Untangled Health

Consumers Unite To Drive The Changes We Need

Tag: Advocacy

An advocate gets busy while every politician and “talking head” takes credit for healthcare model ideas published long ago.

Reconciling data in my six health portals

Reconciling data in my six health portals

I watched Barbara Starfield again last night. She passed away in 2011 but it seamed as though she was sitting in my living room telling me everything will be alright but many of us will never get our way. Barbara spent several decades studying the characteristics of health systems all over the world. Her final conclusions were simple and easy to implement as long as social agreements were made between consumers of healthcare services and their providers. The contract (sort of) is that my primary care doctor will be available when needed if I promise to contact his or her office before going to the ER for an earache or other non-emergent condition; my doctor also agrees to follow my care as I transition through life stages and address all mental and physical health conditions as they arise by assuring I connect with the correct specialist if required. The specialists in return are in constant contact with my primary care doctor so the primary care clinic is coordinating continuous and comprehensive care and reviewing all interactions between myself and other medical environments. Like I said earlier this week. Someone to watch over me. I first learned of Dr. Starfield in 2001 and followed her publications. Funny, she was never accepted to sit on any best-practice boards but the scientific community considered her work to be spectacular in terms of statistical approach and quality. In other words, she looked for the null hypothesis also.

Again…concerns over repeal and replace.

Some more diatribe with hope at sarcastic humor is written for you below. Please follow through to the end as I pasted a really cool graphic pointing you to a new society of consumers and professionals that might fix the system over the long run.

The conversation doesn’t stop at my dinner table, on my phone, through IM or Facebook. It seems as though my popularity index took a healthy bump after November 8th, 2016. I wish I could be happy about the reasons for the traffic.
“Jeff, you are on Medicare are you concerned?”

