As my mind jumped between my judgment and intolerance of numerous human character defects; across a spectrum of political beliefs there was a man about to die from diabetic ketoacidosis.  He had lost 50 pounds in weight and for reasons that were none of my business no medicine.

 

I just hung up the phone after speaking with his aunt: I gave her the number of a community health center where the young man can access a primary care medical home and learn –if he desires- to take care of himself. That is the problem in the moment.

 

Realizing that I am one of those fickle human beings described above I needed to stop thinking and do the next right thing.

 

The next right thing will always be: To decrease suffering for another. When I am so sick that I am unable to help another or take care of myself then the next right thing is to?

 

Ask for help!!!!

 

So, as the North Carolina Legislature places health and well-being above all else, they will have my respect. That said, since they are human, and I am a human, if any one of them needs some groceries they are welcome to split what I have in my refrigerator.

 

You see:

 

At age 10 a man tackled my ‘entitled’ drunken mother as I jumped from our kitchen table on-to his back with a steak knife ready to cut his throat.

 

At the age of 13 I said “I will never drink alcohol or take drugs”

 

At the age of 19 I acquired hepatitis C (guess how)

 

At the age of 25 I had to borrow money for insulin (help of another)

 

At the age of 31 I stopped drinking and drugging (help of many and my higher power)

 

At the age of 36 I had asked a team of people to help people suffering with lung disease become more independent and comfortable: Literally healing people into their inevitable death. I did not have to ask: ten years later; the team simply told me how much they loved me.

 

There have been times in my life when others would throw me away and times when they called on me to feel safe. At what point should I be judged by others. Isn’t it our duty to love unconditionally in the moment: To believe in our truth that people change, life is precious and it is not ours to judge?

 

Moving forward NC Legislature, I hope you all will sit back and reflect on the importance of your actions. How many tomorrows are you sacrificing that do not belong to you.

diab expense nc cos

 

 

 

 

NC General Assembly Run’s Amuck

Here is what you can plan on seeing frequently in NC Emergency Departments as people with diabetes lose contact with the guidance of their primary care medical homes.
Dying a piece at a time diabetic vascular disease

This letter is to my neighbors in North Carolina, all of you:

I am presently at the Patient Centered Primary Care Collaborative, a national forum of Fortune 500 companies such as IBM, Anthem WellPoint, United Healthcare; Aetna; and clinical groups such as The American Academy of Family Physicians and others. My point is: This is a non-partisan, multiple perspective group of America’s best thinkers in business and industry that convened in 2006 to identify what works with regard to delivery mechanisms, payment reform and consumer engagement.

I am a member of PCPCC and serve as a co-chair on their health information technology committee and adviser to the Patient-Family and Consumers group. Yesterday I was a panel member discussing both topics. Why, because of my experience with my healthcare (diabetes for 48 years) and work with the folks that founded the current system.
After this meeting I will be attending the Colorado Patient Centered Primary Care Collaborative meeting at 1:00 PM this afternoon.

I am interested in Colorado’s perspective since they adopted North Carolina’s successful program: North Carolina Community Care Network which tethers Medicaid Patients to a Medical Home. Our program in NC has been evolving for twenty years: Starting as a simple demonstration and ultimately proving its capacity to manage a diverse population of patients coming through different payers including Medicare, Medicaid and Health-Choice. After joining what has become a national movement to bring patients closer to their primary care physicians Colorado’s pilot initiative has demonstrated reduced-cost per enrollee and improvements in health outcomes. The return on investment is well north of 2:1.

As these programs expand they will be using organizational ideas that originated among the talented North Carolina physicians and allied health professionals in the between 1994 and the present-day. NC tax-payers and the private sector joined forces; offering financial commitment and support staff to ramp-up the rate of adoption of Medical Home processes. Their support of Community Care is due to their effectiveness. This work is now being replicated across the country and is thought to be pivotal to the reduction in cost and the much-needed improvement in National Healthcare Outcomes.

Unfortunately, my neighbors and I in NC will no longer receive the benefit of our State’s recognized excellence in primary care delivery as the NC General Assembly has elected to ignore the desire of the public and take the next step toward the ‘outsourcing’ of Medicaid to a national HMO. “Sorry folks we have been hijacked by gorilla corporate tactics to influence a 3 trillion-dollar industry.”

I must inform you of your success and the magnitude of abandonment.

Here are the facts as described above:

NC has demonstrated wonderful cost savings with their community designed care coordination and case management programs. You may hear them referred to as Community Care of North Carolina. They are composed of 14 different not-for profit organizations assigned the task of providing care while controlling inflation in Medicaid. I worked with the team on assembling programs that would provide unbiased expert evaluation on their health and cost outcomes, those that become national benchmarks.

Your communities responded to the call for participation in Medicaid reform. Now, all of us that thought we were included have been abandoned: And believe it or not: Our Governor is one of the good guys: After he put a great deal of effort into learning about what works and listening to the feedback of local healthcare experts he supported the implementation of Accountable Care Organizations and the continued use of Community Care of NC as the service providers.

How do I know this? I had coffee with Fortune 100 executives yesterday who have been trying to help the Governor and NC Physician networks. I cannot disclose anything other than this. The detail is disgusting and speaks to issues that most in our country worked through in the 1970s. Suffice it to say that your elected officials were able to locate an HMO plan outside of NC that is able to tell a wonderful story. Since the legislature (as members have directly admitted to me) do not understand healthcare data and population analysis they have hired consultants to assist. These consultants pale in comparison to the experts that have recently met with Governor McCrory in an attempt to save the State of the Art system currently in place.

All systems of care need improvement today. Clinics and providers are not all the same. That said, we have plenty of successful models in NC to draw from.

Regardless of the following truths your General Assembly has decided to dispose with advice from the recognized experts in the field.

The Nations’s  industrial leaders are adopting your healthcare services design because they are confident that it works.

• Our State is a respected leader across the USA through the success of its bilateral Medicaid Managed Care model that evolved through your feedback and the constant vigilance on regional measures of cost benefit and cost efficiency.
• You have been abandoned while distracted by a conservative argument for small Federal government. The influence from outside our State is present and sizable.
• Through the invocation of States rights, our GA turned down sufficient funding to care for an extra 400,000 poor people in this State. Our uninsured would be insured otherwise and hundreds of jobs would be created to perform the needed individual health assessments, identification of clinical disorders and implementation of a course of treatment.
• You are handing over the health management of the woman next door: You know the one who works two jobs to feed her family to an external, antiquated delivery concept that demonstrates only two things:
o Reduced cost
o Reduction in health and wellness with loss of access to primary and specialty care.

Since no-one could imagine our legislature retreating from previous commitments I thought it might be a good idea to take this year and advance the treatment of diabetics by concentrating on our well-known problems with untreated diabetic eye disease among the poor. I was counting on the Community Care Networks to take our patients, established a collaborating group of eye doctors and created the program outline for a Diabetes Eyesight Preservation Initiative.

Due to the changes in attitude and changes in latitude expressed by the GA last week a program to treat diabetics at high risk for becoming blind at a cost roughly 50% of local hospital charges is being placed on hold. I can not ask my ophthalmology friends to plan on Medicaid reimbursement with the knowledge that the payers could change overnight. Two bad I guess for several hundred people who have been unable to receive specialty eye care.

I hope my readers understand what I am saying. I have difficulty describing such a complex and corrupt industry to my friends and family. The General Assembly has knowingly ignored your desire and taken action that will –in the eyes of our nations most published professionals likely do harm to the poor.

Additional note one day later:

I have been informed by my endocrinologist that the practice will no longer accept NC Medicaid. This is due to the uncertainty of the GA final budget.

I am retired today and have no reason to distort the truth. I am fortunate to have wonderful people in my life outside of NC who validate or challenge my conclusions. Without my friends I would question my sanity and think I was caught in the twilight zone.
\I am willing to work with others toward a system that is faithful to its original design requirement: Provide room for the poor and middle class (now the same, check your retirement account) to succeed in a country of opportunity. Have we lost it?

