Untangled Health

Consumers Unite To Drive The Changes We Need

Tag: Diabetes

What is at risk if Obamacare is Rescinded

Reconciling data in my six health portals

What is at risk for all subscriber to commercial insurance programs if Obamacare is Rescinded?

This analysis with specific allegorical references was posted by my friend Wendy today. I find it accurate and far beyond my skills to interpret and describe What is at risk for EVERY-BODY

Obama Care is. . . The ACA (Affordable Care Act)
Last night as his first order of business the new president signed an executive order to repeal the ACA. Here’s what this means… even if you are safely covered behind employer-provided insurance, the protections set forth in the ACA (Affordable Care Act), apply to you too. And if those protections are repealed along with the rest (or any part) of the program, you will also be affected.
That means you may be trapped in a job, because your pre-existing condition may mean you will not qualify for new insurance offered by another employer, and the cost of private insurance would be prohibitive. If your employer shuts down, lays you off, or even changes insurers, well, you are out of luck. The Senate GOP voted this week that they would not require an eventual ACA replacement to protect against discrimination for pre-existing conditions, which was the standard before the ACA.
It means that you (a young adult under the age of 26) or your adult children (over 18) may find yourselves without the protection of insurance, as the Senate GOP voted last night that an eventual ACA replacement will not be required to allow young people to remain on their parents’ insurance up to the age of 26.
It means that if you have a high-risk pregnancy, or life-threatening illness such as cancer, you may not be able to afford all the care you need, because you may hit lifetime or annual caps. If you have an infant born with any kind of severe medical condition, or premature, they may hit their lifetime insurance cap before they are old enough to walk. The Senate GOP voted last night that an eventual ACA replacement program would not be required to prohibit lifetime insurance caps.
It means that if you are a struggling parent who is uninsured or under-insured, you will no longer be able to count on at least your kids getting the routine medical and dental care they need under the Children’s Health Insurance Plan (CHIP). The Senate GOP voted that CHIP is not required to be protected by an eventual ACA replacement.
These provisions of the ACA affect everyone in this country, not just those without insurance through their employers.
If you are not okay with these changes, call your representatives and let them know what’s important to you. Nothing has been set in stone yet, but our legislators have shown us a map of what they plan to do if constituents don’t make their voices heard loud and clear.
Hold down here to copy, paste, and post (do not share) on your timeline, if you feel this information needs to be passed on.

This is a comment from NORA on FaceBook
As a person with R.A. (pre-existing condition) Before ACA I was never able to purchase even basic insurance for under $1500 a month and thus went without insurance from the time I graduated University until I was 49 years old. It’s $2000 per visit to a Rheumatologist, so I only went once a year and could not afford medications. I lived with daily debilitating pain and exhaustion among other things. If you know somebody with RA you know is serious. ACA provided me with good affordable care at a price I can afford $359 a month. I responded very well to BASIC medications for RA that I could never afford before (but with ACA can) and am now able to live life normally and run my small business again. My great Doctors also noticed I had serious liver damage from years of taking OTC pain relievers like Tylenol and Aleve. They were able to fix that too. They said it may have killed me or become cancer without treatment, at the least led to early death. If I lose coverage for my Meds am already planning to go on SSD and Medicaid and close my business. True Story. #ACAWORKS PS Only deplorables don’t want people to have health insurance.
Like · Reply · 1 · 19 hrs · Edited
Wendy Lannon
Wendy Lannon I think of you Nora whenever I hear people say ACA doesn’t work. #ACAWORKS

SalesForce as a Patient-Centered Longitudinal Care Platform | I am one happy Diabetic!

The technology facilitating Patient Centered Care arrived over ten years ago. It was all a matter of configuration!

The technology facilitating Patient Centered Care arrived over ten years ago. It was all a matter of configuration!

