Medicare ’s Bundled Payment Programs Suffer From Fatal Flaws, But There Is A Logical Alternative
Several authors from the Brookings Institution recently argued in favor of making Medicare’s Bundled Payment for Care Improvement (BPCI) initiative mandatory. While the principles guiding their recommendations are sound, the recommendations themselves fail to acknowledge five fatal methodological flaws within the BPCI program. Their analysis also overlooks the most logical and reasonable alternative: a physician-focused episode-of-care payment model.
Five Fatal Flaws Of The BPCI Initiative
1. Hospital-Centricity
Each BPCI bundle is triggered by an inpatient stay and in particular by a specific diagnosis-related group (DR...
Source: Health Affairs Blog - May 9, 2017 Category: Health Management Authors: François de Brantes Tags: Costs and Spending Insurance and Coverage Medicare Payment Policy Alternative Payment Models Bundled Payment for Care Improvement initiative Bundled Payments Merit-Based Incentive Payment System Physician-Focused Payment Model Technical Ad Source Type: blogs
Making A Prohibition On Preexisting Condition Exclusions Effective Requires Additional Measures
One of the most popular components of the Affordable Care Act (ACA) is the prohibition on preexisting condition exclusions, eliminating the practice in which insurers exclude coverage for health problems that people had prior to enrolling in an insurance plan. People do not like the idea that an insurer does not have to pay for care that people need due to a previously known health problem. But prohibitions on preexisting condition exclusions alone are insufficient to protect those with health problems and ensure their affordable access to necessary care. Meaningful protections require a package of policies: guaranteed iss...
Source: Health Affairs Blog - May 2, 2017 Category: Health Management Authors: Linda Blumberg and John Holahan Tags: Costs and Spending Featured Following the ACA Insurance and Coverage Quality ACA repeal and replace American Health Care Act community rating Essential Health Benefits preexisting conditions Source Type: blogs
Finding Good Medical Resources
This always amazes me. People get diagnosed with a medical ailment and then don ' t use the good medical resources available. If you need medical information, you need to do a little research to find the resources.A good patient takes time to learn about any significant medical ailment so they better understand their health. If you are educated you will be less stressed and potentially handle your ailment better. You really do not want to just jump on the internet and google your ailment. That is the worst thing to do.A good first step is to ask your doctor who diagnosed you on where you can get good information. Its their...
Source: Caroline's Breast Cancer Blog - May 2, 2017 Category: Cancer & Oncology Tags: ailments medical research stress Source Type: blogs
Fight Aging! Newsletter, May 1st 2017
In this study we demonstrate the use of clustered regularly interspaced short palindromic repeats (CRISPR)-based epigenome editing to alter cell response to inflammatory environments by repressing inflammatory cytokine cell receptors, specifically TNFR1 and IL1R1. This has applications for many inflammatory-driven diseases. It could be applied for arthritis or to therapeutic cells that are being delivered to inflammatory environments that need to be protected from inflammation."
In chronic back pain, for example, slipped or herniated discs are a result of damaged tissue when inflammation causes cells to create molec...
Source: Fight Aging! - April 30, 2017 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Am I or Will I Get Better?
I get asked often, am I getting better? Have any of my doctors found a miraculous treatment for me?The answers are and always will be a big fat ' no ' .There are different kinds of ailments out there. They are (in my non medical terminology):Acute - an ailment which happens and gets better. Think a cut, the flu, appendicitis, Lyme disease.Chronic - an ailment which occurs and lasts and lasts and lasts. Think things like arthritis, fibromyalgia, degenerating disks, etc.Terminal - an ailment which will kill you. "Terminal illnesses or infections are consideredincurable when there are no conservative therapies available which...
Source: Caroline's Breast Cancer Blog - April 26, 2017 Category: Cancer & Oncology Tags: ailments chronic conditions medical treatment pain management Source Type: blogs
Osteoarthritis as an Inflammatory Condition
This open access paper discusses current views on the degree to which osteoarthritis is driven by inflammation, as is the case for many other age-related diseases. With aging the immune system declines into a malfunctioning state of chronic inflammation, ever more active while also ever less effective at the tasks of destroying pathogens and errant cells. In young people, inflammation in short bursts is a necessary part of the immune response, but in the old it becomes a consistent destructive process, gnawing away at the proper function of organs and systems in the body and brain. Addressing this in some way, perhaps thro...
Source: Fight Aging! - April 24, 2017 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
A New Attempt Emerges To Bridge GOP Divisions On AHCA (Updated)
April 21 Update: New Aid For State Formulary Review At REGTAP
On April 17, 2017, CMS announced that it would be turning the job of drug formulary review for qualified health plans over to state regulators in the thirteen HealthCare.gov states that have plan management responsibility. On April 19, CMS offered at its REGTAP.info website (registration required) a seminar on the qualified health plan (QHP) application review tools for prescription drugs that the states may use for these reviews.
The EHB Category and Class Drug Count Tool, which is new for the 2018 QHP review period, reviews drug lists to ensure that QHPs com...
Source: Health Affairs Blog - April 20, 2017 Category: Health Management Authors: Timothy Jost Tags: Costs and Spending Featured Following the ACA Insurance and Coverage Source Type: blogs
Overcoming Challenges Of Outcomes-Based Contracting For Pharmaceuticals: Early Lessons From The Genentech – Priority Health Pilot
Conclusion
Outcomes-based agreements are a natural extension of a health care delivery-and-reimbursement environment that is moving toward value. With provider organizations taking increasing accountability for both costs and outcomes, it is becoming incumbent upon manufacturers to demonstrate the economic, clinical, and quality-of-life benefits of their medicines. The pilot described here was successful in that Genentech and Priority Health both learned how to overcome clinical, operational, and contractual challenges and demonstrated that this type of agreement is feasible. Genentech and Priority Health believe pilots li...
