Untangled Health

Consumers Unite To Drive The Changes We Need

Tag: #healthcareblog.#chemconnector#ONC#NCHICA#

What is at risk if Obamacare is Rescinded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What is at risk for all subscriber to commercial insurance programs if Obamacare is Rescinded?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 And if those protections are repealed along with the rest (or any part) of the program, you will also be affected.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

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

What is important! Life, Death and Taxes

Hopeful

Hopeful

The most important messages I carry are personally empowering. They are seldom original but channeled through the “bright spirits” I encounter in life.

To be empowered in this confusing world requires a grasp on reality. I will be 60 next week, a milestone I never cherished; even less so today with recent memory of the loss of my father, mother, brother and best friend of 30 plus years.
I was so freaking sad today when I woke that I found it hard to make a cup of coffee. I preferred to sit in my armchair (nicknamed the neurotic’s spaceship) and discuss the meaning of life with Bodi my loyal canine friend.
When I opened my social portal into the virtual world I discovered a friend’s post. A warm soul I met in a business conference two years ago, April Koontz had posted an important message; another piece of wisdom that I find to be a blessing for all of us.
I have chosen to teach about how to survive in America if one is ill perhaps it is time to focus on the ultimate reality for my lifetime. I will not witness a fix. We are far from agreement on the definition of health and well-being and human rights in American Society to imagine anything close to a satisfactory solution in my generation.

 

So perhaps I will continue to post interesting tidbits and ideas with hope of enlightening those who did not work 35 years in healthcare; but most importantly I will re-state my agreement with the video below; a presentation by @Michael Hebb, the founder of Death Over Dinner’s Ted Talk below – a must see!

A great thanks to April for bringing this to my breakfast table this morning.

Community Care of North Carolina goes for the gold: Proving valid reduction in hospitalization among Medicaid enrollees with Chronic Disease

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

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

I have not been posting much lately due to activities with the Patient Centered Primary Care Collaborative. We are working on an analysis of accreditation standards which will ultimately be used to verify Medical Home processes, procedures and clinical outcomes. Check out their website as you consumer types will have a chance to see what others are doing for you to assure you access to the best in health care as we reform the system over the next few decades.

I am very enthusiastic these days as I am seeing the changes I have hoped for my entire life as person with diabetes since 1966. As a child my doctor was always available to teach how to master my illness and provide tips with mechanisms I could use to reduce my cost: especially when I entered college. My docs have been so cool, I can never adequately thank them. Purchasing a glucometer and testing reagents for me when I was uninsured; providing free laser therapy when my employer dumped the plan I had in favor of becoming self insured. If you want an interesting read see an old post of mine titled Physician heroes.

Today I call your attention to Community Care of NC. The organization that employed me as their clinical informatics lead back in 2002. These folks are using a model of population management and patient care that I had seen work in Massachusetts in the 1990s. To that end my wife and I moved here in 2001 to work for CCNC. They use a centralized partnership between private healthcare industry and public agencies including Medicaid, Public Health, Mental Health and Substance Abuse Services, the NC Medical Society and the local branch or thee Academy of Family Physicians.

The central teams keep improving patient targeting and clinical outcomes analysis using a variety of statistical sources and deliver regionalized community information from 12 different 501c3 Community Care Networks. The individual Networks then put care coordinators, case managers, pharmacists and administrative staff in place to create local flavors of patient centered care. All have guiding physician committees and other staff who collaborate with subspecialists as well as local hospitals. The net result is a care continuum surrounding the sickest individuals where the team focuses on goals set by the patient, their family and the team. They have been doing this for fifteen years now and I can attest to the fact that they are one of only a few Patient Centered Medical Home Networks in the country that are using a web-native care plan accessible to all on the patient team as well as multiple other physician practice improvement web apps totally focused on education, assessment of each doctors population and measurement of patient outcome.

This week they published the proof in the pudding. After long struggles against threats to defund the program they survived. They are now audited in full and have demonstrated hospital utilization rates falling at 10% per year in the chronic disease population. We are talking HUNDREDS of MILLIONS of DOLLARS in savings folks on top of hugely improved clinical outcomes and patient satisfaction with their sense of well-being.

I have always said that I needed a lot of help in my life. Since I knew how to assemble a care team for myself I figured I may as well help others do the same. Today, in 2015 we have the mechanisms in play to reconnect patients with their physicians. Please step up and teach your docs about your needs, wants and struggles as it will take us a while to walk out of the woods.

nc hospitalization trends under CCNC

Celebrating physicians who stick with patients that are non-compliant due to financial barriers.

Reconciling data in my six health portals

Reconciling data in my six health portals

 

 

 

THERE ARE LIVES IN THE BALANCE

 

This is a synopsis of my attempt to bring affordable timely retina care to impoverished people with diabetes in Eastern NC. I sent this note to the Medicaid Managed Care entity: Community Care of North Carolina and was able to schedule a meeting as a result.