I am pumped!
Years ago…1997 I believe; I had a job working for DocSite: the company founded by Physiatrist John Haughton MD that became one of the premier Registry products used as the EMR community was attempting to define itself. In the DocSite product we collected measures or “clinical indicators” that were compiled around the patient and associated with an infinity of conditions. Essentially the data design allowed physicians and grant recipients to have a single patient record yet extract, analyze and report on any constellation of outcome measures without having to spend money on redundant disease registry products. Example: Blood pressure is an important measurement for diabetes and heart failure. In diabetes the measure importance is 1) how often it is done and 2) the blood pressure value. In Heart failure the same measures of process (measurement frequency) and outcome (BP value) are required but they might be different depending on the cardiovascular guideline and contrasting diabetes guideline. In the DocSite system the blood pressure recording was simply a vital sign. The rules defining threshold for compliance with guideline were defined separately and associated with multiple conditions. When the doctor generated the data for PQRI and the Cardiovascular Excellence programs a single patient outcomes dataset was generated based on the programs associated with the patient. When the patient returned to any clinician using the Docsite system the Visit Encounter Sheet displayed the current measures due, the last values and trends for each measure and gave the physician or extender a place to generate an education note. Inexpensive, simple, multi-user, modifiable for EBG and data submission automated through clerical “generate and send PQRI data”. Now, I owned some stock in the company so I am biased but quite frankly I thought the system was elegant once it received data feeds from pharma and labs!

All of us at DocSite used a Client Relationship Management cloud application in our client services department. After using it for three years or so those of us that had worked in a previous company “the forerunner of DocSite” called Cognimed all thought that Sales Force had the proper design to create a community wide care coordination and patient centered care planning tool We had built one in the 1990s and sold it and moved on with our lives.
Today I see SalesForce has entered the arena. Knowing what I know about its capabilities I hope they capture the market by landslide. Please if you thinking about building a new care management platform…dont. As a patient, I would love to see this thing as an App. in all of my clinicians hands and on my IPhone please. Check out their demo. I am sure it all does not work as advertised but I can attest to the fact that they had the correct data model ten years ago!

Reconciling data in my six health portals

Reconciling data in my six health portals

Time to pull the sheet out from underneath healthcare in America. In one step. Eliminate Insurance, Medicare, Government Programs, and see what we come up with. Please leave a note on my grave as to the outcome.

someone-to-watch

Thank you friends from LinkedIn today. Those discussing our frustration and describing a need to sit down and discuss the disaster that was and the disaster that will be.

Without action that-is!

Rephrased: My friend states our Medical system is far to complicated and polluted with bad ideas to resolve through a bunch of silo business meetings of silo organizations who define for us consumers exactly what health is, what we need to consume to maintain it and how much we should pay!

My point was to provoke: Strictly because I have similar judgments. I recently have seminar to senior men on functional decline over life for avg American male. Then overlay of possible interventions and services through death. Then described business layer and regulatory layer.
Your point Bruce Pisetzner is precisely why we need to define the pain for all stakeholders. When I say “stakeholder” I include consumers from all socio-economic classes as well as the professionals who treat them and the “business opportunities” created between 1965 and today that supposedly state a clear value added to the system of care.
Spent my career sketching iterations of your shell games. It seems to me: and I hold a straw-man judgment; that 1) as a country we have no agreement on what “health”is e.g. functional status, emotional status, absence of disease, bio-psychosocial well being etc. Far too much room to allow a free-market enterprise to explode without revisiting what is necessary to achieve healthy population goals.
Then of course we have the employer – employee entanglement.
Then of course the Government – Defined Benefit issue.
As patient with chronic disease, provider – admin acute care for 8, provider-admin post acute for 10, HIT product architect for 10 and community healthcare integration consultant for 10; predictive analyst for 8: I have watched the money flow. Oh how I have watched the money flow. Some even into my pocket. $25K a year out to stay alive and well with diabetes.
Perhaps it is time we all tell the truth. Insurance company, Large Employers, Small Employers, Provider Types, Patient Types and so on.

