Untangled Health

Consumers Unite To Drive The Changes We Need

Tag: Fox

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

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…
Secularize and

I hope.

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

Take a chance, dispense with our differences and share the 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”

Donald Berwick | The Health Care Blog

We are dropped from the universe into loving hands (unfortunately not for all though)






Donald Berwick | The Health Care Blog.

I am losing hope. Dr. Donald Berwick has been an individual that I have followed since 1996 when I lived in Boston. He is foremost a dedicated servant to efforts involving improving the quality of healthcare in our country. I am not using the term quality as a market strategy here but from the perspective of a person with diabetes who would trust this man with his life. Dr. Berwick IS Dr. Safety. He is the founder of the Institute for Healthcare Improvement where many of us policy and quality wonks spend our time learning new strategies to decrease medical error rates and prevent morbidity and mortality in hospitals. Dr. Berwick launched the save 100,000 lives campaign that focused on the National Institute of Medicine report from 2000 titled Crossing the Quality Chasm. In it they cited hospital acquired preventable infection, and many other issues as being unacceptable. We learned to quickly diffuse treatment guidelines for the prevention of ventilator acquired pneumonia and empowered fast response teams all over the country in demonstration hospitals. The fast response protocol allows any observant (family member, housekeeping staff etc. to hit a panic button if they sense a patient is in danger). Trust me folks, thousands of people have died who could have been saved if the patient’s family or nursing assistant who know the patient better than the attending physicians and charge nurses were allowed to activate a multidisciplinary rapid clinical evaluation.  I have experienced this as a clinician and personally when my niece Marianna passed away from  an asthma exacerbation that was observed hours earlier and reported by a respiratory therapist whose request to call for an emergency evaluation was disregarded by the local hospital’s charge nurse. She was 32 years old and NO ONE should die from asthma these days.

So Dr. Berwick was appointed to direct the Centers for Medicare and Medicaid Services in 2009 due to his international respect and knowledge of our healthcare system. According to NPR he was asked to step down this week as congress would not re-confirm his appointment. Why? Because he had made a positive comment about the UK National Health Service.

Once again we have a completely biased and uninformed group of bureaucrats drawing conclusions that we are commie, pinko socialists using antiquated references and experiences from the cold war: branding individuals with outdated labels, selling their fear to the ignorant voter who by no means is stupid but simply uninformed as to the corruption and shell games that drive health care practice in our country.

I am having flashbacks from Archie Bunker in the All in the Family series from the 1970s.

Meanwhile, we have republicans and democrats (all of whom you and I elected) being exposed for their million dollar hypocritical business deals and appear to not care as we re-elect, re-elect and re-elect. So we are headed to slaughter.

I am not giving up: I have been screaming for consumer rights as a patient, provider and program manager for thirty years. I have evidence of direct commentary from State officials demanding a termination of my contract with one of my customers three years after I left the State’s employ. The information presented was false, I confronted the issue with proof which discredited the spurious information by my personal patents and documentation; received a tearful apology and had no recourse since the NC law has a one year statute of limitations on defamation of character. By the way, my client whose board member instructed her to beware of me immediately informed me of the conversation and kept me on to perform my strategic contract which they were quite pleased with.

The issues that we have here refer back to the discussion on finding the gold that we all have to offer as opposed to presumptive guilt of our industrial colleagues. I am disgusted at our species and sometimes wonder if we shouldn’t hit the reset button.

So, we have fired one of the most dedicated professionals in our clinical world who has given thousands of free lifetime hours during his most productive time in life as a simple act of service.  He was the wrong brand… for those who continue to believe that 2011 is no different from 1776 and use such arguments to convince you my friends that they actually know what they are doing.

I am begging you to take your country back in a peaceful manner by understanding where the shadow people are, following the dollar and asking yourself if it is working for you. I ask that you not blame a single party, institution or person but own the responsibility yourself and find strength in your numbers.

As history usually points out I imagine that nothing will change, the occupy wall street and tea party movements will become nothing more than marketing tools for democrats and republicans next year and all will be diluted when we experience some form of economic recovery and we continue to not engage the homeless “eye to eye”.

Are you familiar with the behavior of Tasmanian Devils AND have you seen the movie 13.

With love and respect to my readers:

Jeffrey Harris   Communitarian Republicrat with fiscal conservative beliefs.

So you all know: every one of my wealthy and successful friends who agree with my opinions keep telling me to shut up as they are frightened for my career. You see I presently have no job and they want me to keep a low profile. My defect of character here is that I can’t as to do so would be to abandon my hope for eliminating disparities in health outcomes.

Dr. Berwick, I apologize for every vote I cast save for the President in 2008. I have hope and will continue to follow you in your efforts to teach us all that we actually have a heart. Perhaps quick 2D echos on every citizen to help them identify with that piece of themselves that miraculously works itself to death to maintain each persons life.

Put differences aside and respect the gold that all bring to the table

Most of you have read the commentary below regarding my debate on The Health Care Blog with some bright and intelligent folks with experience in the benefits (insurance) sector.

I am posting the last discussion between my friend Nate and I. My response to his commentary is first, then you can see what he had to say after your read about my hysterical week!