If anyone would like to publish detail, simple facts to expose the reality do not hesitate to contact me. I have data and information regarding this topic that will stand in court and my family has no fear to work with others in an attempt to expose the material prior to the 2014 election.

New Bumper Sticker Idea: NC General Assembly : Perfecting Legal Genocide

 

 

States Rights to create their own Healthcare System : The best solution for our universal contempt for “Obamacare”

You owe it to yourself to read this

You owe it to yourself to read this

Hopeful

Hopeful

I just left the keynote session at PCPCC. The Speaker, T.R. Reed who wrote “The Healing of America”; the well know exploratory of systems of care from around the world offered-up a solution.

As you know I am in Colorado, a State that is describing why we no longer need two political parties. Here we have a conservative history yet marijuana is now legal PERIOD.

I also think of Vermont as a similar place one can relax and turn off the political diatribe and get to the issues.

Anyway, Colorado has implemented a multi-payer collaborative of physicians and their community partners to create one of the best examples of Community Health Homes to date: They are increasing patient access to care, improving the quality of care and spending less money.

T.R. Suggests States’ invoke Section 4 rule 1332 of PPACA to accomplish the conservative objective to rid our country of Obamacare. The liberal objective of universal coverage would also occur as this is the formula for higher quality, lower cost and the greatest satisfaction among patients and providers. We have known this for quite some time. In fact T.R.s book was published in 2009, was a NY times best-seller yet receives scant press coverage: I wonder why?

Well, I will bring the idea home to NC and try to explain ‘one more time’ that universal coverage is not a pledge to socialism, just plain old common sense. All one has to do is look at the business model.

Peace from the High-lands

Local Physicians “Pay it Forward”

Patient education

FluroDR

I am hopeful today. I will be leaving to join friends at the Western Regional Conference of the Patient Centered Primary Care Collaborative in Denver and just found out that a pilot grass-roots effort to identify Medicaid patients who have not received eye exams and engage them with a collaborative of specialty-care physicians will be moving ahead with the support of local advocates.

Taylor Retina Center and I have been working on this project since last October. As noted in other posts, our current climate for Medicaid patients is less than friendly. I am a very fortunate man to have my eyesight almost 50 years after the onset of my type 1 diabetes and have come to appreciate the differences in health outcomes and healthcare process indicators between those of us with private insurance and those who receive Medicaid funding. I moved to NC in 2001 because of their progressive Primary Care Case Management programs in Medicaid, have enjoyed watching their success and have concern for the future due to the current proposed changes by our State General Assembly.

That said, I have been introduced to physicians and grass-roots organizations who take it upon themselves to orchestrate access to health care resources and engage patients in self-management activities. We will stay healthy, introduce consumers to the self-mastery component of chronic care management; locate the best examples of treatment paradigms and broadcast our success.

To make a long story short, my friends at Taylor Retina Center and My Eyes Optometry have assembled an efficient screening and intervention model. They have been concerned that Medicaid patients tend to skip these exams (50% miss the yearly testing). The patients frequently show up for care with horribly diseased retinas that could have been saved if identified months earlier. The technology and talent available today will preserve a diabetics eyesight for a lifetime if the patient is tightly bound to a team of caring physicians and assumes responsibility for their disease; yet we have trouble with access to care resulting from what are counter-intuitive restraints to Medicaid funding and refusal to expand coverage under a national health reform effort.

I believe it is our responsibility to reach out and work with our community doctors to create medical homes and promote their clinical integration with the supporting specialists in the community health home environment.

Specialists integrating with Medical Homes to solve a major problem among diabetics in North Carolina.

NC Legislature Let-Down

cmis_use“I thought we were going to keep what worked?”

The NC General Assembly, as an independent move regardless of feedback from their electorate, physicians, Medicaid program evaluation programs is moving forward with plans to throw the baby out with the bath water. www.NC Health News May 30, 2014.

It is a sad moment indeed to see the citizens of NC exploited by their General Assembly. As a person who has had diabetes for 47 of 57 years. As a person who spent 15 years traveling the US assisting “the hired guns of the assembly” win bids for population care management under capitation I can attest to the trickery in numbers, computer vapor-ware and conveniently forgotten success of in-place efforts between 1990 and now.

The GA will find data to back their claims of NC Medicaid efforts failure to improve quality and decrease cost. When I attended the Medicaid reform meeting in Raleigh, I sat next to a former legislator who was also an MD. The NC Budget office had just finished describing that NC Medicaid’s claimed savings was a result of unfair comparison to other States with a different % of children in the program. I informed the man that the approach used was inaccurate and that the Office of Rural Health had gone to the extremes of analyzing differences in utilization between the States CCNC Medical Home program and Fee for Service basic Medicaid. These extremes included using well-recognized illness burden modeling tools that are commonly used by the best healthcare economists in the US. There has never been any doubt that the program in place through CCNC was effective.

My wife and I moved here in 2001 after the sales of our company to a commercial insurance disease management vendor. The vendor “Active Health Management” then sold itself to Aetna. Aetna insures over 20 million individuals. I had read about the pioneering efforts of Mr. James Bernstein’s Community Care of NC program (then called Access 2 now called CCNC): A program which challenges each region to self-determine areas needing improvement in healthcare processes by carefully examining their own data. Then the CCNC program aligns State DHHS resources with local providers to work together to accomplish documented goals as guided by industry standard project plans. I moved here to work with CCNC as the opportunity to learn from the best and take part in the reform we need was enticing. These were the people that had been trained in the Nation’s best public health graduate education programs. Many of the from our own UNC.

NC was one of a few States that knew of the few simple aspects of care necessary to reduce the rate of inflation in health spending. While the rest of the country was wasting money on Disease Management Programs sold by private industry CCNC and DMA had the foresight to understand that you can only make these improvements through local partnership. The basis of change is multi-pronged including these objectives: 1) Patients receive incentive to contact their primary care docs before going to an emergency room, 2) care managers to assist the 20% of the population spending 80% of the resources choose the correct care and engage in self – management and the creation of patient centered care plans that addresses all barriers to health including transportation issues to and from medical appointments and compliance with medication use for chronic conditions.

These are the things that the most respected professionals in the USA teach states that need help. Funny that some of NCs current Medicaid CCNC leadership are invited to other states to educate their legislature on how to reform Medicaid to demonstrate methods to a) find, engage and treat the highest cost, sickest people in the insurance pool; b) engage patients in managing their own illness as Greensboro did when it taught mothers how to hydrate their children instead of visiting the ER and c) reduce the threat to the States economy.

All of this published by the National Institute for Health Improvement Triple Aim measures to improve our Nations Health, our satisfaction with the system in general and lower the cost per person/year.

So here you are NC, years of recognized success; national awards for design; a web-native care coordination platform which allows any professional to view the patients history of treatment, list of problems and medications along with the published, evidenced based goals that the patient and treating team are working toward; a physician portal allowing physicians to review their improvement success and areas where they can tighten up their practice; a portal allowing physicians to contrast their performance against their peers setting the stage for friendly competition: Virtually all of the tools that the supposed consultants will tell the legislature they need.

The IT infrastructure for N3CN’s data center which houses the web-applications noted above along with the support staff to address the needs of 14 networks caring for over 1 million North Carolina citizens has over 300 simultaneous users including case managers and physicians and meets HIPAA security standards. It allows the professional to access critical information in a time of acute need; something the States hospitals are just now implementing and still have not agreed to share information on the NCHIE. It was designed and implemented for a fraction of the cost of commercial systems using a public-private partnership model. Does anyone know about this?

So, we have a nationally recognized program, we have nationally recognized population health management information system architecture, we have healthier diabetics and asthmatics and those of us who worked in the system that actually know something about medicine and being a patient are asked to be panel speakers in regional US conferences on Patient Centered Care somehow get discounted by a General Assembly without the skills to understand the nature of the problem. I know this since the person sitting next to me in the Medicaid open forum told me “we do not understand the data” when I asked him if he needed some help to tease out fact from fiction.