I created this blog post on the fly but thought it important to get out here now!

cropped-stcroix-jeff.pngsevere retinopathy

From Obama to ObamaTrumpCare

someone-to-watch

Someone to watch over me…….
Dear Doctor, will you please make sure I receive the RIGHT CARE!
What do you know about me Doc?
Do you have time to spend with me today; perhaps discuss who I am in the world, what my goals are and what I think might help me feel better?
Are you interested in my Well-Being? Do you and your staff ever discuss Well-Being or is it all veiled in a pile of healthcare acronyms; where Well-Being is described by absence of symptoms and disease?
Do you have the opportunity to discuss my goals and interventions with my other doctors? Sometimes I am not sure you folks talk because my information: from religion and employment history to list of medicines varies between practices. I thought someone was fixing all of the electronic health record issues ten years ago?
I noticed that all of my personal physicians that I have chosen over the last fifteen years are selling their practice or merging into some sort of healthcare system that appears to be managed by the local hospital; is this a good thing? I am really not sure you see me because the person at the registration desk doesn’t recognize me and your Medical Assistant told me that you only had time for 10 a minute appointment today.
Actually, to be honest with you; I am concerned for your Well-Being Doc because you have dark circles below your eyes and tell me that you are up until 10:00 PM each night completing your records at home. I realize that the new electronic health records are cool but shouldn’t they increase your quality of life as opposed to drain any remaining discretionary time you have with your family?
Ya know Doc, I have learned allot about healthcare in my life: Yeah, some because of my training and work but mostly because I have these….”conditions”. The “conditions” have presented adequate challenge to require me to understand the “bits and pieces” that string this system together. I’ll bet you don’t learn much about being a patient in medical school. I am not sure how you could do it without adding another two years to your fourteen years of post-grad education.
Did you know that I have spent ten hours in the last month trying to get a prescription authorized? You know the prescription that makes living with RSD and diabetic neuropathy tolerable! It appears that someone didn’t install your e-prescribing system correctly; something to do with prescription received and filled acknowledgments? I don’t know Man; it seems like the fax machine and pharmacy calls worked better than this e-Rx stuff. The long and short of it is that between your practice, my insurance carrier, and my CVS pharmacy the most efficient transaction I can hope for when I am in pain is 48 hours. My “Well-Being” wasn’t so “Well” this month…..
BUT my A1c is 6.5, my blood pressure is 124/78, my immunizations and other measures of health process and management outcomes are all great. I am pleased to be one of the good data points on your quality report and certainly testify to CMS and Blue Cross that you deserve an extra 5% for your hard work. Might be nice though if I received a discount on my insulin copay for the snappy A1c that has kept my feet attached to my legs and my body out of the hospital these last 50 years.