To: The Executive Director of North Carolina Community Care Networks,

“I have three retina ophthalmologists with nine clinics in four counties that are willing to take Medicaid patients. When I retired they asked me what I wanted to do. They had saved my eyesight and I told them that the disparity in services in NC had been my chief frustration since moving here. I said I would like to find as many diabetics as possible who were not compliant with retinal screening or follow-up care due to financial barriers. They agreed to treat as many as I could find after reading my proposal.

Many physicians are dropping Medicaid patients in NC. I have found some excellent, compassionate doctors who want to help.
Will you please help me strategize for an outreach effort. I will do all the work.”

I created a program guide for Medicaid describing access rules and services available. I started with Medicaid because their process outcomes revealed 40%-50% of diabetics missing annual eye exams. Furthermore this was in counties where over 1/3 of the diabetic populations had poor control (A1c > 9%) and therefore were more likely to have disease of the retina.

I met with the Community Care folks who (in my opinion) have a wonderful care coordination and patient centered care model. They informed me that they couldn’t perform specialty referrals as it showed preferential treatment. I responded with:” Many ophthalmologists do not see Medicaid patients and your data point out an underserved chronically ill population. I went on to say that the local hospital charged for a vitrectomy was $12,000 and that my friends would be willing to contract for $3900. They responded with a requirement that I recruit doctors from other practices.

So the retinal surgeons I was working with created a business relationship with an optometry group to perform annual screenings. Since Medicaid had stopped paying for eye exams in non diabetics, many diabetics stopped scheduling their exams as they also thought their services were dropped. However NC Medicaid does cover optometry for persons with diabetes. I guess the messages have not been tested for clarity and understanding in the Medicaid population?

After spending 9 months working with this ophthalmology group to reach out and treat people who are literally going blind due to gaps in care, addressing the needs of the Managed Care Organization (Community Care of North Carolina or CCNC) and following up with additional requests for an audience with their primary care physicians we received no follow through from CCCNC and we have continued to treat diabetics as they trickle in from primary care and emergency room practices with acute retinal hemorrhage and vision loss.

I imagine this is a political issue, as irrational behavior in healthcare systems is usually due to hidden agendas that go unseen in the public. Unseen you say! Yes the pun is intended.

We apologize to the impoverished diabetics of North Carolina, we are here for you, will  always assure you get the best care regardless of your capacity to pay.

If you need help visit this website and schedule an appointment. Taylor Retina Center

These folks saved my vision and I am sure they will save yours if you are able to get to them in time. I hope to have wider support and advertising from agencies trusted with reaching out to help you in the future. For now, no luck with Medicaid CCNC.

The images below illustrate a normal retina and a young 20 y/o diabetic woman with severe diabetic retinopathy as she appeared during her first visit to the clinic’s practice. One must appreciate how much retinal tissue can be lost before the patient notices the change. This is the underlying reason for annual – biannual screenings. When I interviewed the physicians they stated that 20 patients per year appear in their office with this level of injury who are insured by Medicaid or have no insurance at all. They have never denied treatment. Since they own their laser and have ownership in a day surgery center they are also able to address the financial concerns of the operating room provider.

20 year old woman with severe disease                                                Normal Retina

severe retinopathy

A normal retina

 

 

 

 

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 Continues to brainwash its citizens

 

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

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This is a recent opinion from Brian Balfour of Raleigh’s Civitas Institute. My response follows.

From Raleigh News and Observer Saturday December 28, 2014

Last week, yet another study claiming that expanding Medicaid in North Carolina would create tens of thousands of jobs was released and dutifully reported by the media. The findings of such studies, however, are based upon a fatally flawed assumption that Medicaid coverage equates to access to medical care.

The latest report, produced by George Washington University researchers, declares that North Carolina will miss out on 43,000 jobs in the next five years, along with $21 billion in federal money, if it continues to refuse Medicaid expansion as prescribed in Obamacare. The study’s findings largely echo other recent reports, such as a January study produced by the North Carolina Institute of Medicine that came to similar conclusions.

The job growth claims are based on the state’s “drawing down” additional federal funds due to Medicaid expansion. As the GWU report describes, “Since most of the cost of a Medicaid expansion would be borne by the federal government, expansion would result in billions of dollars in additional federal funding flowing into North Carolina. These funds will initially be paid to health care providers, such as hospitals, clinics or pharmacies, as health care payments for Medicaid services.”

This income received by health care providers is then spent on suppliers (such as medicine, medical supplies) and in their community on goods and services such as groceries, clothes and movies.

