Consulo Indicium - 10/11/18
Information for your Consideration…
Combatting the Opioid Menace – The US Department of Health and Human Services (DHHS) recently announced that the agency has “awarded more than $1 billion in grants to states, communities and organizations fighting the opioid crisis.” The bulk of the money ($930 million) has been allocated to support state efforts related to providing treatment and prevention services in combating the opioid problem. DHHS also has allocated more than $350 million to community health centers throughout the nation to increase access for substance use disorder and mental health services. The efforts are to be applauded but, we need to go beyond ex post facto treatment. Prevention is the key and a broad strategy for engaging in prevention has yet to be put forward in an effective way. So, let’s give the Administration credit for what’s been done but push them to do more. The opioid problem cuts across all societal sectors. More effort needs to be put into solving the problem…
Health Care Leaders Group Speak Out on Top Concerns – The HealthCare Executive Group (HCEG) recently released its Top 10 list of concerns. The group consists of provider, payor, technology and other related industry leaders who engage in a multiple day discussion before determining their consensus list of issues. The results of their list which presents challenges, issues and opportunities were as follows:
1. Data & Analytics: Rising to the top of the list, the issue was all about leveraging the data – especially the clinical data – to manage health care more effectively and to support decision-making.
2. Total Consumer Health: The consensus was focused on improving the overall medical, social, financial, and environmental well-being of individuals seeking health care services.
3. Population Health Services: There has been lots of talk about population health but not as much action. The discussions centered on operationalizing community-based health strategies that support chronic care management, drive clinical integration, and address barriers by integrating the social determinants of health as action points.
4. Value-based Payments: Again, another area that has gotten lots of talk and less action. The need for systems to support the targeting of specific medical conditions to improve quality of care and manage costs rose to the top of the discussion points.
5. The Digital Healthcare Organization: Health care is becoming a digital enterprise so literally all elements of the health care network including: portals, patient literacy, cost transparency, digital payments, mobile wearables and devices, other patient-generated data, remote monitoring, and omni-channel access/distribution of data were all issues that percolated to the top of the agenda.
6. Rising Pharmacy Costs: Strategies to address the continuing escalation of pharma costs along with the best approaches for measuring benefits to quality of care and total healthcare costs were highlighted
7. External Market Disruption: Suffice it to say, there was lots of discussion about the plethora of announcements emanating from new players in health care like Amazon, Chase, Apple, Walmart, Google – and, others...
8. Operational Effectiveness: The spectrum of opportunities for creating efficiencies was discussed including: implementing lean quality programs, process efficiency (with new core business models), robotics automation, revenue cycle management, and real-/near-time point of sales transactions.
9. Opioid Management: The struggle continues despite investments at the state and federal level for developing strategies to identify and support individuals and populations who struggle with substance abuse/addiction or are at-risk of addiction.
10. Cybersecurity: Finally, for the fourth year in a row, cybersecurity was listed in the Top 10 list. The protection of data by maintaining the privacy and security of consumer information and trust in sharing data were top concerns.
The Source of Academic Leadership – For the last century at least and probably longer, the USA has been a leader in academic circles. Our research, our universities, our academicians have been the points of discovery for this little wonder we call, Earth. It’s been the Golden Age in America. But, we are seeing the glimmer of change on the horizon and, the challenge is coming from the East. I remember my first visit to China in 1978 as a member of one of the very first delegations of health care professionals to visit China since before the Revolution. We were impressed with the many public health measures that had been implemented to improve the health of the people. It was remarkable! But, it was also obvious that China was well behind the USA in research, acute care and much of the rest of health care. Now, 40 years later (yes, 40 – argh), China is coming of age as a leader in the scholarly community. In recent years, the Chinese government has shifted its focus from investments that improve agriculture and manufacturing toward more scientific efforts. Witness the growth of investment in the technology sector as well as the fact that 11 of the top 100 universities globally are Chinese. During the ensuing period, Chinese academics have also moved to the pole position in the academic publications for math, the physical sciences and engineering where the number of academic publications has quadrupled since 2000. For example, in Nature and Science, 20% of the publications emanate from Chinese authors based at Chinese universities. Research in health care is not far behind. While the quality of their output is not up to par with the US, it’s not far behind either…
So, what’s the US response? Rather than embracing the change, the US government under the Trump Administration has started tightening the rules for obtaining study or work visas for Chinese academics – which now represent 1/3 of foreign students studying in America. The clamp down is being done on the notion that these academicians are gaining too much information and knowledge by studying in the US. However, our US scientific community has reacted with alarm. Knowledge is porous. The good part about the Chinese studying in the US is that they get to know our culture, the way we live, the way we think and – while there are many good elements about Chinese culture – they learn the US is not some evil empire. Scientific process absolutely requires an open collaboration. If, in fact, there are documented episodes of espionage or unsuitable behavior we have other avenues for managing such situations like criminal prosecution or academic expulsion. But, simply building a wall against academic collaboration will result in exactly the wrong result – the slow decline of research leadership in America. Rather than closing our doors, we should open them wide and serve as the source of collaboration and collegial exchange. At the end of the day, such an approach will yield far greater results than hiding behind our borders.
Paying It Forward – Yet another survey is out noting that workers are shouldering an ever-growing share of their medical costs because employers are simply passing along the additional health insurance costs in the form of deductibles. The non-profit Kaiser Family Foundation conducted a survey showing that health insurance premiums and deductibles for American workers continued to escalate in 2018. But, it wasn’t just the escalation, it was also the fact that cost increases are outpacing wage growth and inflation. For example, the average cost of a family health plan is now $19,616 a year, with workers contributing $5,547, or about a quarter of the cost. Employers pick up the balance of health plan costs for the workers as a benefit. But, the number of workers with large deductibles is increasing. In 2009, only 7% of workers had a deductible of $2000 for single coverage. Today, it is 26% (See Table). What we’ve seen in the market place is that health insurance premium increases have moderated, increasing by about 5%. However, deductibles have marched forward as employers adopt strategies which shift the cost burden to the workers. With the Republican efforts in play to undo the Accountable Care Act (ACA), access to affordable insurance has become increasingly problematic. I’ve said this before BUT – rather than undoing, we need to amend the ACA. After all, even though neither political party seems to believe it, solutions do come to the middle. They are not at the extremes of political agendas. Perhaps the focus should shift toward doing something right for the American people as a whole. The next revolution that we will see in the streets are marches about access to health care. Mark my word – they are coming. In 2000, 68% of the employers offered health insurance. That dropped to just over one-half by 2017 although it has increased to 57% for 2018. This is the one issue I get more emails on than any other – except, of course, those related to restaurants and where to eat…