Untangled Health

Consumers Unite To Drive The Changes We Need

Jeff

Chronic Illness Mastery Surviving and Thriving in a system ranked 50/55 by the Bloomberg Health Efficiency Index. (2016) I am a thirty five year healthcare industry career professional with a notable leadership track-record in patient-centered, population-focused care. My mission at this stage of my life is to assist the chronically ill with the personal health management skills necessary to assure wellbeing and safe experiences when encountering both private and public healthcare systems.

Interview on The State of Things “A personal history”

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

Dear Friends, I am scheduled to be interviewed on “The State of Things” on WUNC, this Thursday at 12:06 PM. This is a one hour event regarding the Opioid Crisis in NC. I am the first speaker and will be reflecting on my experience with the disease of Opioid Use Disorder as a young man and later in life as a chronic pain patient; chronic disease management program manager and work as a community health program performance evaluator today. I invite all to listen.
All of my work is converging on a common mission: To inform others of the Strengths, Weaknesses, Opportunities and Threats in our Healthcare System. My work with #RightCare is all about recruiting citizens from the grassroots of my community to participate in reform while keeping the best of what we have. America has much to celebrate when it comes to our achievements and much to invent to raise us up to our potential.
This week; two things come to mind: The opioid crisis and how it creates an opportunity for us to recognize addiction as a chronic disease and chronic pain as a leading cause of disability in this country. What should be done, what can be done and what we are doing. Then the budget work in DC: The fact that there is no continuing resolution to fund the Community Health Centers of America who serve some nine million people. This venue is the most cost effective and important part of our health care system and it will surprise all to find out how these centers beat out the commercial, healthcare apparatus hand over fist when it comes to health outcomes and cost management. I hope everyone is on their phones and email to request their representatives for funding I the new budget. If we lose it, the economic and health burden will be tremendous.
Always thinking of you,
Jeffrey
PS: #RIghtCare Join Now!

Public Health vs. National Emergency …Get real folks.

Last October Mr. Trump called for a Public Health vs. National Emergency releasing minimal (less than $50K per recipient agency)to address the Opioid Crisis. Yet today- as I review unpublished epidemiology statistics on Hepatitis C cases I find the trend that I have posted here! Well, for those that care more about money than the people afflicted by the disease I hope they can appreciate the fact that each case of Hepatitis C can cost $100,000 in prescription medications and that is the BARE MINIMUM of cost per case associated with the illness.
Just food for thought.

Loss of Federal Funding for repayment of Medical and Dental School Debt. How we are abandoning the poor and underserved in Healthcare Critical Access Regions


From our friends at NC Health NewsAs the Raleigh Area Right Care Alliance Chapter Leader I want to voice our displeasure at the barriers to financing a medical education that have recently surfaced. It appears our congress is succeeding at making huge strides backwards in the wonderful advancements toward improving the health of our most vulnerable populations.
I moved here in 2001 to work with the Rural Health programs that were implementing what we now refer to as Medical Homes. North Carolina was one of the most advanced states in the Nation when it came to addressing the needs of poor, chronically ill children in rural locations. I was thrilled to have the opportunity to work with these projects which have received national awards for improving the health and controlling the inflation of healthcare cost of high risk populations. I can recall late night meetings with physicians working for roughly half of what they could earn elsewhere as they paid the government back for the opportunity to go to medical or dental school and later serve people in critical access areas. Their sense of generosity, expert knowledge and willingness to contribute are the highlights of my career.
Regardless of the data, the US Congress and the NC General Assembly have made terrible mistakes that will severely impact the health status of our poor. They will claim otherwise but as a professional healthcare program evaluator I can honestly say they are making counter-intuitive decisions that deserve a public challenge. We intend to do this through public education events in 2018.
Tonight I am thinking about the complications with dental hygiene and periodontal disease that our children have in this State and the success of our Federally Qualified Health Centers at treating these kids, their improved health outcomes and more importantly chance to have a healthy life free of chronic disease which is brought about by chronic inflammation.
I will pray for the well-being of our children as it becomes more difficult to find providers willing to serve them. History repeats itself unfortunately and we have plenty of experience that illustrates the suffering and loss of health in populations that are underserved.