Well yes; you see, as we become older the likelihood of needing assistance from case managers, specialists, short stays in skilled nursing or rehabilitation facilities increases. Same with home health services which is always the preferred place to recover from the self-inflicted fractured hip that occurred while my masculine ego informed me of my capacity to clean out my gutters.
One of the most important changes to the clinical language coming from Obamacare is the right for all patients cared for by primary care doctors with Medicare contracts to receive “Coordinated, Comprehensive Care”. Lately you might have heard the terms: “Patient Centered Care” or “Medical Home”. You probably heard President Elect Trump mention “Patient Centered” or a new commercial by Humana presented by a handsome young doctor stating that Humana’s system of Patient Centered Care is superior because of their capacity to coordinate your care within their “medical community”. Then you will watch a local conservative pundit state: “those stupid narrow networks tried through Obamacare didn’t work: here is a toast to repeal and replace.
This stuff cracks me up for the same proponents of patient centered care realize that closely collaborating narrow networks can provide you with clinical personnel that understand your needs better than anyone else! In fact, they have the same attributes of a Patient Centered Care Team using a single medical record and plan of care to increase safety and minimize mistakes. Yet you will hear no one (perhaps save me and a few of us that are tired of scraping the poop off our boots) tell you that the words Patient Centered, Narrow Network, Accountable Outcomes, Value Added Payment, Medical Homes, and all other terms implying a tightly coordinated, error free clinical team surrounding all patients are not original concepts. In fact, they are in place in many of our successful neighbor nations who provide universal enrollment and have always demonstrated lower reliance on emergency room services for basic medicine, better health outcomes and no difference in treatment effectiveness for cancer, diabetes, cardiovascular disease and other leading causes of premature mortality. Our own CMS (The Centers for Medicare and Medicaid Services) have published the policy here July 2016:
So all of a sudden the administration of 2017 will be using terminology invented by others to describe care models that work after years of academic surveillance by healthcare policy analysists and already written into The Patient Protection Affordable Care Act or what the opponents call “Obama-Care”.
My prediction is we will keep the new payment systems for coordinated care and chronic disease care management. However, the credit for the success will fall under a new Trump label. My fears is that the same three insurance companies comprising the oligopoly of payers for American Healthcare will recoup their lost profits of mandated care without premium inflation for the chronically ill by shifting the premiums higher for those with pre-existing conditions. So here is another question from the week:
“Jeff, what will I do now I couldn’t get covered because of my history of cancer before the ACA?” “What if “Trump-care” requires coverage for pre-existing illnesses but allows insurance companies to include the illness in the premium pricing model? “ My response to this question was “not sure, my cost in the NC High Risk Insurance Pool for my diabetes prior to Obamacare was $1200.00 per month not including co-pays. Today it is $350.00.
More on Patient Centered Care AKA Medical Homes AKA Integrated Care AKA Chronic Illness Care.
I discussed the integrated care model and its payment adjustments to my Men’s group on Thursday night as they requested a primer on planning for their last ten years of life. Their hope was that our system of care had evolved and they would not have to lose their homes to cover the long-term care charges. Many of the guys in my group neglected to buy long term care insurance when they were young and healthy, had since suffered a chronic disease diagnosis and episode of treatment and no longer qualified for long term care insurance. They could however place $10 K per month into an account to pre-pay up to one year of long term care. This is what my father did: In 2006 he entered into a contract with a transitional care organization. He paid them $350,000 for full access to assisted living and long term care until his death. They also allowed him to live in the attached apartment complex for independent seniors for an additional rent of $3200 per month including one meal per day. Not a bad deal eh? Oh yeah…one more oversight: My friends ; all retired upper middle class professionals had no idea that Medicare didn’t pay for long term custodial care either in home or inpatient facility.
Now, like I said the other day, I am a bit tired of shouting the truth to those who were unfortunate enough to buy into the following promise: “Oh we will have the most wonderful healthcare system in the world” and “We promise to repeal the expensive policies and replace with something better.
We were on our way folks: The biggest mistake, President Obama’s team was denied the necessary Medicaid expansion for ALL not SOME States by our supreme courts. If you don’t understand the math I will be pleased to describe it in another column. Basically when the folks that would have had access to Medicaid don’t receive the insurance they still consume services. The loss of revenue winds up on the balance sheets of hospitals and providers and they respond by increasing their cost per service. The insurance companies pay more and your premiums increase. So… my neighbors policy (55 year old male) in NC costs $11,000 per year. The very same policy in New Hampshire where they expanded Medicaid costs $5,500 per year. As Mr. Obama leaves keep in mind that the rate of increase in health costs since the inception of Obama Care is the lowest it has been in 40 years.
Somehow, someway; we need to cover everybody. If we do not we cannot cover the losses incurred in the private sector without the Magical Thinking that has been sold you for so many decade. Hide the losses, get others to pay for the losses through modest increases in cost of living and blame the doctors, and hospitals who give away more free care than you could ever imagine.
What would happen if our incredible consumer driven internet harnessed the decision support technology that we use daily on Amazon and instantly brings the right service to you when needed should you or a loved one become ill? What if we harnessed IBM Watson to make the diagnosis thereby reducing error rates and reducing unnecessary utilization of expensive diagnostic procedures?
What if we didn’t need insurance companies any more to assess population risk and perform preauthorization services while we waited for our new medication?
Since we have all of the data connecting lifestyle, culture, nutrition, infection and the human genome can anyone appreciate where we are headed with our capacity to discover the cause of disease and effect of treatment? This is not decades from now my friends; it is within the reach of our children’s lifetime. I have wonderful friends with incredible scientific minds that are creating open source technologies to accomplish human collaboration like humankind has never witnessed. The only barrier to their success is a loss of priority to cure disease, increase well-being and expand the functional-years of human life.
Or…we can keep these technologies secret, forget those we have developed through the natural sequestration of competing private enterprise and traditional silo thinking. If this is where we are headed then the best investment to assure a painless end of life if you are not surrounded by humanitarian friends is my undying support for the second amendment. If you catch my drift.

Check out Right Care Folks!

Right Care Now

Right Care Now

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

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.

Trouble Across the Pond. Once again, no one to blame but everyone. Look at the entire system for your answers.

A good day

Once again my friends, any system which places organizational success in the media, executive bonus, or ridiculous ‘service excellence’ survey results over clear-cut measures of process, and medical outcomes first will lead to suffering. Suffering of patients, families…our identity?
Recently, in Raleigh NC a large hospital system has been cited for Medicare fraud (Wake Medical). As the story unfolds the CEO stated that a single mid-level manager from Patient Services changed physician’s orders to charge Medicare for multiple episodes of care as opposed to observation days only. I find the sacrifice of lower level employees horrific. I also know this to be a common behavior in the US.

These problems are systemic and global. They specifically speak to a decline in the humanity of ‘human services’.

There is a lesson in this video from across the pond.
Pay attention to the proposed Standards and compare to what we have or do not have at home.
Consumers of services (yes us patients):

Please do not accept lip service as transparent publications on safety and quality and cost are promised under the new health-reform act. Scream out for standard reporting, standard methods of measurement and reliable statistics.

Grieve please! Step out of your head and grieve.

cemetary at duskGoodbye little angels: Thank-you for the gift of sacrifice; providing one more opportunity for us to share common bonds.