The N3CN organization is positioned with others to take accountability for the population that the assembly is concerned about. Functioning as ACO for multiple commuted local networks is a dreamlike structure that many states would pay millions to introduce. You see, we not only have the knowledge and technology, we have the countless life years of experience in our native state: but instead, the GA wants to hire nurses to call me from California to discuss my diabetes management issues and send me a nice refrigerator magnet and new web-site to track my health. Unfortunately it wont talk to my Duke, UNC, Federal Blue Button website when I start Medicare this year.

Wow!!!!!!!!!

Many Thanks to e-Patients –a time to reflect with gratitude.

 

An old teaching slide from 2008

An old teaching slide from 2008 

 

I want to thank my fellow e-Patient Casey Quinlan for recognizing my recent comment on e-Patients.Net.

 

“Frustrating it is; says Yoda”; that 2014 did not pre-date 1997. I had much more energy in 1997: Perhaps too much.

 

 

I reference 1997 as the year that I departed my work as a clinical program manager to work in e-Health. We didn’t call it e-Health then. Although Electronic Medical Records did exist; they were isolated to large hospital-like institutions such as the VA Medical Centers’ and were not designed to provide the functions available through modern ‘electronic health records’.

Many of us “early adopters” of information science could not understand why it was possible for Domino’s Pizza to maintain a record of our eating habits and deliver hundreds of pizzas to a locality throughout each football-weekend without a hiccup.: 1) pick up phone, 2) call nearest Dominos, 3) declare name and address, 4) authorize payment, 5) pace the floor for twenty minutes, 6) protect the delivery person by fending off eight hungry men from grabbing at the steaming-hot (well sort-of) pies in his hands and 7) laugh hysterically at your friends as they spill tomato sauce and toppings all over your ‘state of the art’ 300 pound 37” Big-Screen-TV.

You see, we could not understand why Domino’s had this technology; let alone the banking industry’s ATMs and long-time regular consumers of health services could not 1) count on the pharmacy ability to refill prescriptions without error, 2) count on hospitals and physician offices to keep our administrative and demographic information consistent between different clinics let alone the information most likely to cause therapeutic misadventure if not ported between points of care (allergies, chronic conditions and problems, medication dose schedules, history of procedures performed, emergency contacts, ETC.).

Those of us working to coordinate care and educate patients and families on the topic of Disease Self-Mastery commented “year after agonizing year” that “information is good medicine”; “missing information causes premature mortality” and “redundant information is expensive in both time and money”. The inability for a patient’s medical history to be stored for quick access and accurately portray the bio-psycho-social status of a person with chronic disease caused our clients to be branded as “revolving door patients”. Those who could not manage their own health-needs and were the reason for an exponentially rising National health care cost that policy-makers used to threaten future funding of our programs as we worked figure out the secret of the “secret-sauce”.

In 1997: Those of us attempting to manage our own disease, spent ridiculous hours each year documenting, forwarding, reviewing, speaking with new providers and writing checks to literally stay alive and productive for our families and employers.

Well, I would like to say it is all fixed! After-all, in 1997 we were in the era of the information technology bubble and the implementation of the World Wide Web so we left our clinical careers to work with “the geeks” to carve out a solution. We thought it would all be in-place by 2004! The problem you see; was that it took at least a decade to figure out what “the IT is” and what “the IT isn’t” and in –reality; in 2014 we realize that our issues were more related to “a social paradigm-shift” as opposed to the absence of technology. We are probably 50% there in terms of definition. We are 100% there in terms of technology and 25% there in terms of defining the rules and use-cases for the capture, digestion, analysis, transmission, and relevance ranking by work-environment to attaining the possible impact on e-Health to our collective experience, quality of life, safety and economic impact.

These apps ,, devices and vendors all connect to my HealthVault today.

These apps ,, devices and vendors all connect to my HealthVault today.

This year however is a turning point for us consumers that are the BIG-SPENDERS. By now you should note that your medications are ‘mostly (with sheepish grin on my face) correct between providers and that we can at least digitally sign and forward administrative and clinical documents between providers in milliseconds as opposed to weeks. Persons with diabetes, cardiovascular disease, cancer, asthma, head injury, auto-immune disease should be able to log-on to review all relevant clinical monitoring information, securely dialog with physicians and family members, download and upload data from home testing equipment, request refills and perform research whenever we are at Starbucks. There are some security glitches but if I can risk sharing my smart-phone with a shopping app. I can certainly use it to help me manage my healthcare.

 

 

 

I am retired now, slowed down enough to be ‘coined’ disabled but juiced-up enough to spend the foreseeable future gathering ‘consumer-power’ with my fellow ‘e-patients’ as part of this ‘e-society’; shouting out with my friend Casey, he nature of our needs and declaring the economic value of the products and services. After all, it is our game to change: Isn’t It!

PS: I do not have enough time and energy keeping-up with my blog. I do my best and return occasionally with a cerebral burp of two.  This is because finally, the world has a place for us: I am active as a volunteer with the Patient-Centered Primary Care Collaborative and make an extra buck or two pursuing a dream: The Diabetes Eyesight Preservation Program; where one patient convinced three physicians to treat anyone who needed treatment regardless of ‘ability to pay’!

Well, to be truthful: “They asked me what I was going to do with all of my time (tee-hee).”

 

 

The Medical Home’s Impact on Cost & Quality | Patient-Centered Primary Care Collaborative

Hopeful

VERY HOPEFUL!

Please take a moment to enjoy this recent publication from the Patient Centered Primary Care Collaborative. The success of the Patient Centered Primary Care Care should be spread far and wide!

If you have not joined us please consider membership.

http://www.pcpcc.org/

The Medical Home’s Impact on Cost & Quality | Patient-Centered Primary Care Collaborative.

Self-Interest as the cornerstone of failure in Americas Healthcare System

I fear we will lose  the opportunity to re-think the legislative changes required to assure the success of the Affordable Care Act. Instead it might simply die. My reasoning is clear. The original work lost all structural integrity in terms of economic sustainability. This was the outcome of supporters of the legislation sacrificing so many critical features to corporate interests.

I am exhausted and have few words left.  Why do we cling to fears, doubts and insecurities that were issues of the  Cold War.  “Oh we can’t consider universal coverage as this is a Socialist construct.

If we look round us, all civilized nations figured out a long time ago that universal coverage is mandatory for the economics of health-care to be self-sustaining.  Here is my response to a recent petition. I hope my readers will take it seriously.

Sue, I have decided to discontinue any business that UntangledHealth.com has with Staples. Then again, I only purchase two computers per year and will not make a dent in their bottom line. At the same time it is important for all to understand that this has less to do with the legality of the situation than the moral standards we choose to live by in America.We have a wonderful opportunity through a free enterprise system to create huge personal wealth. Personal, now translates to corporations as individuals. Self-Interest stimulates wonderful innovation yet unless closely monitored for “intent” will consume a society in short order.

 

 

Plenty of historical examples: eg: other empires. For those active in the E-Patient Movement or Patient, Family, Community Centered  Medical Home Movement or E-Health Movement you have a responsibility to weigh-in on the economic issues in health-care. Please add your wisdom, we need you.   JFH

Not an insurance company, just an empowered consumer.

Hopeful

Hopeful

My report for today:

Helped one more person register his family for an affordable insurance product using Healthcare.gov

Sequence

Met friend at 4:00 for dinner prior to our club meeting. Turn’s out he is lost in acronyms and asked for help.

Over the course of the next four hours we improved his ability to self-advocate, submitted an application and lessened his anger and fear of OBAMACARE.

My objective was met by my friends eloquent ability to inform his teacher of the many reasons OBAMACARE should have never been named OBAMACARE and his understanding of healthcare as it differed from earlier in the day when he could only think of it as “the monthly premium “or the cost of a subspecialists co-pay”; or “a communist scam”.

