Fee-For-Service: Predominant, Winning & Stupid
By MATTHEW HOLT In recent days and weeks, there have been three stories that have really brought home to me the inanity of how we run our health care system. Spoiler alert, they have the commonality that they all are made problematic by payment per individual transaction—better known as fee-for-service. First, several health insurers who sold their reputation to Wall Street as being wizards at understanding how doctors and patients behave had the curtain pulled back to reveal the man pulling the levers was missing a dashboard or dial or three. It happened to United, Humana and more, but I’ll focus on Agilon becau...
Source: The Health Care Blog - March 4, 2024 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Matthew Holt Change Healthcare Colorado fee for service Humana UCHealth United HealthGroup Source Type: blogs

So what can we do about health care costs?
By MATTHEW HOLT Last week Jeff Goldsmith wrote a great article in part explaining why health care costs in the US went up so much between 1965 and 2010. He also pointed out that health care has been the same portion of GDP for more than a decade (although we haven’t had a major recession in that time other than the Covid 2020 blip when it went up to 19%). However, it’s worth remembering that we are spending 17.3% of GDP while the other main OECD countries are spending 11-12%. Now it’s true that the US has lots of social problems that show up in heath spending and also that those other countries probably spend ...
Source: The Health Care Blog - February 20, 2024 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Matthew Holt Buzz Cooper Datmouth health spending Jeff Goldsmith John Wennberg Medicare Price controls Source Type: blogs

Consider Bypassing Your Health Insurance to Afford Certain Type 1 Diabetes-Related Medicines and Supplies
Since it ' s January (a new year), and about half of all Americans with employer-sponsored healthcare insurance plans have some deductibles to satisfy before their healthcare insurance really kicks-in to cover much of anything and deductibles reset on January 1, I thought perhaps this might be a good time to write about my own experience with high-deductible insurance plans and some intelligent work-arounds which I ' ve discovered to deal with those. Who knows? You might (as I did) find you actually like using a particular brand or variety of insulin which is not " preferred " by your insurance ' s PBM, or maybe you f...
Source: Scott's Web Log - January 11, 2024 Category: Endocrinology Tags: type 1 diabetes 2024 bypass insurance manufacturer coupons PBM ' PBMs unbranded insulin Source Type: blogs

PursueCare Completes Series B Fundraising Round and Acquires Digital Therapeutics Developed by Pear Therapeutics, Inc.
The Fundraising and Acquisition of Digital Therapeutics for SUD Strengthens PursueCare’s Ability to Provide Care for Individuals with Addiction PursueCare, a digital addiction treatment provider, today announced the completion of a Series B fundraising round totaling $20 million. The Series B round was led by T.Rx Capital and Yamaha Motor Ventures, with participation from Seyen Capital and OCA Ventures. The proceeds from the financing will support PursueCare’s ongoing collaborative care initiatives with health systems across 11 states, as well as expansion into value-based care with Medicaid managed care and other heal...
Source: EMR and HIPAA - January 5, 2024 Category: Information Technology Authors: Healthcare IT News Tags: Health IT Company Healthcare IT Corey McCann Health IT Acquisitions Healthcare M&A Nicholas Mercadante OCA Ventures Pear Therapeutics PursueCare reSET reSET-O Seyen Capital T.Rx Capital Yamaha Motor Ventures Source Type: blogs

High-deductible health plans: a barrier to care for chronic conditions
At the peak of the coronavirus crisis in 2020, American policymakers were faced with the critical challenge of how to encourage as many Americans as possible to be tested for and vaccinated against the COVID-19 virus. Fortunately, Congress rose to this challenge by passing legislation that, in addition to providing these services to the uninsured, Read more… High-deductible health plans: a barrier to care for chronic conditions originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - December 31, 2023 Category: General Medicine Authors: Tags: Policy Diabetes Endocrinology Source Type: blogs

Abbott Gets Real About " Formulary Exclusions " Bankrolled by Rival Dexcom in the U.S.
My followers may recall that I ' ve written not-so-kind blog posts about how Dexcom paying legally-exempted rebate kickbacks (seehttps://blog.sstrumello.com/2023/06/dexcom-pays-pbms-kickbacks-to-exclude.html for one such blog post) to major Pharmacy Benefit Managers (PBMs) contingent upon " formulary exclusions of less costly rival continuous glucose monitoring (CGM) systems such as Abbott Freestyle Libre. The retail prices for both CGM sensor brands are remarkably close (ranging from $57.33/sensor to $61.28/sensor). However, the cost computation is not based on the cost per sensor, but must be computed on a cost per ...
Source: Scott's Web Log - December 14, 2023 Category: Endocrinology Tags: 2023 Abbott Freestyle Libre 3 coupons Dexcom PBM PBMs Source Type: blogs