Your day brings us together: BLOWING AWAY our capacity to…
Explain,
Politicize,
Theologize,
Secularize and
Personalize…

I hope.

Perhaps we will take this moment to sit together
And grieve…

Take a chance, dispense with our differences and share the love…

Yes, LOVE
The Glue of the Universe

Jeffrey Halbstein-Harris: December 14th, 2012

Would someone clean this mess up?  "Oh...that is our responsibility; never mind"

Would someone clean this mess up? “Oh…that is our responsibility; never mind”

A National Message: Your Physician is Waiting To Help You Untangle Your Own Healthcare

 

The prevalence of incorrect information in healthcare records becomes frighteningly clear when a new doctor asks you how long you have had the brain-tumor that you didn’t know about! (Personal experience last year, luckily I was able to inform her of the fact that I did not have a brain tumor)

This presentation clearly illustrates the importance of patient and family familiarity with their physician’s medical record notes.

For those of us who have difficulty remembering numerous encounters with the medical profession, the names of our medications and the procedures we have required; we now have an opportunity to both improve our care and prevent hazardous errors.

I anticipate the maturation of secure communication and documentation technology across the web over the last decade will significantly reduce morbidity and mortality once consumers weave the electronic health record process into their lives to the degree they now engage social media services. I encourage all of the patients I work with to become part of the solution through self-advocacy and engaging with on-line organizations such as #The Society for Participatory Medicine.

Please enjoy the video below and this new Forbes post:

Finding payment assistance when you are not insured

Okay……. I just had a cold realization that I needed to write something quick so folks do not automatically believe that they are not insurable. This comes after a friend who was employed as a master’s level case worker called me for help. She was disabled last year and is now on Social Security Disability Income. She was not assisted with enrollment in one of the numerous options available.

Medicaid, CHIPS etc.

First off: If you are receiving Social Security Disability you should either have Medicare or Medicaid or both. In some instances you may have a policy from your former employer. You can call your county DSS for this.

If you fall below a State determined percentage of Federal Poverty Level Guidelines you might qualify if you are a female with children or pregnant. In addition if you have children they may qualify for a program called CHIPS Children s Health Insurance Program. Once again your County’s Department of Social Security will assist you. 

If you are poor and over 65 years of age you may qualify for Medicaid assistance for the elderly.

If you are blind you will qualify for Medicaid as well.

Here is the Federal Poverty Guideline Table:

 

If you have chronic illness and are not disabled, not female with children, not over 65 years of age, not blind and not financially exhausted:

Medicaid is financed through State and Federal resources. I believe States this year pay 35% with 65%b coming from Federal Govt. If your State elected to use the Federal expansion money for Medicaid you may qualify for one of the new eligibility category’s in 2014. For example; until health reform I would not qualify for Medicaid until I became completely disabled from my Diabetes, even if I made poverty level income and did not have enough money for my insulin and other medications. Today, if North Carolina decides to add the new category’s I will. All of the money for the category that includes me will come from the Federal government and then gradually decrease to 90%

Non-Medicaid High Risk Pools

If you are high risk like me e.g. have a chronic disease and have been excluded previously  you will qualify in many states for a high risk, low-cost insurance pool which is partially funded through other Federal and State resources. For an example check out Inclusive Health of NC which is my wonderful State’s offering. My policy was decreased by 50% after the affordable care act was created. In 2009 it was $1140/mo. for me alone. Today it would be around $450/mo. for me alone.  

Inclusive Health the NC High Risk Insurance Product

 

 

 

 

 

 

 

 

Finally since this is a short post: Use the new US Government Insurance Finder

US Government Insurance Finder

 

 

 

 

 

 

 

 

 My list is by NO MEANS COMPREHENSIVE!  You have many choices and you should never get stuck as an UNINSURED SELF PAY on any service provider’s patient accounting system. If you do, you will pay a multiple of the charge anyone else pays. For example: My stress test with an echocardiogram last week  had a total charge amount of $3000 for combined technical and physician services. However after applying the adjustments through Blue Cross the hospital and provider were paid $642.00 and my co-pay was $64.20. If I had no insurance I would have been responsible for the total amount! By the way, this too is an obstacle that goes away through the Affordable Care Act!!!!!! PLEASE, PLEASE, PLEASE… do not let yourself become bankrupt due to a lack of knowledge as to how to make this crazy system work for you!! You have choices. If for some reason you remain uninsured: BE SURE TO BARGAIN WITH ALL PROVIDERS FOR A DISCOUNT THAT IS ROUGHLY EQUAL TO THE CONTRACT AMOUNT THEY RECEIVE FROM THEIR LARGEST INSURANCE PLAN! After all if you were at Jiffy Lube and everyone that came in through the door paid a different price for the standard oil change you would question the business manager ‘wouldn’t you’?