Why We Need Universal Health Coverage

I am disgusted by the frequency of the statement: “Universal Coverage… We can’t do that… That would be Communist!”
As opposed to falling back to arguments relating to the Cold War (although Mr. Trump and Mr. Putin would be happy to re-engage past behavior) how about we look at EVERY OTHER INDUSTRIALIZED NATION IN THE WORLD and compare their health care financing strategy and health outcomes to ours. You see: We stand alone in the World. We are the only industrialized nation that refused to believe that the math of population health science (simple arithmetic) forces civilized nations to pool money and spread it across the entire population of infants, children, young adults, middle aged adults, young-old adults and old-old adults to bring the average cost of health care down to an affordable per-capita rate.
Here are the data from the 2016 OECD Report. You have heard of these folks haven’t you? They met in KOBE in 2016 to discuss global health.

The Study

How these countries finance healthcare

Nothing is different. The older you are, the more health care services you consume.

How long ago each country embraced Universal Coverage

Yes, the more you spend on health care the longer you live. But why is America so expensive?

The more you spend out of pocket the shorter your life span. The more Primary Care Doctors you have per unit of population the longer you live!

A reason we all need someone to watch over us when hospitalized!

As discussed in several posts between December 2015 and today I call upon healthcare consumers to “Learn the System”. The Service Excellence, scores, JCAHO ratings and next door neighbor reviews of your hospital mean little if you are a statistic. Infection Control, Readmission Rates and other measures of quality are available at: Medicare. Gov | Hospital Compare! Please write me if you have questions. Feel free to ask about the numerous Therapeutic Misadventures I have witnessed that will never show on a quality report.
The Trump Administration is doing everything it can to cut the legs out from the transparency tools that were put in place under the direction of the Obama Administration. These tools are all you have to evaluate the quality and safety of your institutions and providers.
Consumers step up and demand the care you deserve – AND PAY FOR!

Medicare Penalizes Group Of 751 Hospitals For Patient Injuries

The federal government Thursday lowered a year’s worth of Medicare payments to 751 hospitals to penalize them for having the highest rates of patient injuries.

More than half also were punished last year through the penalty, which was created by the Affordable Care Act and began four years ago. The program is designed as a financial incentive for hospitals to avoid infections and other mishaps, such as blood clots and bedsores.

Get The Data: See All 751 Hospitals Penalized

Is Your Hospital On The List?

Get the dataHere are the 751 hospitals hit with safety penalties for 2018.

The penalties again fell heavily on teaching hospitals, although less than before. A third of them were punished this year, a Kaiser Health News analysis of the penalties found. Last year, the penalty was levied on nearly half of the nation’s teaching hospitals.

The 115 penalized academic medical centers this year include Denver Health Medical Center, Grady Memorial Hospital in Atlanta, The Mount Sinai Hospital in New York City, Northwestern Memorial Hospital in Chicago, Stanford Health Care hospitals in California and the University of California-San Francisco (UCSF) Medical Center, according to federal records.

“Academic medical centers serve patients with more-complex conditions who are at greater risk of hospital-acquired infections (HAIs) compared to community health care providers,” Stanford Health Care said in a written statement. “Hospitals with a high rate of immunocompromised patients will always seem to have higher HAIs.”

Hospitals that treat large proportions of low-income people also were fined more than hospitals with a more affluent patient base, the analysis found. About a third of those safety-net hospitals were penalized, roughly the same as last year.

Can you believe this one?