So what is Right Care? How do we know if we get it? Is it through the Diabetes DM report? Is it through the patient satisfaction survey that I take at each and every service provider I see? They all are very similar, I wonder if anyone has ever considered a “whole system measure”; at least something better than the Service Excellence Survey that reminds me of the material sent to me by American Airlines after every business trip. By the way, I always give my providers 5 stars with the exception of the conglomerate that bought up the primary care practices; their employees seem miserable. I find it amusing that their employees all where buttons that say “Ask me about the “Name of Healthcare Institutions” WAY. I guess they all have some kind of culture that is supposed to make my experience less painful as a consumer? Perhaps more like Disney Land I suppose.
What I really long for is my diabetes pediatrician from 1965. Dr. Lipmann. He always asked me to discuss how I was feeling about school, whether I had enough to eat at home, did I have any dreams and whether or not my diabetes would prevent me from achieving my dreams. Heck, he called me on Sunday night to as how I was feeling when my urine sugars were running 4 plus. When I left his care at the age of thirteen he had illuminated an interest in human biology that has carried me through my life. On a darker side of my childhood life he also notified “Children’s Protective Services” when he discovered I was living in an alcoholic flop-house!
My friend Tony is from another country. His mom had a CVA last year. She was transported to the ER, hospitalized, transferred to a facility with real rehabilitation specialists and doctors on staff daily, discharged home with visiting nurses and therapists and returned to society as a healthy 75 year old woman who is now completely independent. Her cost? Well there was no cost to her and the average cost per person for health services in her country is 1/2 of what it is in the USA.
In meeting with my insurance adviser the other day I was informed that my healthcare cost will be more than $500,000 between now and my death; with my diabetes, RSD, neuropathy etc. I wonder how we will cover the services. I really don’t want to be one of those patients that I cared for early on in my career. You know….like the old man and WWII B17 Aviator that looked up at me shortly before he died and said “Ya know Jeff; I used to be somebody once”.
The end of his life was no different than my fathers. Dad died last year from pneumonia at the age of 87. We had just celebrated Memorial Day. He called me complaining of a chest cold and 48 hours later I found myself sitting at his bedside with new onset dementia, consolidated breath sounds, a temperature of 101 degrees and abdominal cramps. I asked the Nursing Assistant to get him a bed pan and she informed me that he “just got off the pan”. A few minutes later I overheard her complaining to her supervisor that she had no intention of getting my Pop out of bed because he was a difficult transfer due to his combativeness. Pop was angry for sure but not combative. Then I witnessed the IV nurse insert a 18 gauge catheter into my pops wrist. She never registered IV access and proceeded to deliver 500 cc of solution into the sub-cutaneous space. This was the only vein he had left since they had made the same error the night before in the opposite hand. By 6PM his hand was as large as a soft-ball and this was hours after I complained about her technique.
So the following day Pop got a PICC line. PICC lines are infection risks!

Three days later I took him to the SNF with his PICC line and met with the therapists. Dad was becoming more lucid but I had concerns. I met with the Charge Nurse and facility director to assure his good care. I was concerned about the additional risk for infection from his new PICC line. You see, this facility was part of his life-long $450,000 investment in a continuing care environment; supposedly the best available in Huntsville Alabama. I used to direct clinical services departments in these facilities earlier in my career and was aware of their financial strain as they attempted to deliver hospital level care for 1/3 the cost.
I saw Pop the next day while he was cycling on the recumbent bicycle in the rehabilitation department. He had 20 minutes of therapy to go but as soon as I showed up to watch his work-out the therapist terminated the session and quickly wheeled Pop to his room so we could chat. Dad looked horribly sad, I knelt down to say good-bye kissing him on the forehead I said “I love you Dad!”; he looked up and said “And I love you Jeff”. These were our last words.
Three days later I received a call at 3AM from a person who could not speak English. He mentioned my father’s name and I asked for someone who could speak more clearly. The second person I spoke with also could not speak English. Finally a paramedic picked up the phone…”Mr. Harris, your father is unresponsive and we are taking him to the hospital”.
After a quick dialog I was able to determine that Pop had explosive diarrhea several hours earlier and simply lost consciousness. I called ahead to the Emergency Department to inform them of my father’s forthcoming arrival and that I was worried he might be septic. I told the doctor that Pop was a DNR patient and he should call me when he arrived. When Pop was evaluated the ER Doctor called me with his lab results and it was quite evident that he was dying and most certainly had been allowed to dehydrate while at the Rehabilitation Hospital OOPS I mean Skilled Nursing Facility OOPS I am not sure what I mean. God did I weep as the ER doctor and I discussed his DNR.
I wrestle with the fact that I might have been able to save Pop if I had pushed for re-hydration, antibiotics and other therapy but I couldn’t help think about Pops state of well-being. You see my brother and I had spent years shuffling him around between neurosurgery in Birmingham and other clinical facilities. At one point I had imitated a physician to keep my father from being discharged prematurely after his brain tumor operation. He had been in the hospital for a week. The Medicare Prospective Payment was going to pay for eight days and the hospital was pushing him out to a skilled nursing facility. I watched my Pop eating and realized he had an aspiration problem. Fearful of aspiration pneumonia I asked to have him discharged to the rehabilitation beds at the University Medical Center. I wanted him to receive a speech language therapy evaluation for aspiration risk and rehabilitation services. To get the transfer to rehabilitation where a doctor and therapists would be available; I had to retrieve every clinical skill I had when meeting with the staff to justify his case. When they assumed I was a doctor, I let it ride. Feeling shame the next day I convinced myself that I would do whatever I needed to protect my father.
You know, to make sure he would receive the
Right Care.