e-Patient Jeff Harris

Blessings

 

PS: if I can help in any way respond with a question or write me at jeffharris@untangledhealthcare.come

 

New Comment On Self-Management Responsibility

A snapshot of my PHR s data-store homepage MS HealthVault

Jeffrey Harris • Sandy, I enjoyed your comment and want to tease out a couple of points:
If best healthcare is measured by vital measures such as infant mortality, number of quality adjusted life years between age 65 and death and social perception we really don’t provide the best healthcare. For existence: I have a brother-in-law who has been hospitalized for syncope and loss of bladder-bowel function in addition to anxiety and right-sided hemiparesis three times in the last eight weeks. Discharges are always premature with an inconclusive diagnosis while all symptoms and signs point to micro vascular injury to his brain. He has fallen at home and been taken to ER a total of six times. The hospitals treating him are two well-known academic medical centers who keep avoiding the commitment of concluding his dx. I argued for IP rehab but Blue Cross denied the admission due to his inability to participate in three hours of therapy each day. At this point he is living at home alone with his son who has significant developmental disability.

What has happened in my opinion is the staffs of each facility see a 375lb man with 100 pack year history of smoking and wash their hands of going the extra mile. I understand this and have been there myself until my ‘higher self’ shook the judgments out of me.

I worked in PM&R for ten years and would have no problem creating a treatment plan that would occupy three hours per day of my brother’s time using the neuro-rehab team. But… here I sit in the great State of North Carolina with three medical schools within 25 miles of my home and I am powerless over people’s judgmental bigotry obscuring their human empathy. Our healthcare system is sick on many levels. Yes we need policy, procedure, payment mechanisms and total inclusion but a thoughtful look at our internal judgments and motivation wouldn’t hurt either.

I like the idea on penalizing people for poor compliance. I also like the idea of rewarding people who exercise good self-management. I have had diabetes type 1 for 45 years, hepatitis c for 30 years and neuropathic pain syndrome for two years which has required I reduce my schedule to part-time. What I can tell you is that I and many others find chronic disease a lot of work and certainly wouldn’t mind a seven hour work day if we agreed to attend the corporate aerobics class for the remaining hour. This may seem as if I am whining but we see it as being given the supports necessary to take care of our human bodies; for without them we have no contribution for the society that constantly complains about the cost of our care.

Thanks for your thoughts, I believe I mirrored what your ideas are but perhaps introduced some thoughts through the consumer’s lens.
Jeff
UntangledHealthcare.com

 

Patient Advocates! New tools to step up and remotely monitor emotional components of chronic disease along with standard physical indicators

As you all know: Disease or Dis…Ease… is comprised of four components to be addressed by patients and their care-giving support groups. These domains include: Disease, Impairment, Disability ad Handicap. For example: A blind diabetic presents as follows:

  1. Disease: Diabetic Retinopathy
  2. Impairment: Vision
  3. Disability: Blindness
  4. Handicap: Cannot read LCD screen on insulin pump.

If all are not considered as part of a treatment plan we tend to place our head in the sand and lose the patient to depression induced suicide while being fixated on BMI and A1C. Well here is something exciting!!!!!

 

The convergence of psychosocial data (adjustment scales, depression index, mood, pain etc.) with other digitized remote biometric data e.g. interstitial glucose will add great value to examining the correlation of emotional/behavioral patterns and glycemic control for diabetics as well as give insight into correlations in many other diseases.  This is a big deal for me as a diabetic and even bigger as I consider the research we could do. In the 1990s our team introduced patient-family group visits to our ambulatory COPD management program and reduced hospital in-patient days by 70% (N=300). In the virtual world we have a way to accomplish the same objective (Care, Share and Never be alone and afraid).

I have been reviewing various tools for self-management and secure communication for diabetes, heart failure, COPD, Addiction and so on as success in managing these conditions relates to social support and data vigilance. I am also trying to get large pharmacy providers off their feet and please consider adding a remote retinal camera and Apple I Phone to their diabetes management programs as a pilot. In NC I have a group of physicians willing to read the retinal photos if I can get a camera ($10K) and head out into the woods where our indigent are losing vision and functional capacity early in life due to lack of linkage to primary care. Imagine what could be done with bio-psycho-social monitoring. Of course we will need funding for interventions but we can drive off that bridge when we get to it.

So please take a look at this project THE GINGER IO COLLABORATIVE  http://ginger.io/the-platform/

 

 

 

Jeff Harris

Untangled HealthCare LLC