I found my Peeps. Why I joined The Right Care Alliance

To build a new system we need the voice of millions struggling to survive as they try to understand, coordinate and afford America’s health care resources

 

Since becoming disabled I have dedicated my time to reforming our healthcare system. My drive emerged from my experiences  living with diabetes and other complex co-morbid conditions since 1966 coupled with my experiences working within our healthcare system for thirty-three years as a hands-on the caregiver, administrator, program leader and HIT visionary. To date: After five years of dedicated personal time I located only one organization –PCPCC that brought all of the Stakeholders together necessary to alter a system that has failed so many. My work with PCPCC brought me to Washington DC and opened other opportunities to influence legislative language, such as the variety of submissions to CMS for defining the Patient Centered Medical Homes. That said, where the work and effort was worthwhile, I have reached a personal conclusion that the American Health Care Apparatus needs to be designed and implemented from the bottom up. Without soliciting opinion, educating the people about our failure in moral values we will not realize our dream. A long-time fan of Continuous Quality Improvement in medicine I notice a missing feed-forward element in design when it comes to our national perspective: The Patient Perspective. Much is celebrated about patient-family inclusion in health care delivery design yet I fear what we celebrate is often the result of Service Excellence Performance Surveys, JCAHO and CARF reviews, NCQA Accreditation Surveys and other attempts to qualify and quantify processes that have not fulfilled  my personal criteria for “Going to the people”. If we are going to do this thing: We need to start over. The Right Care Alliance is on track and I am thrilled to assist with the integration of the proper minds and voices necessary to build a functional health care system.

Since becoming disabled in 2012 I have discovered what I consider to be a lack of attention to those consumers who are the most under-served; at times I fear a lack of respect for their capacity to contribute. My sense is that the arrays of NFP organizations working to define methods for health care reform and specify a concise mission are struggling with their identity (excluding folks like Families USA). Organizations such as The Society for Participatory Medicine actually have membership fees which prohibit some from joining in the effort. I participate in the private conversations among leaders and have brought this to their attention. They do however have a scholarship program for membership dues. Where the intent is respected this is hardly the mechanism to attract contribution from the community or patients who are actually the consumers accounting for 50%-70% of America’s health care budget.

When I analyzed the membership roster of S4PM in 2015 I found that 32% of their membership identified themselves as patients first. Confused, I brought this to their attention. One year later, many more patients emerged. These were mostly individuals who had more than 16 years of education and were actively engaged in other professional activities. We need these people, but once again they hardly represent the grass-roots of the healthcare services consumer.  Their mission is decidedly not health care reform, but focused on bringing patients and physicians together to form collaborative medical teams. We need these people in our discussion as we create our new system. However, I suggest their priority is not the same as the System Reformer for without a system that guarantees a bio-psycho-social care plan to all Americans we have failed. Other Patient-Centered Organizations such as Patient’s Like Me are providing a service and at the same time a clever disguise for a population research database that is funded largely through the Pharmaceutical Industry.  Patients like Me (I am a member)offers the opportunity to establish a virtual peer-support community and access to treatment guidelines and research. I love this system as it brings folks to my kitchen table that help me address the chronic pain I deal with each day, but at the same time I recognize we are freely giving away personal health information in exchange for the service. At the other end of the spectrum I have found Veritas Healthcare  where a small group of physicians, administrators, non-physician caregivers and patients are creating a new definition for those actively involved in saving lives from day-to-day through pushing the limits of healthcare reform in their local communities. They brand themselves Health Angels, I am a member and contribute to their initiative. We are many AND We are scattered.

Over the years I have come to fear we will miss an opportunity to establish a driving force as the most important voices in health care are lost or diluted through the diffusion of their input across an “over-abundance” of the organizations soliciting their involvement. Always anxious to help these stakeholders will easily donate a lot of their energy toward the cause “Fixing Healthcare” but once they sense they are being exploited will drop-out and assume a protective posture.

With experienced leadership, funding and most-importantly Humility I sense there is sufficient energy to establish a ‘critical mass effect on re-writing America’s plan for supporting the Health and Well Being of its citizens in future generations. That said, the barriers are many: Our present leadership in DC and a misinformed public that is being split into near civil-war we struggle to overcome the noise. So… time is of the essence and somehow, someway we need to corral these voices and experiences (hence knowledge) that is scattered throughout the internet, inner city and rural America into a single force. My prayer is that The RightCare Alliance will provide the necessary gravity to bring us together.