As the ACA (Obamacare) was implemented I began to have hope. You see, this year 2017 is the beginning of Medicare’s observation of how well inpatient hospitals and post-acute care facilities integrate. One important measure they are watching is the frequency of readmission to acute care for the same diagnosis. This combined measure of how well institutions, nursing homes, home health networks and primary care communicate regarding a patient’s process as they are handed off between facilities is to prevent patients from becoming ill and requiring re-hospitalization. Trust me folks, it used to be horrible: I can remember turning patients around as they arrived at our rehabilitation hospital and sending them straight back to the Medical Center that had just discharged them. You see, some were still in heart failure and semi-conscious; not only could they not participate in rehabilitation; to attempt rehabilitation might have killed them. But you see, the hospitals were not linked to the rehabilitation and skilled nursing facilities through a common therapeutic goal and reimbursement mechanism. The hospital in Boston just wanted to discharge the patient prior to exceeding their Medicare reimbursement allotment. We however had marketing nurses out in the field accepting any warm body with a heartbeat that just might survive a 21 day Medicare stay in a Skilled Nursing Environment.
My friends had no idea why I never lost my job by reversing the trajectory of these patients. What they did not know was that I had a compassionate family owned corporation employing me who trusted my clinical intuition.
Alas… as of today….Obamacare is being repealed and we have yet to be informed about “TrumpCare”. My guess us that we will return to the past with the exception of mandatory care for persons with pre-existing conditions. Then we will see just how much our policies cost and what our end of year out of pocket expense will be.
For my wife and I,
We are searching once more for our peeps. This week I have looked at my well-being through the end of my life if we ex-patriate to Canada. My cost will be $0.00 for healthcare. My waiting time for a CAT scan will double but Canada’s outcomes for Cancer and Cardiovascular Disease and diabetes are slightly better than in the USA. So what do we have to lose? In fact, Canada doesn’t amputate many diabetic limbs. You know why? Because all of their diabetics have access to care!

Fondly thinking of you fellow patients and consumers;
Jeffrey Halbstein-Harris
• An advocate for those who feel lost
• Always watching
• Harnessing the compassion that surrounds you in a time of crisis
• Connecting you with the best science available
• Minding your pocketbook
• Working to return you home safely

Hello Darkness My Old Friend…

I am witnessing an illogical social rage emerge that “if we are not steadfast to our principles of tolerance and acceptance” could ignite into a civil crisis even greater than what I (we) witnessed in the 60s and early 70s.
The content displayed on the Internet is usually present for a single purpose: to sell an idea.
So now we have evidence of dishonesty and amoral behavior.
As I chase material down to its source I find frequently that the information is genuine but stretched beyond its context. Meaning: a video purporting to expose poor security architecture of a 10 year old vote tabulation computer is released from a blog that claims a vast conspiracy to undermine our election process. However, the machine tested was studied through “real scientific procedure” by Stanford years ago and found to be defective, thereby causing the vendor to lose its contracts with election management authority’s .
The video published within the last few days had a single intent: convince the public that we have a crisis in our voting apparatus and a probable conspiracy.
On the same blog the moderator claims our support of foreigners in need is far greater than our effort to support those of us on Social Security. ” How can our Government support thousands of Syrian refugees when it can not give a raise to Soc. Security recipients!”
These words are meant to do nothing but divide us.
On another blog I find the video of a silly man embarrassing himself by making petty comments regarding his power over women. The guy was 59 years old and behaving like an adolescent braggart. Ask me if I care. I think I am intelligent enough to not consider him suitable for public office through listening to his speech alone; let alone some silly dialog he had with a Hollywood “Child” .
Now Most of my friends and I are not content with our choices in this election cycle. However, we know we can survive another 4 years waiting for another leader to emerge if we vote for Sec. Clinton.
But the generation below me: the folks that didn’t experience the Cold War, Vietnam, Students being shot on campus, the pictures in Time of beautiful men hanging from trees by their neck throughout the South. The beginning of and final failure of the war on drugs, Project Apollo.
They can’ t seem to realize that corruption is everywhere but reflected by genuine love and collaborative effort in the very same moment.
The candidates in our election today are simply warning lights on our social dashboard : bringing our attention to our fear of powerlessness, loss of faith in humanity and capacity to understand how each of us is perfectly imperfect. From George Washington to Whoever wins this election ; all of our leaders , all of our heroes have nasty moments along their life-path; They were and are human also.
I think it is time to silence our voices, lay down our pens and video recording devices and sit down for a discussion. Perhaps a discussion that will illuminate our fears, doubts, insecurities, desires, hopes and dreams. Through this work we might once again find our commonalities and work together to re-form our nation.
We are broken…..I think, but not irreparable.