The fatal flaw in this methodology, however, is that in order to “draw down” federal Medicaid dollars, actual medical services need to be provided to Medicaid patients. It is only when doctors actually treat Medicaid patients that the federal government pays those providers for the services.

 

For instance, the NCIOM study assumes that more than 500,000 North Carolinians will not only enroll in Medicaid under expansion, but each would receive on average roughly $4,300 in medical services each year. As these services are rendered, the doctors and hospitals are paid by the federal Medicaid program, which injects the money into the state’s economy and spurs the job creation, according to the studies.

But here’s where the studies’ jobs claims fall apart: North Carolina already suffers from a shortage of doctors.

According to federal guidelines, 78 counties in North Carolina qualify as Health Professional Shortage Areas because of shortages of primary medical care doctors. And the problem is getting worse. According to the Shep’s Center for Health Services Research at UNC-Chapel Hill, North Carolina’s supply of primary care physicians is dwindling, dropping from 9.4 per 10,000 people in 2010 to 7.9 doctors per 10,000 people in 2011.

Indeed, a 2011 survey by the Association of American Medical Colleges found that only 15 states have fewer primary care physicians per capita than North Carolina. The doctor shortage is especially pronounced in the state’s rural areas, where there is a greater concentration of Medicaid enrollees as a share of the population.

And more to the point, not only is there a general doctor shortage in North Carolina, there is a shortage of doctors accepting Medicaid patients.

Medicaid roles in North Carolina have ballooned from about 1 million in 2003 to roughly 1.7 million today. Adding another 500,000 would push the program over 2 million enrollees and mark more than a million new Medicaid patients in a dozen years.

All this would take place when the number of physicians accepting Medicaid patients is dwindling.

Imagine adding since 2003 the equivalent of the entire population of Wake County to a group of people fighting over a shrinking pool of doctors. Making matters worse, a 2012 article in Health Affairs found that one-fourth of North Carolina’s physicians will not take any new Medicaid patients.

In short, there simply is not nearly enough doctors to meet the demand, and things could get worse.

As reported recently by WRAL, “A survey this year by The Physicians Foundation found that 81 percent of doctors describe themselves as either over-extended or at full capacity, and 44 percent said they planned to cut back on the number of patients they see, retire, work part-time or close their practice to new patients.”

Such extreme supply constraints tells us that if North Carolina were to expand Medicaid, the newly enrolled would have great difficulty actually seeing a doctor. Coverage will not equal access.

If new enrollees in the already overcrowded Medicaid program don’t have access to care, then there won’t be any services provided. With no services provided, no federal dollars are “drawn down” to Medicaid providers. The whole premise behind the studies purporting to show job creation is unsupportable.

Brian Balfour is policy director of the Civitas Institute in Raleigh.

Read more here: http://www.newsobserver.com/2014/12/26/4427841/why-medicaid-expansion-wont-boost.html?sp=/99/108/#storylink=cpy

 

 

Untangled Health’s Response

Jeffrey Harris · Consultant Community Medical Home Implementation: PCPCC Co-Chair e-Health Group; Director Diabetes Eyesight Preservation Program Taylor Retina Center
I am writing In response to Brian Balfour’ opinion on the relationship between expanding Medicaid in NC and job growth on Saturday December 28, 2014.