Source: Health Affairs Blog - April 3, 2017 Category: Health Management Authors: John Fox and Marc Watrous Tags: Costs and Spending Drugs and Medical Innovation Payment Policy Outcomes-based agreements Source Type: blogs
ICER Devalues People With Rheumatoid Arthritis
(Source: drugwonks.com Blog)
Source: drugwonks.com Blog - March 29, 2017 Category: Pharmaceuticals Source Type: blogs
I Am Rebelling
Sometimes I need to let my inner rebel out and stop being such a good patient. I usually try to be a good patient (and go to my appointments, take my meds as prescribed, talk to my doctors honestly and generally do what they want me to). But not right now.Last fall I was told I have sleep apnea and my doctors want me to have a CPAP machine for sleeping. I got my CPAP machine and hate it. I can ' t stand having anything on my face while I sleep. I am on my second mask and still cannot deal with it. I wake up and want to rip it off my face. If I sleep with the mask on, I don ' t ever feel rested and have the weirdest dreams....
Source: Caroline's Breast Cancer Blog - March 23, 2017 Category: Cancer & Oncology Tags: apnea CPAP lack of sleep rebelling Source Type: blogs
Things Are Not Working As Planned
Sometimes, things just don ' t go as you wanted or expected. Its a fact of life and we need to learn to cope, change directions, and move on.In the grand scheme of things, my original plans were that would I grow up, go to college, get a job, a career, married, kids, retire to a life of happiness and world travel. Well, we know what happened to that. I got as far as ' go to college ' when my health started taking over my life. One little cancer diagnosis has a big emotional impact and it took time to get my life back together.So I regrouped and started over at college, etc. The job and career went okay. I did eventually go...
Source: Caroline's Breast Cancer Blog - March 14, 2017 Category: Cancer & Oncology Tags: being healthy housebound life new house Source Type: blogs
Study Links Multiple Sclerosis to Dementia Risk
It’s MS Awareness Week in the United States — the time of year that the National Multiple Sclerosis Society and people living with MS try to spread awareness of this disease. For the past several years, I’ve determined to spend this week educating people who live with MS about the disease they have.
For past MS awareness weeks, I’ve written pieces on MS history and about the first recorded cases of MS. Today I write about research suggesting what might be in some of our futures. It’s not a happy topic, but I believe that forewarned is forearmed.
A recent study published in the Journal of Epidemiology &...
Source: Life with MS - March 7, 2017 Category: Neurology Authors: Trevis Gleason Tags: multiple sclerosis awareness life with MS Living with MS MS and family MS symptoms trevis gleason Source Type: blogs
Invisible High-Risk Pools: How Congress Can Lower Premiums And Deal With Pre-Existing Conditions
As Congress and the Trump administration move forward with plans to repeal and replace the Affordable Care Act (ACA), they are looking for proven state-led reforms that maintain access for those with pre-existing conditions in the current exchange market while also lowering premiums for everyone buying insurance in the individual market.
Maine faced similar challenges in 2011 as it sought to unwind failed experiments that pushed its market into a long-term death spiral. But by creating an invisible high-risk pool and relaxing its premium rating bands, Maine policymakers were able to cut premiums in half while still guarant...
Source: Health Affairs Blog - March 2, 2017 Category: Health Management Authors: Joel Allumbaugh, Tarren Bragdon and Josh Archambault Tags: Following the ACA Health Policy Lab Insurance and Coverage ACA repeal and replace high-risk pools pre-existing conditions Source Type: blogs
Could Grains Cause Autoimmunity?
The prolamin proteins of grains— the gliadin of wheat, secalin of rye, hordein of barley, and zein of corn— initiate the small intestinal process that cause a perfect storm in our bodies. And they do so in more than one way. You could even argue that prolamin proteins are perfectly crafted to create autoimmunity.
Prolamin proteins of grains are masters at molecular mimicry. The prolamin proteins have been found to trigger immune responses to a number of human proteins, including the synapsin protein of the nervous system; the transglutaminase enzyme found in the liver, muscle, brain, and other organs; the endomysium of...
Source: Wheat Belly Blog - March 1, 2017 Category: Cardiology Authors: Dr. Davis Tags: Autoimmunity Dr. Davis Grain Free Lifestyle Grains Grains and Grasses Wheat Belly Lifestyle Wheat Belly Success Stories Wheat Belly Total Health Wheat-Free Lifestyle Inflammation low-carb Weight Loss Source Type: blogs
Call me Ms. Grumpy
I am very grumpy these days. I think part of it is juggling my medical issues. But its also that I have been dealing with a lot of pain, and in new body parts. I am still on that never ending roller coaster of ' wait its another doctor appointment ' each week. Also, my stupid CPAP machine doesn ' t help me. I have given up even using it because the mask doesn ' t work for me.Last night I almost cancelled all my plans for today to stay home and pout. But I realize pouting never got anyone anything so I ditched that. I did get some good sleep last night which helps. And my reward today is getting my nails done this afternoon...
Source: Caroline's Breast Cancer Blog - February 24, 2017 Category: Cancer & Oncology Tags: ailments crabbiness stress Source Type: blogs