“Obamacare has no value”…”Until it has value”

I assisted a man with insurance enrollment yesterday on healthcare.gov. He had recently lost his job and was looking at a $1000 per month COBRA rate.
A conservative fellow who didn’t support “Obamacare” now says: “For the first time I like this legislation and can see why it is needed!”
His rate while unemployed?
$85.00 per month for low deductible.
One down, thousands to go!

A Patients Gripe with Donald Traumatizing the sick and suffering: How the President of the United States intentionally injured the health and well-being of the Chronically Ill.

Thanks Donald: As if the chronically ill don’t have enough to worry about, you have successfully created a barrier to our choice of health care plans.

Each year those of us who live with chronic illness spend weeks researching the plans made available to us through the Affordable Care (Obamacare) website Healthcare. Gov. We spend hours upon hours calculating our drug costs, assuring our primary care doctors are in a plan or specialty care networks that provide services such as retinal surgery, dialysis, exercise prescription, nutrition and counseling to persons with diabetes are available to the consumer. Many of us are in-line for Medicare within the next decade or so. For example, a person with diabetes or cardiovascular disease or in many cases BOTH is gainfully employed and adding value to society throughout his or her life. These folks –like myself-  live with a chronic progressive illness and spend much of their time managing their health to avert the need for urgent care services and maximize their well-being. Then… years into the illness, they find themselves taken leave of their full-time work due to the complications associated with the disease. For me, it was neuropathy at age 58 after nearly fifty years of successful self-management of diabetes. Once on the roles of Medicare our health care expense  (of interest to you I am sure) is directly related to the quality of the interdisciplinary care team that supports us in our daily self management. In the mid to late stages of chronic illness we have spent years cultivating our resources to maximize our health, functional status and quality of life. This occurs before Medicare and for many of us who went uninsured or under-insured prior to Obamacare we have had several years to bring these providers into our Care-Team and stabilize our decline in health status. As each enrollment period rolls-by we peruse the plans available to us and select those that support the providers we have selected or are intending to add to our network if certain problems arise (example, diabetic retinopathy).In case you didn’t know and I am sure you didn’t the chronically ill account for over 50% of the Medicare Budget yet represent only 10% or less of the population depending on whose statistics you are referencing.Here are some interesting statistics regarding the cost of care for Medicare Enrollees straight out of YOUR CMS Chartbook! So here we are, stressed out and trying to figure out where to get the time to select the health plan, we need to reduce the complications from the chronic illnesses we live with. All of this having direct relationship to the resources we will consume when we are transitioning to Medicare. Perhaps you will be long out of office by the time our cost hits the taxpayers back pocket and it isn’t an issue to you. Your political desire to be seen as a barrier to the ACA is more important. It can’t be a financial issue, Donald for any ten Medicare Patients with Chronic illness who experience significant progression of their illness as a result of choosing the wrong insurance plans during your presidency will far outspend any savings you introduced through cutting access to the Healthcare.Gov website. NPR article on Navigator Frustration

 

My Overstressed Physician (Prior Authorizations, Referrals, Stress, Prescription Assistance Programs, Electonic Health Records and More)

The following video covers just one aspect of my concerns regarding the infringement on Patient Centered Care by the “Business of Medicine”. I have reflected in the past about the cumbersome “Business Process Centered” components of health care delivery that prevent our providers (Doctor, Nurses, Technicians, Therapists ETC.) from focusing on the “Big Picture”. What I am referring to are the dimensions of health that require thorough assessment and attention to detail for the treating provider to accurately judge what is happening in our body, draft a treatment plan and execute the orders. Right Care to me is my team’s full understanding of my biology, culture, mental health and physical health needs, the social roles I play in my community and the support available in my community when it is necessary for me to stay healthy and productive.