Enjoy

Patient commits suicide faulting pharmaceutical prior authorization rules as the cause.

Many untold stories

 

Patient commits suicide claiming prior authorization pharmaceutical rules as the cause.

Melt down, do you ever have them?

Well I will share mine with the world in this very moment.

I have carried hepatitis c for thirty-eight years now. That is until two days ago when my blood work returned the result of no detectable virus.

My family’s cheer is magnificent as everyone had considered this diagnosis to be the reason for my premature demise.

The medication I am taking (Harvoni) was approved for 90 days by the Federal Blue Cross program and I am now completing the second month of therapy. The protocol calls for 12 weeks of therapy due to a history of viral re-emergence using an 8 week protocol. We were lucky to get the medication as one course of therapy is $100,000! That is in the USA of course. In Egypt it is $1000.

CVS Care Mark was denied my refill as the date of the prior authorization expiration is tomorrow. That’s right TOMORROW!!!

It turns out that the Blue Cross administered program has a 24 hour lead time required for refills. Their internal processes begin flagging patients for cancellation one day before the actual term date!

So here I sit, just another patient with a life threatening illness who was given the hope of cure one week ago and now is pedaling as fast as he can to get help from his physician to extend the authorization of a medicine that is –on paper- still authorized!

They tell us patients with chronic disease that we are subject to depression. Feelings of hopelessness, loss of energy, inability to concentrate, suicidal ideation: Well I have all of them now. After 48 years of chronic disease, a 33 year career in healthcare where I operated at executive levels high enough to find out some ‘very ugly truths’ regarding this sector of the free market I feel ready to throw in the towel.

So for the next generation of patients: know this…you are on your own. This means it is up to you to find the best team of physicians, nurses, employers, insurance companies and friends to respond to your needs. It will be up to you to command them. It is time to stop being a passenger in the system.

I am the captain of my vessel. I have a wonderful team who is trying their hardest to get me the final dose of medication needed to save my life. I have just been wounded brother and sister so I will lay here for a while and bleed. Then –with your help; I will stand-up and continue telling my truth.

The truth that spills forth in the form of factual events involving actual people making life and death decisions has been held back until this point. I still try to earn a few dollars in the industry and do not want to become one of the untouchables. Perhaps it is time to execute my right to free speech.

When I am done I will rest and figure out another strategy for supplemental income in retirement.  It might be time to close this chapter and dance.

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

 

 

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.

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.

Quality and Efficiency in Small Practices Transitioning to Patient Centered Medical Homes: A Randomized Trial | Patient-Centered Primary Care Collaborative

Please visit my friends at Patient Centered Primary Care Collaborative; they are stepping up to remodel medicine for you and I.

As you know: Untangled Health is deeply committed to the Medical Home Concept. Had I not fought to establish these types of relationships with my primary care providers throug the years I would not have the health I enjoy today in spite of my chronic disease.

Quality and Efficiency in Small Practices Transitioning to Patient Centered Medical Homes: A Randomized Trial | Patient-Centered Primary Care Collaborative.