We ended the night with one happy conservative family man receiving a quote for his silver policy for a family of three. The monthly premium is $200 less than last years and his services have increased.

As we concluded the evening he asked if I ever thought of inventing a software program that would track all important health information for patients.  He had evidently been responsible for a $4000 co-pay on an $18,000 ER visit for chest-pain. This was mostly due to his inability to articulate a thorough history to the doctors on staff.

I described to him the importance of maintaining a relationship with a primary care physician and then logged on to MyHealthRecord at Duke and MS Health-Vault to demonstrate the rather rough but much better communication I had with my physicians and interoperability of pharmacy and EMR systems. Then I described how these data could be used to empower a person in an emergency with timely and acurate information. His conclusion: Jeesh, I probably would not have needed the expensive work-up if the doctors had access to all these studies!

One more convert.

So little time….

But one more convert.

Tomorrow’s agenda: Meet with ophthalmology practice to organize diabetic eyesight preservation program for non-Medicaid, uninsured folks in NC. So far, I have the cost of a vitrectomy reduced from $12000 at a local hospital to $4800. Not bad for a days work!

Jeff Harris

Not an insurance company, just an empowered consumer.

On Care-Giving

Heck! With health insurance we can afford a cup of coffee!

Heck! With health insurance we can afford a cup of coffee!

Please choose the correct response:

We are all care-givers at some point in our lives.

(Yes) (No)

We will all require care-givers at some point in our lives

(Yes) (No)

It is 3PM on a hot August afternoon in North Carolina. Gathering around my brother Bruce in the spare bedroom of my home are my father, my wife Carol, my brother s children and the occasional visitor.

Bruce is 54- although he stopped smoking fifteen years ago we are now tearfully sharing the last moments of his life. Through his semi-conscious mind, he listens to our conversation.

Leaning over my sweet brother I ask him if he would like some more morphine. He struggles to respond, reaching deep within himself and utters a raspy, lungs filling with fluid “JEFF?”

 

I respond with yes and again ask him if he needs more pain medication? Looking up he utters the last words I will hear from him “Yes. Please”.

At 8:30 PM, Bruce loses control of his bowels. My father, Carol and I gently roll him on his side to change the bedding. He struggles against us, yet we accomplish the task.  We quickly change the bedding, clean the poop from his butt and –like a newborn baby, turn him over on his side.

A small trickle of blood spills forth from his lips and his eyes begin to dilate. “My God He’s Gone” says my wife. Leaning down close to his face I stare into his eyes, tell him he is safe, he is loved and to “go toward the light”. Bruce takes one final breath in my arms; his body jerks and he is gone.

Collapsing on his body I scream out the agony of loss. Making sounds like a little boy I weep “My brudder, Bruce, Oh God”. My father falls on top of me. The man who fought in the Philippines, and buried his wife just one year earlier begins sobbing. We become a grief sandwich; my dead brother, my father, my wife and I: All piled up on the hospital bed. Finally…it was over.

Many do not receive the blessing of being present during the death of a loved one at home. For most, this episode occurs in a clinical environment; for a variety of reasons I suppose. But my career in medicine had given me sufficient insight to understand how ill-prepared our society is to “heal a person into death”.

Bruce and I had a contract. When he received his diagnosis 18 months previously we discussed –in detail- his wishes, the mechanisms to determine what the best treatment approach is; the statistical probability of survival and the financial cost his family in a variety of scenarios. One might think this is all done for us by our physician, or social workers, or ‘for-Gods-Sake” someone else. Unless of course, he or she has spent the last 34 years working as clinician, administrator and chronic disease program manager across all settings of healthcare. A new perspective emerges for folks with this occupational history. An awareness of true cost, profit margins and unending business opportunities that have gathered so much wealth for “value added” service providers in a free market economy. We also understand that in America, we spend twice as much per-capita on health care of any industrialized nation, have lower health outcomes and can be the only Nation to claim health care cost as the leading cause of bankruptcy.

Not so? Well, in 1996 I was flown down to New York City by my employer, a skilled nursing organization. My job at the time: Evaluate five patients who were permanently on life support and losing their financial resources. My company, under contract with NY Hospitals would move these patients to another State establish residency for the individual and collect the Medicaid reimbursement from the State where we were located. This reimbursement for a person on a ventilator was double the New York Rate.

As I deplaned from our corporate Cessna that day, one of the Senior VPS’ asked “How long do you think that last case you looked at will live Jeff”. You see, buried deep within that – statement was the profit calculation. I remember that night well. Carol and I had just been married. When I arrived home I sobbed in her arms; Fearing for all of us.

What do I know as a caregiver and care recipient who has had diabetes for 47 of 57 years of his life? Well, that if we have any sense of humanity within our value system and we are human: We will both give and receive care before we die.

Our system is not designed to accept death. As a result, where resources are unavailable many Americans are left to care for their dying loved ones with few skills. However, where the administrative processes are burdensome, we should also recognize the beauty and reward of helping a loved one cope with these phases in their life. In actuality I used to send patients home on ventilators having educated the family to care for them. They did just fine and in over ten years, no-one ever lost their life due to a family member’s ignorance or misjudgment. PLEASE: I BEG YOU TO ASK ME ABOUT THE HOSPITAL IN CONTRAST TO THE LAST STATEMENT.

I suggest that we include a social contract to educate our children as to the process of acquiring health-care and the personal commitment required for managing our cost-of-care as our system changes. High school would be a great place to start.

I know that we have choices but many of us in America do not believe we have any power when it comes to the treatment we receive, the cost of the treatment, the alternatives and best practices. If we did, we wouldn’t require case managers, patient advocates, Accountable Care Organizations to assure we are treated well. Heck, the new health reform assumes we are unable to do our own research or select the right provider. This is why these job descriptions exist and corporations are contracted to keep watch on the quality of care we receive.

I submit that this may be true for now. But I also submit a challenge to Americans:  A challenge for all of us to step away from our televisions and disregard sound-bites. A challenge to become self – educated consumers. It is not as complicated as one might think but you need to understand the shell game.

And by the way, the shell-game is not going away.

Turn off your television!

Holly Cow!!

Holly Cow!!

As I listened to the Senate hearings today I was very disappointed to hear our elected officials use your time and money to skew your opinion on the ACA. (ObamaCare). Many of these folks now profess to understand the complexity of integrating hundreds, perhaps thousands of separate insurance products with eligibility determination and e-commerce.

Turn off your TV. There is a great deal of good work going on. Stay informed through your own research. and do not rely on the interpretation of single individuals. Ignorance propagates  more ignorance and the consumers are always the target of distorted truth.

 

 

 

 

 

 

 

 

 

 

graphic rep of national hie

Provider and patient feedback 10/01/2013: and a diabetic finds his laser treatment.

Hopeful

True story:
Man with diabetic retinopathy
September 30, 2013 No health insurance
October 1, 2013 Accepted by NC Blue Cross for $284 per month
I am ecstatic!
I received a call yesterday: A report from an ophthalmologist friend who I am assisting to develop a diabetes eyesight preservation program: “Jeff, we are so excited; our patient y has insurance! Last year we performed his treatment for free. Now, after January 1st we will be able to charge for his laser surgery.”
“Great!” I said; “imagine how many sight years will be gained, now we just need to find them, get then enrolled and treated!”
By the way, this doctor is a dear friend; one of the guys; he and his partners have never denied service to a patient based on their ability to pay. He is slowing down now at age 67, brought on two new partners that are young, accepting of his philosophy and simply thrilled to be practicing their art. There is enough left to earn what they consider a good living and now expand their practice to those patients who have been afraid to approach the office ask for a favor.
This is the first good news I have written about in two years. I hope to continue with this trend!

 

 

 

Seeing the Invisible: Desperate for dental work, an all-night wait

Seeing the Invisible: Desperate for dental work, an all-night wait | Seeing the invisible | NewsObserver.com

 

The invisible North Carolinian waits in line for relief of pain

From Raleigh News and Observer Sunday August 25, 2013

 

I beg all to share this article on our dental care system in. North Carolina. This is only one example of a crumbling infrastructure as the policy makers in Raleigh decide to not accept solutions.