Here is the point!  We need to talk among ourselves. We need to realize that each one of us has wisdom and truth. We need to come up with our own questions. We need to derive our own conclusions; we need to accept failure without scapegoating people or institutions. This is the foundation of our society my friends and I fear that we don’t participate anymore. We allow Pundits, Politicians and Industry define who we are and what we want. Please read on…




I wanted to get back to you all week. Unfortunately I had an embarrassing incident wherein I tripped while walking my dog. With both hands occupied I did the traditional face-plant onto the concrete. As my nose touched down a foul crack echoed through the neighborhood. All I could think was ****$$$%%%   that hurt! Second thought, get out of here fast before someone sees your foolishness. I trotted down the hill with Bodi ; blood dripping everywhere; bag of dog poop in one hand and dog leash in other. This all culminated in 12 hours of ER evaluation with a final diagnosis of broken cartilage but all else in-tact. Of course I had the obligatory CT of my head. I even called my primary care doc before I left for the ER stating that all I cared about was whether or not I had any cranial fractures otherwise treatment would not be a concern until it all healed. Knowing I wanted a simple skull series of x-rays; I got the full-house. This of course was due to my Blue Cross.

While in the ER I watched the non-urgent bumped elbows, chronic knee pains and earache’s come and go as three true rescues were attended to by full medical teams and in one case…a Chaplin.  I kept asking myself why it hasn’t gotten any better with all of our efforts at managed care and now: Primary care Medical Homes.

When I managed Pulmonary Rehabilitation Programs I held to strict criteria that the tobacco addicts had to be free from all tobacco products and receive counseling as required. In ten years I discharged two patients early because they elected to smoke in the bathrooms. We had a 10 bed facility and I simply stated to the patients that we had a waiting list and needed commitment: In other words a zero tolerance contract. This was the ONLY time in my clinical work where the corporate administrators of any company allowed me to sacrifice revenue for health-beliefs.

In the early 1980’s ,my profession was blessed with all kinds of cool technologies: New high-resolution cardiac cath lab equipment, electrophysiology and 2 dimensional ultrasound. I had been hired to open a new diagnostic clinic in New Hampshire where we had three competing hospitals within 15 miles of each other. We were fortunate enough to hire the first cardiology group and I was hired from Los Angeles due to my cardiovascular skill set. Here is how we justified each purchase of new diagnostic equipment.

Population count X (prevalence +incidence rate) X Medicare MAC (it was lower than commercial so we hedged our bets)X estimate of cases expressed as a % of diseased population. Once I had the revenue I would simply divide it by the capital cost and incremental cost of operation to establish break-even. In most cases, break-even was less than 12 months. As long as costs were below $1M we did not need a certificate of need. Between 1981 and 1982 I became the instant hero at the hospital with the new revenue centers. The small community-funded hospital eventually sold to Hospital Corporation of America (I am sure you know their history), and I went on with my career chasing revenue center to revenue center as managed care established rules which simply required us to relocate the patient to a slightly lower cost of care facility. I could tell you some great stories from the road back then.

Within five years we had three hospitals with a combined 600 beds caring for 150,000 people: each with competing services including cardiovascular medicine and neurology.

As I sat in the ER the other day I thought of your comment on the era of cost-control in medicine: When we had no insurance and everyone self-insured: This resonated with me as ‘truth’. Of course, back then we were just starting to experiment with open heart surgery. But you nailed it brother. My reality is that with the exception of us folks that traverse the payer-provider line few really understand how the M1 works in healthcare. The escalation in cost through value added services and no requirement for us to have the vaguest idea how to read an EOB.

So my point all this time was that I actually agree with you on many points. For example I have what I call the Harris Index of Diagnostic Inefficiency. It is the ratio of MRI scanners to population where the USA is three times higher than other countries; and the Dartmouth Atlas linear regression of cardiac surgery rates to number of cardiothoracic surgeons per 100,000 persons. This is after correcting for illness burden of course.

One of the missions of my Blog is to bridge the gap between the lay-public and professionals and create parity of knowledge around cost benefit and cost efficiency. Kind of like when we learned that out cars didn’t need the $800 under treatment to prevent rust after paying for it for so many years.

So I want to thank you for putting me back in touch with a need to expose the shell game. Like you, I simply have no short-term solution so want to leave blame out of my discussion other than pointing to a system run-amuck with overpriced services, too many inflationary steps in the value chain and too many people on public subsidy. I will continue to argue for some form of provision of healthcare services for those who do not have the ability to pay. But…due to our conversation and my soul-searching and my trip to the ER and the 33 years of saying to myself “this doesn’t make sense” : I will push for a better mechanism for means-testing and a time limited resource to slow down our social Darwinism …perhaps.

Let’s stay in touch as your perspective is a critical lens that needs to be added to the ‘big picture’.

Take care,


You can reach me on Twitter: @untangledhealth




Nate Ogden says:

November 8, 2011 at 5:02 pm

” I believe that society must reach agreement on how to help those who can’t help themselves.”

Haven’t we tried this and it failed miserably? I don’t see how this can ever work but on paper when we allow those that can’t help themselves to self identify and those seeking assistance are given power of taxation and regualtion over those with the ability to assist.

Is it still help/assistance when its confiscated against the will of those that have it?

“in a free market with no cost control”

The most efficient we ever were and the most effective cost control in the world was when people paid for their own healthcare totally or paid then seeked reimbursement. The lack of cost control is a perception when in fact the implementation of managed care under the guise of cost control increased cost. ACA is a recent example, whats affordable about it? What did manage care manage?

“Medicare/Medicaid landed on the seen far too late in my opinion: Then we passed the ACA hybrid”

Whole lot of failed reform skipped over here.

no need to apologize its going to take some nasty fights and maybe even worse to break through 60 years of lies and misinformation. I strongly agree with the need for an informed public, i just disagree on how we fix it. You appear to gravitate to the educated and polite method of teaching. I prefer to call an idiot an idiot and tell them to pull their head from their ass. Not so much so they change their mind and see the light, most people can’t admit when they are wrong to that level, more so other people see how wrong those people are and stop being influenced by them.

Thank you for the lively debate

No Humor For Today a message from the 99%

The photo is enough:  Excerpted from Facebook