During my visits to my doctor the processes’ of assessment, diagnosis, planning, intervention and monitoring are interlinked and any disruption will present a barrier and possibly introduce an error in treatment or missed opportunity to cure a silent condition. These missed opportunities to improve our health are often referred to as Co-missions or Omissions in care. Co-missions occur when our medications interact and cause an exacerbation of an existing illness or cause a new illness to occur. An example might be the treatment of a person with Diabetes who is taking insulin with a Beta-blocking drug such as Metoprolol. This might cause hypoglycemic Unawareness  and the patient will not be aware of a low blood sugar. An example of an Omission in Care  is when a patient is unable to continue taking a medication. The lack of evidence of prescription refills in the patient medical record might create and alert for the doctor to review, but one cannot assume that this is always the case. Beyond being aware of the missed refill the doctor or the clinics Care Coordinators should follow-up with the patient to determine the reason for non-compliance with the patients care-plan. In America financial reasons often prevent us from being able to adhere to our medication regimen and the answer to the dilemma can be as simple as contacting the drug manufacturer and applying for funds through a Prescription Assistance Program. The #partnership for Prescription Assistance is an organization that will help those with financial resource issues. So, what do you do if your doctor doesn’t have the time to spend educating you to look out for hypoglycemic unawareness, refer you to a Prescription Assistance Program or get transportation to the clinic each month for your periodic check of your blood clotting time? Should all of us be self-sufficient with these skills? I suppose in a perfect world this might be the case, but I certainly wouldn’t place this responsibility on the average lower to middle class patient today. We are far too busy just making ends meet and in many cases our health suffers.

Electronic Health Records were our great hope for unburdening the provider and the clinic staff from clerical activities that are required in the day-to-day management of a population of patients. The average primary care provider often has 2000 patients unless they are a concierge practice; which the average Joe or Jame cannot afford. Your referral to the laboratory for routine blood sampling frequently requires the doctor to link the appropriate diagnosis with the lab test or the chart will not close out after the visit and the order will not be communicated to the lab  performing your test. Today, I watched my doctor and his “documentation specialist” carefully navigate several screens in the EMR as the doctor ordered various labs and cross linked them to my problem list. These processes make a lot of sense when they relate to care quality. For example, you do not want a doctor to order tests that are not going to increase his or her knowledge of what’s ailing you.  However, in the cases I see today; and I see a lot since I am a person with multiple chronic illnesses: My doctor is dancing to the tune of the Insurance Company and looking over his back to make sure he isn’t over-utilizing or mis-utilizing his privilege to order expensive diagnostic procedures: When I see my doctor stressed out,  rushing through and missing pieces of his exam: I start to fret that he will leave his present employment and I will lose yet another good primary care physician (I have lost three in the last five years for these reasons).

So my doctor is overwhelmed with filling in the correct fields in a health record to avoid penalties from his administration. My quality of care is declining. The burden in my opinion is a caused by an over-complicated system created by folks interested in the possibilities of Big Data AND the residual business process requirements of a Managed Care Business Model that no longer is valid since our doctors today come well prepared to make high quality decisions based on the published  best practices emerging from the literature accompanied by embedded decision support in their information systems; or has someone been fibbing about what the technology does for us?

Are you willing to step up and work with your doctor to define and deliver the Right Care by the Right People, at the Right Time, in the Right Place?

 

Right Care Action Week Event

Untangledhealth.com conducted a Right Care Action Week Cafe for The Right Care Alliance on October 19th at Elder Path Raleigh; an MKP.org Men’s Group. We discussed, engaged, educated and empowered this group of elders to master their future health through selecting providers and institutions that offer  the highest quality, highest value services with proven integration of clinical services throughout the continuum of care.  I am excited to see this community of men step forward to model active consumerism in Health Care and dedication to teaching their peers the methods consumers can use to evaluate their regional resources. 

Topics covered included the Self Advocacy Process, Selection of High Quality Health Facilities and Providers, The Five Wishes, Transitional Care Hazard Avoidance, Medication Cost and many others. As always, UntangledHeath.com’s desire is to teach patients to advocate for themselves and their families.

We look forward to working with the Right Care Alliance in the future.

The pictures below include slides from our discussion. I will be recording the entire presentation soon!