 

Since election of new state legislature and GOVERNOR MCCRORY

Highest unemployment rate:

  • Decision to end extended unemployment

Lowest teacher pay

  • No pay increase.
  • Yet. Pay to Governor Staff increased to $120K as he states “they need a livable wage”.

One of the most notable Medicaid Primary Care systems in the country with improvement in health quality and reduction in health cost for many years now.

  • Yet the legislature and Gov. decide to not accept sustainable Federal reimbursement for increasing enrollment in Medicaid, making healthcare unavailable to 500,000 people.

Reduction in substance abuse detoxification beds

  • Yet we have some of the highest rates of addiction and alcohol related teenage fatalities in the US.

Stipend for food stamps…..nah

Need so many papers to vote; it is as difficult as my Jewish relatives’ attempts to leave Germany in 1943.

Decision to not create a health exchange leaving a 3 company oligopoly to set insurance rates due to lack of competition.

The people standing in line for dental care in this photo are our neighbors. Can you imagine needing a root canal, being unable to eat, experiencing severe pain every time you had a drink of soda? Then being denied care?

Is this how it was in the 30′s Dad?

 HELP! The new Director of HHS has hired a 24 year-old with no experience in Public Health to be her policy adviser and his salary is $85,000; more than twice the pay of a teacher with a master’s degree.

Oh yeah, we won’t pay salary differential to teachers who achieve graduate level degree in education!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Seeing the Invisible: Desperate for dental work, an all-night wait | Seeing the invisible | NewsObserver.com.

Hold hands for a moment and a solution will come: Enough social debate on health-care.

Heck! With health insurance we can afford a cup of coffee!

Heck! With health insurance we can afford a cup of coffee!

How we spent our Summer, 2013

JeffreyHalbstein-Harris

Carol Lolley-Harris

On her way to work; my lovely wife Carol was “run off the road” by another hurried North Carolinian. Carol works in the Wake Medical Center Emergency Room. On this day she arrived by ambulance.

Click here for video

Proposed health insurance rates still closely guarded in N.C. – Greensboro – The Business Journal

Can believe NC?

Can you believe NC?

I know there is a rat around here somewhere.

I know there is a rat around here somewhere.

Here is a link to the NC Insurance Commission Oligopoly’s plans to inform its consumers of insurance rates.

Essentially, the rates are filed for 60 + plans to be released by three company’s of which Blue Cross is the only with statewide networks.

Proposed health insurance rates still closely guarded in N.C. – Greensboro – The Business Journal.

 

 

The citizens of my state are kept in the dark until Oct. 1st. After 34 years in the healthcare industry; with numerous projects and discussions with payers, providers and patient groups I can assure your readers that the decision to not publish rates on what appears to be 67 different health plans (Garner Cleveland-Record, 8/07/2013) is a proverbial ‘punch in the gut’ to the citizens of our State.

First our legislature refuses to accept the federal contributions for Medicaid Expansion, then decides to not participate in the creation of its own competitive exchange and now we are –like mushrooms; left in the dark with regard to critical information necessary for health planning.

In retirement I am working as a community educator with a focus on health services planning throughout one’s life. Most people in the US do not understand healthcare; the complex relationships between business entities; how these relationships inflate cost, an individual’s rights to receive care in accordance with best practice or the historical cost of services and products absorbed by an individual with a chronic illness such as asthma or diabetes: Let alone how to select an insurance company product by carefully evaluating future needs.

We all have the skill to purchase a car. We review the cost of the car and affordability of the monthly payment, we review Consumer Reports or Edmund online or Kelly Blue Book to ascertain future value, cost of repairs and so on. Then we make a rational decision based on the data. Or, like-me we ignore the data and purchase a car with noted mechanical issues and pray for a better outcome. Regardless of the decision we had the data to start with.

So, in October, the legislatures guaranteed oligopoly will release plan descriptions and member fees, then the consumer will need to evaluate their family health situation and make a best guess.

I plan to assist as many as possible, I do not sell any products but have worked in all three sectors of the industry, managed a disease management program and have had diabetes for 47 years along with other co-morbid complications. As the policies changed I managed to stay ahead of the challenges but it has been a struggle. I have never received accurate individualized information from an insurer, physician, or case manager who was employed by an organization fighting for its piece of the pie. The lack of alignment of value proposition alone has driven me crazy. However, when it came time for an insulin pump in 1984 as managed care took hold in America I received the equipment I needed through advocating for myself.

I predict the million or so individuals who are without insurance in North Carolina will begin receiving targeted sales and marketing information in September followed by a call from someone calling themselves a Patient Advocate. The encounter will be posed to educate the consumers when in reality the consumer will be driven like cattle into the sweet spot for the organization that employs the advocate.

It is a real shame…there are a few folks in North Carolina who can help the general public but they are scarce. To my friends in the trenches of population medicine, I ask you to step up and assist your neighbors.

Jeffrey Harris

919-779-7368

www.untangledhealth.com

Health Insurance Marketplace for Individuals | HealthCare.gov

Heck! With health insurance we can afford a cup of coffee!

Heck! With health insurance we can afford a cup of coffee!

Untangled Health shares revised tools for the uninsured. Enjoy the experience.

Please share with friends seeking information on both individual and corporate healthcare insurance exchange. Hopefully we will all see a more affordable premium: Similar to the rates published recently  in other states such as California.

For my friends in NC…Sorry our elected officials are not willing to evolve so those with incomes below 4 times Federal Poverty Level will not qualify for less costly Medicaid insurance.   

Anyway, click on the link below.

                Revised Federal Health Insurance Marketplace

Patient Care Alert! Don’t accept free self monitoring supplies through telephone solicitation without involving your physician.

IMAG0110Patient Centered Care requires patients and families to assume an active role in their health management.Recently, I have fallen victim to daily calls from “National Diabetes Supply Experts” offering free testing equipment. If I accepted  each offer I would need to change supply brands through requesting a new prescription from my Medical Home. This process happens thousands of times per week without the inclusion of the physician and patient in a discussion regarding the benefit of supply change. Your data, including diagnostic information (for me Diabetes) is being leaked, purchased or stolen. I have now filed a case for data breach through the OCR mechanism.

Your decisions matter: Not just for you, but for the Nation as a whole.

The priorities of Health Reform include improving access to services, medicines and supplies to all who are in need. One special population: Those with chronic illness; require recurrent refills for home monitoring and therapeutic supplies. For example: As a diabetic I require home glucose monitoring supplies and much more. The photo above shows my kitchen table while preparing for a business trip. You will observe that I have an insulin pump, a continuous glucose monitoring instrument, the associated catheters and an impressive array of prescription medications.

The cost of supplies to me personally exceed $5000 per year in addition to my current $800 per month insurance premium. The cost of my supplies to my insurance company also exceed $8,000 per year over the past two decades.

Now! Another purpose EQUALLY IMPORTANT of the Affordable Care Act is to make health care AFFORDABLE!

Because we decided to maintain a multiple payer system we continue to have a dichotomy between public and private funding sources e.g. Medicare and Blue Cross. As a result many entities are competing for your business as a healthcare product consumer.

Where we have free market, we have human entrepreneurial ingenuity. As I have said in the past, folks like me have always managed to figure out a way to maintain our cash flow during times of legislative change. So, lately: through the lens of a patient and former healthcare entrepreneur I have witnessed the following behavior:

Somewhere, somehow a bunch of mail order diabetes supply services have been calling my home. Over the past three weeks, the calls occurred daily from three different telephone numbers. Each call represented a different company and each agent had the same script:

“Hello Mr. Harris; I represent “Acme Diabetes Excellence” we have been chosen by your insurance company to provide you with a new technology for blood sugar monitoring. I need to collect some basic information to fulfill this order and your free supplies will be mailed shortly.”