The man standing next to me in Church in Four Oaks NC in 2011 said; “you must have sugar”; as he observed me checking my blood with a finger stick. “Sure do brother I said, since the age of 10, this is my 44th year with diabetes, I assume you have the disease also.” “Sure do, runs in my family: I am scheduled to have several toes amputated next week.” I could not help but notice the soft cast and bandage on his leg and told him I was sorry that he had to be the victim of such an avoidable circumstance. “Avoidable?” he said; this happens to everyone in my family; we all assume it is par for the course.”
These are the people who would receive coverage under Medicaid expansion should NC decide to follow the recommendation of the Federal Government under the Affordable Care Act. In fact, more than 400,000 of these people who are presently uninsured would have a source of payment for Medical Care. I know them well as I was one and if not for the generosity of friends would have gone without insulin on several occasions in my life.
On Saturday, Brian Balfour, policy director of the Civitas Institute in Raleigh demonstrated a common misunderstanding of health economics. He states NC will not expand Jobs through accepting Federal Medicaid expansion money because we historically have underserved areas with few physicians who cannot expand their caseloads. I guess this means that in a free market society if a geographical area in need of services receives funding and resources to increase their supply of services that the suppliers of such services (Community Clinics, Medical Schools) will not increase the capacity of the delivery system?
Mr. Balfour further fails to recognize that these patients are already receiving treatment often for free in local emergency departments, further inflating the cost of healthcare to the insured.
By the way, Mr. Balfour fails to recognize that North Carolina wrote the book on how to provide Medicaid coordinated care through a Primary Care Medical home which has served as the ‘how-to’ guide for numerous other states (Community Care of NC).
Let’s see: Where Mr. Balfour is correct with regard to our need to expand the number of primary care physicians we have multiple mechanisms in place through ACA that are making the profession of primary care medicine much more attractive. I point the reader to one of many publications demonstrating the return on investment for engaging individuals in patient centered primary care Profiles in interprofessional health training. Since President Bush called for the adoption of electronic health record technology we are now well passed the early adopter stage of connected information systems that allow us to find large segments of our population that require access to specialty care thereby prospectively catching the crisis before it occurs and saving all stakeholders time and money; but more importantly mitigating the risk for the permanent suffering that arises from poorly managed chronic disease. Telemedicine is now a recognized intervention and carries a reasonable fee for patients and doctors to feel as though they receive a fair exchange in value (wellness for the patient and salary’s for the doctor’s practice). One thing any student of economics learns is that investments in technology and advancements in process favor a positive shift in the supply demand curve and its derivative…productivity. Let me recap: New tech, new care coordinating jobs, new analysts’ jobs = MORE JOBS!
In my work I spend a great deal of time assisting the public with the interpretation of so-called facts and opinions arising through think-tanks and praised by the media. I am confident in my judgment that NC Medicaid should expand in accordance with ACA policy. So are the Vice President of the IBM Global Health Initiative, our Governor and every other well versed healthcare economist regardless of political party affiliation. I suggest you do some of your own reading (reports vs opinions like mine). Good luck to my 400000 friends that are deprived of fair health care services when they are ill.
One more thing:
Physicians are willing to treat Medicaid patients. I spend my time looking for specialty care. And have located retina surgeons willing to treat diabetics regardless of funding: Simply to preserve eyesight.
Jeffrey Harris
Consulting Program Manager Taylor Retinal Center
Co-Chair Patient Centered Primary Care Collaborative Washington DC

Hooray Humana for providing useful tools to family caregivers.

Yikes!!

Yikes!!

Lately I have complained about the lack of utility if not barriers created by various e- communication tools that seem to complicate the process of educating consumers on the topics within the domain of self-mastery.
After losing my poa agreement with my father, Humana finally
Let me know that I am now Pop’s designated healthcare proxy.
I find the letter engaging with plenty of contact info content and a promise to send me a care-advocates guidebook with accompanying educational material for visit preparation, medication reconciliation and financial management.
I will let you know how useful it is when received.

For now, a gratuitous thank you to a payer stepping into the medical home care team role with both patient and family!

A Chronic Disease Patient Reports On e-HR and p-HR utility

 

Reconciling data in my six health portals

Reconciling data in my six health portals

I will be attending the PCPCC annual conference next week and moderating a session on Do It Yourself Primary Care Medical Homes.

Most of my time of late has been attending to my ‘case’ as the demands of self-management are now more complex with the advent of new tools which were to lighten our load. Nowadays I spend at lease two hours each week keeping my 4 p-HRs up to date across four specialty physicians.

Why you ask? Well it appears that someone forgot to turn on the ‘interoperability switch’. I am sure it is here somewhere, I just can’t find it. I know the standards were written for certification purposes, I even have a copy of them. For some reason, here in metropolitan RTP North Carolina: Duke, Wake Med and UNC have all established contracts with Epic. The physicians that I use are independent and they have all chosen AllSCRIPTS and this is my patient experience.

NOTHING CONNECTS

I HAVE AN EPIC MY CHART PORTAL AT UNC

I HAVE ANOTHER EPIC MYCHART PORTAL AT DUKE

I HAVE AN ALLSCRIPTS-MEDFUSION PORTAl AT GARNER INTERNAL MEDICINE

I HAVE AN ALLSCRIPTS MEDFUSION PORTAL AT SOUTHERN DERMATOLOGY

I HAVE AN ALLSCRIPTS PORTAL WITH NO MED FUSION AT NC CARDIOLOGY

I HAVE AN ALLSCRIPTS PORTAL WITH NO MED FUSION AT MY ENDOCRINOLOGIST

I HAVE A HEALTHVAULT PORTAL ATTACHED TO LABCORP AND SURESCRIPTS

 I AM UNABLE TO TRANSFER CCR S BETWEEN RECORDS

THE FACILITIES ARE NOT TRANSFERRING THE RECORDS

OUR TAXPAYERS SUPPOSEDLY BUILT THE NCHIE TO CONNECT TO ALL PROVIDERS

I started out on this journey to reduce errors in medicine in 1997. Why are we still here? Please don’t blame it on Obama, Bush, Clinton; well you get the picture.

Here is my ‘secure message’ to my Medical Home

My recent note to my PCMH

My recent note to my PCMH

 

Physicians retreat from accepting NC Medicaid Patients

cemetary at dusk

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

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

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