No agent has been able to inform me of how they obtained my protected health information and not one agent has allowed me to speak with their supervisor. I have filed a HIPAA data breach complaint with the Office of Civil Rights but suspect nothing will happen.

Most insured diabetics today have multiple blood sugar monitors that have been given to them by their physicians, drug stores and other vendors to try the technology and conclude which device has the most appropriate for their life style. The meters are free because the profit is in the resale of test-strips which have retail prices between $10.00 and $50.00 per package of 50. Each b.rand will only work when coupled to the monitor given away through such wonderful corporate generosity!!

What these companies are doing is taking advantage of some database products that have evidently become available. I find this infuriating as the intrusion on my self-care plan which is negotiated between my medical home personnel, my insurance company and myself will serve no purpose other than inflating individual and aggregate healthcare costs. THIS IS A PROBLEM! IT CAN UNDERMINE THE EFFECTIVENESS OF THE ACA AND I AM ASKING FEDERAL CONSUMER PROTECTION AGENCIES TO RESEARCH THE ISSUE.

I support free market economies. However I suggest human behavior arising from free-market opportunity might be the largest determinant of uncontrolled health care cost escalation.

So, as we work toward building a comprehensive, coordinated team approach to chronic disease, let’s not forget the impact of our decisions when we select self-care technologies.

New post on The Healthcare Blog on Healthcare Cost and Business


This is a social issue: One requiring an amendment to our constitution which clarifies what was intended by the preamble’s reference to “Promoting the General Well Fare”.

I have little hope. After 34 years as a healthcare executive, therapist, HIT visionary and above all: Advocate for fair and proper service access to all US Citizens; I doubt I will have my needs met as a patient:

I also doubt I will ever see harmony between payers, providers, patients and the media. It is far too easy to become distracted by the numerous disparities and factors giving rise to our overall US population cost and the rage between stakeholders. The distractions allow all who work in the industry to define a spot for themselves where they are comfortable: Comfortable with regard to salary, comfortable with regard to business processes, comfortable when they create a new service industry within the market under the argument of cost savings and quality improvement; comfortable, comfortable, comfortable. It is far too easy to reinvent ‘value added’ services and industrial segments. No ONE is in charge. No ONE is willing to step-up and claim they are the Great Oz.

I began my career as a paramedic and then received credentials in respiratory therapy, cardio-vascular technology and pulmonary physiology. My work unfolded as I was promoted to department director and then division director in the first five years; as DRG’s were settling in and hospitals began finding new ways to make money in ancillary services. Healthcare –because of its capacity to rename, re-market, leverage known waste into ‘new savings’ and offer new technologies without utilization controls and proof of social value has been very good to me. My upper middle class salary increased every three years and when it became apparent that HMOS would begin purchasing business logic to approve and deny procedures, define lengths of stay and pummel physicians with outcome data I learned enough about each sector to add consulting value on both ends. Because of the dynamic legislation across both commercial and socialized sectors any entrepreneur could make an excellent living as long as he or she was personable and able to rationalize their behavior in terms of improving quality adjusted life-years for the 85 year-old golfing buddy who needs a second CABG.

Then…in 1989 I began a ten-year period where I retreated to offering disease management programs for folks with moderate to end-stage lung disease. We accomplished a great deal of good for many people in the last years (or months) of their lives.

But in the end I found myself arguing for my ashen patients who had lost their oxygen prescriptions when they rolled off of Massachusetts Medicaid because of a $1.00 per hour bump in salary. I found new ways to ‘work the system for payment for their oxygen’. The oxygen they received through a small machine which cost $750.00 retail was billed to payers at $299.00 per month in 1989 dollars. In 1997 I flew to NYC and other areas of the North East to review individuals who were dependent on ventilators in acute care facilities. The call for help came from the hospitals as they accrued huge losses due to the prospective payment on these cases that were depending on their life support. One day as I was stepping off of the company Cessna the senior VP asked to review my list of cases from the day. Taking interest in an 80 year old woman on the list he asked “how long do you think this one will live Jeff?”; “Is the family willing to transfer her and liquidate her assets?” His self-justification for asking the question was a simple knowledge that he owned an excellent group of rehabilitation hospitals. He was not the type of fella to consider the pain associated with separating a grandmother from her grandchildren.

I left this venture to work in the design of web-based continuous care plans for persons with Chronic Disease. However, even separating myself from the ugliness of clinical care that we all see in our lives I found similar behaviors wherever I went. For example: I had an IT start-up CEO fly us out to the 1999 Managed Care Conference. We had just released a very cool integrated transfer management system the previous month. The founder asked me to place a sign in our booth stating MEDICAL LOSS RATIOs 69%!!!! In essence, he asked me to repeat the MLR of the one brand new client that had purchased our new system the previous month. I felt ashamed and refused. (ref. MLR is amount spent on medical care / member fees)

Eventually I found myself in NC as I declared I wanted to learn about policy. I was hired to work with what I envisioned to be a leader in Medicaid community care management and care coordination. The years I spent in the public sector with special programs under Medicaid only revealed the same type of rationalization for ‘stretching the truth’ or creating political and financial pressure for physicians. The eternal mind-set; we know this is the right thing so we need to keep the program alive.

I found NC Medicaid to have a wonderful program. But, as in many situations in the past I felt boxed in to “the –insert corporate name- WAY”. I have found that questions as to data integrity or suggestions to reduce cost by deploying new technology that will remove a necessary contract with a friendly vendor to always be un-welcome. Many healthcare workers are content with status quo; some are not. So I became a consultant.
My last few years were spent listening to boards of directors who shared numerous conflicts of interest shift charity funding between duplicative projects. I thought the ARRA, HITECH and perhaps parts of the PPACA might make work more enjoyable. Unfortunately, I found myself asking an FQHC who had received $1M in stimulus funding to delay their deployment of telemedicine since they had no plan. I said this just as the checks were being written to purchase high resolution flat panels for the clinics and a local vendor was installing a new VLAN. This was my first day on the contract. After fifteen months they never did succeed with getting their VLAN up and running. I was however able to launch their desired remote-psychiatry service for children with ADDH. How…well I conferred with some geek friends, researched the legal security standards; drove to Best-Buy and installed a three clinic encrypted Skype service. My submitted expense report for the work was $250.00. The cost of the ARRA never implemented tele-medicine service across a new VLAN? $144,000

As a diabetic who is now retired after 44 year’s dancing with the disease and receiving SSDI at the age of 56 I feel as though I waited my entire career. My income is $2400 per month, I have some savings, little debt and many fond memories of the days with my patients. My insurance cost through my wife along with the ‘cost sharing’ pieces of my “cost of care”; roughly $1200 per month.

What I see happening is ONE MORE TIME…new products and services. Last week I was told my physician was to charge me an additional $1500 per year through the local university’s Integrative Health Program. The money evidently is to pay for better access and (I am not kidding) an interest in my LIFE GOALS.

The issue of the cost of health care in the USA has nothing to do with Physicians, Hospitals, HMOs, TPAs, Pharma, Therapists, Insurance Companies or any other entity. The problem is far greater than the sum of the parts.

A society has gone askew with its values when it treats “Well Being” and “Well Fare” as a commodity in a free market system. The value of “Well Being” varies for every person, or culture and when intertwined with the largest factor in “Well Being” in early life (Employment) the calculus becomes complicated enough to manipulate and confuse the masses.

Jeffrey Harris (BS, RCVT,RPFT,LRCP) All exams inflated salary beyond reasonable value for just one more Bozo on the Bus.
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Blessings

Duke Medicine offers to ‘show interest in my life-goals’ for $1500.00 per year!

 

My medical stuff for a 3 day trip!

My medical stuff for a 3 day trip!

February 2013

Last month my father called and complained of being ‘dumped by his primary care physician of 25 years unless he was able to pay an additional $2000.00 per year for concierge services. He said: “Jeff, Dr. Xxx’s nurse called and said that this new program would assure 30 minute follow-up appointments and 60 minute annual evaluations along with a 24 hour, 7 day per week personal communication with the primary care physicians in the practice. I told dad to pay the fee since he could afford it. With disgust, my 84 year-old father and former career NASA aerospace engineer told his Dr. to stick it where the sun doesn’t shine.

Then; on a personal level: I started visiting the Duke Integrative Primary Care program. They have made wonderful changes to my treatment after uncovering several unknown nutritional and biochemical deficiencies. Unfortunately, they tell me today that they will be pleased to accept my commercial insurance but no Medicaid and no Medicare. They also now require that I pay $1500 per year in addition as a membership to the practice as they are limiting the practice size to 600 patients. The administrative RN tells me that this is the only way I can get the services one would expect from a ‘medical home’ such as appointments of sufficient length to “ADDRESS MY LIFE GOALS”. With a smile, the RN says: “Well, with your background Jeff, you know that it is impossible to do without additional funding”. My response was to illuminate (with colorful words) the purpose and methodology of practice re-design when implementing Medical Homes. I find it hysterical that Duke itself claims to be a leader in their own primary care system in the evolution of Medical Home concepts and adherence to Meaningful Use Criteria. I find it disgusting that their ‘offering’ of this concierge service is really nothing more than what over 3000 physicians have been providing through NC Medicaid’s Community Care of North Carolina contract for a decade. I find it nauseating that we are continuing to squeeze profit from a dwindling consumer base and refusing services which are noted to be ‘best practice’ to the poor. People are people I suppose…and subject to greed.
I am writing this as I leave the Duke Integrative Primary Care clinic today, probably for the last time. These folks diagnosed my metabolic issues and low testosterone: I feel better. If I did not ask for the appointment with my “10 minute visit primary care doctor” she would have never referred me to the clinic. I will now return to her and when I am able to afford it I will return for further investigation and treatment of the many factors that decrease my health related quality of life.

March 2013

Note: I returned to my PCP yesterday March 15th, 2013:

She was angry that I had been placed on testosterone since she had worked me up last year for prostatitis. Had she read the notes in the wonderful e-HR that inter-operates with only duke physicians she would have noted that prostatitis is now ruled out, neurogenic bladder is the new dx and that Dukes own specialty physicians had started testosterone replacement with the intention of having primary care pick up the prescription writing responsibility.

She stated she would not write the prescription.

My next move was to walk her through the notes of the physicians she had referred my case to. I then told her that the Duke Integrative Medical practice would charge me $1500 per year if I needed to return to them for the prescription and that I would leave Duke and her primary care practice if she couldn’t address this with the other doctors on my health team.
My doctor says: “Well why would you leave, what is it that you expect?”
I followed with: “Dr. XXX; I would expect that you would have read the consulting notes prior to entering the exam room so we would not wind up in this tense situation where you are asking me to run all over the locality to describe your directions to my specialists as far as who prescribes what” ”Beyond that, I find your employer ‘Duke Primary Care’ attempting to drive my SSDI money as a private payment to their concierge doctors by not allowing the consulting physician to prescribe medications. In other words, he finds the chronic disease which is treatable with integrative techniques and then refers the patient to the front desk to get them enrolled with the two new primary care physicians in the concierge program.” “Furthermore, not only has this new system of care created a barrier to me getting the medications I need but it has done this by not addressing the educational issues that are clearly needed among their own medical staff.” “Oh yeah, one more thing I realize this is not your fault with the exception that you neglected to read the consult results. I believe this is due to the fact that you carry a case load of 2500 patients and become overwhelmed at times.” “Actually Duke has insulted both you and I. You call me whenever I need you and that is why I choose to be treated by your practice. In my view you have a nice start with your Medical Home right here. But your employer is selling a package wherein they differentiate the offering by noting that the concierge physicians are 1) more available and 2) interested in my ‘life goals’. I realize nothing will happen as a result of this discussion today because it relates to Duke Politics. However, if you think about it we have just touched on: Cost of Care, Quality of Care, Patient Satisfaction, Provider Satisfaction and reputation.”

She nodded, said nothing else; spent ten minutes reading my chart and looked up at me with a sad expression. She apologized for “not getting it right”: I responded with “You did not have enough information, you were not educated as to the changes in program marketing and none of this is your fault.” “I promise you that I will only take medications that are prescribed by you for chronic conditions once I return from the specialty consults. I count on you to interact with my other doctors and resolve conflicts on my medication list; but I need to trust the system of care.”
Dr. XXX of Duke and me are still together, we have agreed to how we will relate in the future and how we will survive in a patient-primary care relationship within the context of the Duke System. I think that what transpired over this last month models patient participation in medical decision making, cost control and providing feedback. I hope that my doctor stays with Duke, it seems their turn-over is quite high. Perhaps they should look at those data!

Dear Brother and Sister Patients,

You will find many physicians not agreeing with me when I state that all should have access to 100% of my health record, care plans and prescriptions. They might further disagree (for legal issues) with owning the responsibility of taking into consideration 100% of available information so may be less supportive of data exchange between electronic medical records. 

Please understand: We, that is you and I paid for a seamless ‘inter-operative healths record through ARRA-HITECH funding. Our purpose in asking for this feature was to make sure we did not fall victim to therapeutic misadventure e.g. a physician prescribing a medication that could interfere with your ‘well-being’. YOU NEED THIS as it is one issue, which we call poly-pharmacy that is responsible for well over 100,000 errors in medical practice per year. 

When your doctor gives you your visit summary which should include a problem list and medication list make sure that it correlates with other doctors in your treating team. You might just save your own life!

Governor “Boss Hog” McCrory announces plan to rekindle indentured servitude in exchange for healthcare services.

 

Blessings

Blessings

Human Motivation: Our legislature no longer needs to play cards close to chest; this is a Power-Grab

To the multitude of people and organizations interested in the cost burden of health-care services on the average Constituent.  Please pay attention as you attempt to change the course of a system rooted in 100 years of free-market philosophy: Where human ‘well-being’ is exchanged as a commodity for common currency. In other words: “nothing personal, this is just business”.

On any given day, at least 50% of North Carolina’s existing Medicaid beneficiaries are working persons without access to affordable health insurance. Many…work more than one job to make ends meet.

This statistic glares in the recent event of Governor McCrory’s decision to give his cabinet a salary increase of 8% (average = $108,000 per year). His logic…”They must have a livable wage”. No other State employees saw such increases.

Ironically, on Wednesday February 27th, 2013 Governor Pat McCrory of North Carolina signed into law legislation which prohibits NC from participating in the Federally Funded expansion to Medicaid. This single act will prevent one half million North Carolinians from becoming eligible for Medicaid Benefits. It appears he judges those without access to healthcare services to already have a livable wage?

So here are some facts:

My wife and I moved here in 2001 to participate in what was quickly becoming known as one of the best low-income chronic disease management programs in the United States: NC Medicaid’s Community Care of North Carolina. Working for Community Care of North Carolina, I participated as a team leader in implementing the first statewide care coordination and patient risk management systems in the US. Today, if you are in NC and on Medicaid’s CCNC program you probably have access to chronic disease management programs that are more organized and successful than ANY commercial service. This truth is illustrated by the externally validated reduction in emergency room reliance and improvements in chronic disease management indicators. The external validation has been provided by nationally recognized actuarial firms and schools of public health. In-fact, in North Carolina, one of only a few National Beacon Communities is a Community Care Network.

I enjoyed being part of this effort. Unfortunately I NOW SCREAM OUT TO MY FRIENDS: GET ME THE HELL OUT OF THIS STATE!

I am an example of many of those people in NC who were counting on Medicaid. One of the 60% who have been or are employed and cannot afford health-insurance: a 56-year-old male who within the last year was disabled from his diabetes; a disease diagnosed at age 10, a history of excellent self-mastery of illness. I received my first SSDI check in November. It will be two years before I qualify for Medicare and the $1200 per month premium simply does not fit a net monthly income of $2400.00. I would like to ask Governor McCrory, John Boehner and others of the same philosophy just what they consider affordable when it comes to healthcare cost as a percentage of annual wage?

Their answer unfortunately is either predicated on ignorance or selfishness. I judge that they are not ignorant in the least; although Governor McCrory of late seems to be believing some very questionable information which I have plenty of data to disprove.

How a boy from New England winds up in North Carolina:

 I came to North Carolina to assist the Community Care Program with the data architecture and clinical decision support data model for their Web-resident care coordination application CMIS. This model was a variant of one I had used previously while at Active Health Management the provider of the Care Engine Decision Support System to Aetna. Aetna purchased Active Health for $465 M in 2002. The system employed by North Carolina used similar data objects identified as Problems, Interventions, Goals and Tasks which were generated by Care Coordinators to create shared Care Plans for all Medicaid recipients who were high-risk and high-cost. Essentially, before most were familiar with the importance of Continuity of Care and Comprehensive Care Management: The Community Care of North Carolina Networks were leading the charge with over 600,000 people enrolled in their CMIS software. I feel blessed to have been a part of their success.

 So where are we eleven years later?

I left CCNC in 2006 to work on several national implementation projects utilizing components of what would become the standards for today’s Electronic Health Record. In 2009 I worked for my wife who was an assistance field coordinator for the Obama Campaign. Spending hour’s daily crunching data we were able to redirect or feet on the street to move over 4000 voters who were necessary to make NC a “Blue State” for the first time in many years. We did not do so will this last elections season.

Since 2009 it was obvious that I would need many of the health reform changes to have a satisfactory fall and winter in my life. The neuropathy accelerating, February 2011 was the last month in my career where I was able to work a full-time schedule.

I never worried about getting my needs met. Believing in my country I did not see how in the world Americans could decide to turn their backs on their brothers and sisters. I am quite naïve and I must admit my failure in ratcheting down a secure financial future with the knowledge that my chronic disease would take me out before the age of 60. I honestly was stupid enough to believe that healthcare would become affordable. I know better now…watching as we behave like toddlers in DC and seeing the disapproving looks on the face of men and women in my community when they speak of those ‘people’ who live on entitlements. Well, I guess they can include me in the group. I hope the next time I kneel to perform CPR on one of them (done this three times in my life); they ask me if I receive any entitlements before I start compression.

 

North Carolina Sacrificing Twenty Years of Community Medicine Excellence

Blessings

Blessings

NORTH CAROLINA! Who will you blame as it all falls apart?

Three days into office our new Governor, Pat McCrory introduced his new executive leadership team. I admire all of them. At the same time Governor McCrory adjusted each the salary for each position on the leadership team upwards by 8%.This occurred at a time when NC State Employees have seen no salary increase in several years. With no plans to alter the basic wage of a North Carolina State Employee, Governor McCrory justified the increase as follows: “Well, they all need a living wage”. The average salary of his staff exceeds $108,000!

As we moved into the New Year one of the first agenda items for the NC legislature was the consideration of how NC will participate in the PPACA program. As my friends in the ‘biz’ know, our health reform law allows each State to expand Medicaid by creating new classes for eligibility. Medicaid is the federally supplemented health insurance program for the disadvantaged. Usually the State receives somewhere in the range of 60%-70% of Medicaid Healthcare Costs from the Feds while making up for the rest through State taxes. The expansion will be covered by 100% by federal dollars and then be reduced to 90% after a few years. In addition, the States are allowed to establish their own competitive market basket for insurance plans called a Health Insurance Exchange or share a joint system with the Feds.

For detail on health-reform I suggest you all start at Wikipedia (http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act).

So far this year our newly elected legislature and governor have worked the press nicely by illustrating how expensive Medicaid is and then describing it as a management failure since many aspects of the system regarding clinical care are shared by several divisions (Public Health, Mental Health and The Division of Medical Assistance). These folks actually believe that partnerships are dysfunctional. I guess I agree with regard to administrative costs but certainly not clinical and regulatory expenses since the majority of the covered individuals have co-morbid physical and behavioral health problems along with social environments falling far short of adequate when it comes to primary and secondary prevention due to critical access and affordability barriers. This is not my judgment just a parroted agreement that I hear from the experts in public health. If you want honest expert data and opinion look at the North Carolina Institute of Medicine Website.

As of this week, a final vote has passed through the legislature to prevent expansion and the creation of a competitive insurance market. Instead, the governor and legislature will consolidate and use an insurance eligibility system titled NC Fast or North Carolina Families Accessing Service and Technology.

I was working for NC when NCFAST was funded. It is far passed its original implementation deadlines and I have heard nothing but complaints from the numerous users I speak to at conferences during the year. By the way, unlike smart business people like our new governor purports to be, the NC teams have built much of their own technology, guaranteeing the job security of the staff at the DHHS Division of Information Resource Management (DIRM). Most of my mentors taught me to keep an eye on the work occurring in large commercial sectors and evaluate their offering prior to deciding to build something on my own. I guess there was nothing out there ?

So…no Medicaid expansion AND no Insurance Exchange!!!!

I moved to NC to learn about policy and community organization. Why? Well, in 2001 this was one of the best environments to nurture my growth…as a citizen and as a person. About 4500 physicians collaborate on best practices, assessment of the overall needs of our population as well as the independent needs of their own geographic region. During my tenure (2002-2006) our teams assembled and implemented a fully operational ‘single sign on’ web-native care coordination portal for Medicaid. When we started it served nine networks and contained 250,000 patients. Today, it contains 14 networks and 2 million individual patient records of which around 200,000 are actively managed by one of the 14 networks. You can see why I wanted to move here (grin).

The time spent here has been wonderful regarding my initial purpose and mission. That said, I have learned that our species is threatened and there is no one or no THING to blame. It appears to be a genetic mutation and it is not recessive. In well over 2000 years we have learned that we are a social species in need of a safe container to live: Supported by a community of others; We have learned that we are responsible not only for our-selves but also for our neighbors and children. We have learned that we struggle with a self-obsessive demon that tends to reinforce the opposite axiom: “Only a society of self-interested, competitive individuals will thrive”. Yet in the end, we are all interdependent unless you have figured out how to bury your own remains.

I moved here because of the cool progressive patient centered care-system being created. I had a blast and observed the success. Eleven years later I am disabled, on SSDI from my disability and living on $2400 per month. I think I deserve it since I worked 34 years and paid my taxes. I have a problem though: My diabetes and other co-morbid conditions cost me $500 per month in cost sharing. My wife’s insurance plan costs an additional $500 per month for me to be added to the membership. I had counted on becoming eligible for an affordable plan through an Exchange as it would include benefits for folks like me. Now, North Carolina has decided to keep me out of their pool. The Affordable Care Act is designed to subsidize folks with decreasing stipends up to 400% of the poverty level. Trust me there are a lot of us in this category. It will cost me a bit to have the legislation as my medical equipment will have a surtax and I will pay additional tax if I want a Cadillac plan that covers removal of tattoos placed on my body sometime thirty years ago in some place that I can’t quite remember (just kidding).

Guess I will leave the blog for the night, please drop by on occasion. I am now documenting how I use the Duke Information Portals to manage my care. This week I taught two physicians on my five member team who are not in the Duke System how to access my data. When we reviewed my clinical notes; Medications, labs and tests a major shift occurred in my plan of care. I now have one less physician and am on a new medication that is improving my quality of life by 40% of so. I will create a separate post for this experience as I expect to add the material to the collective education material arising from the e-Patient movement.

 

Peace.

This photo was taken as I prepared for a three-day trip. This is just my medical stuff!

 

Much fun at the check in gate!

Much fun at the check in gate!

HIT at its best

Check out Telcare Cellular Enabled Diabetes Management Platform.

Now we have a example of a technology applied to address consumer and physician hassles.

One device for measuring, cloud storage, analysis and communication for the patient.

For the doctor: This could be the ultimate registry platform for diabetes specialists.

I am pumped…..well I use a pump but I was referring to something else.

Telcare.