Predictive Analytics from eClinicalWorks Serves Front-line Clinics
CareSTL Health has to conserve resources. As a federally qualified health center (FQHC) in St. Louis, MO, CareSTL Health serves people with no insurance. Patients often have trouble getting access to health cares services, suffer from serious illnesses, and need a lot of reassurance and communication to establish trust. Analytics in their eClinicalWorks EHR helps this front-line organization in several ways, according to Chief Medical Officer Hari Nallapaneni, M.D. CareSTL, for example, makes use of the new AI-powered tool from eClinicalWorks that can help identify patients who are a most likely to miss their appointment (...
Source: EMR and HIPAA - December 6, 2023 Category: Information Technology Authors: Colin Hung Tags: AI/Machine Learning Ambulatory Analytics/Big Data C-Suite Leadership Clinical EMR-EHR Health IT Company Healthcare IT CareSTL Health eClinicalWorks eCW FQHC FQHCs Hari Nallapaneni Healthcare AI Healthcare Analytics Healthca Source Type: blogs

Turnarounds are Talent Magnets: University of Chicago Medical Center
By JEFF GOLDSMITH Like birds of a feather, talent in healthcare management often gathers in flocks. The University of Minnesota, University of Michigan and University of Iowa healthcare management programs are all justly famous for graduating, over many decades, an exceptional number of future transformative healthcare leaders. But sometimes, talent comes from the “street”- challenging healthcare turnarounds that attract risk-taking leaders who, in turn, gather young talent around them. The University of Chicago’s urban academic health center has been one of these places. The U of C was (and remains) the la...
Source: The Health Care Blog - November 13, 2023 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Jeff Goldsmith talent University of Chicago Source Type: blogs

Hard Times in the Country
 The AP recently reported onthe disappearance of maternity wards in rural areas: Alisha Alderson placed her folded clothes and everything she needed for the last month of her pregnancy in various suitcases. She never imagined she would have to leave the comfort of her home in rural eastern Oregon just weeks before her due date. But following the abrupt closure in August of the only maternity ward within 40 miles, she decided to stay at her brother ’s house near Boise, Idaho — a two-hour drive through a mountain pass — to be closer to a hospital. . . .A growing number of rural hospitals have been shutt...
Source: Stayin' Alive - September 22, 2023 Category: American Health Source Type: blogs

Has Sensemaking Collapsed When It Comes To U.S. Healthcare?
By MIKE MAGEE This past week my wife and I were at a family event to celebrate my brother-in-law’s 70th birthday. Our extended family has more than a few doctors. A physician nephew who had read CODE BLUE and had a strong interest in health policy asked if I felt I (and others) were too hard on doctors. My response was yes, but that it was intentional and came with the territory. Combining scientific, sometimes life and death expertise, with high-touch compassion, understanding and partnership has always been a “big ask” but that was what we and others had signed up for as “health professionals.” But can a ...
Source: The Health Care Blog - September 5, 2023 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Deming Don Berwick ESCAPE FIRE Karl E. Weick Mike Magee Physicians Sensemaking Source Type: blogs

Upcoming Healthcare Regulations and Their Impact on Healthcare IT
For something as important and as sensitive as healthcare, there are plenty of rules and regulations in place to protect both patients and organizations. However, with healthcare being ever-evolving our regulations are also ever evolving. This can make it extremely difficult to not only follow all of the ones in place today but to prepare our organizations for the upcoming regulations. To help out, we reached out to our amazing Healthcare IT Today Community to see which healthcare regulations they foresee having a big impact on healthcare IT. The following is what they had to say. Stephen Sofoul, SVP, Data & Decision S...
Source: EMR and HIPAA - August 28, 2023 Category: Information Technology Authors: Grayson Miller Tags: Administration Ambulatory C-Suite Leadership Health IT Company Healthcare IT Hospital - Health System LTPAC Regulations Andrew Harding athenahealth Brightside Health Cassie Choi Darena Solutions e4 Services Freshpaint Healthc Source Type: blogs

Insurance Deductibles Don't Work Well for Patients with Chronic Illnesses. Some strategies for PWD's With HDHP's to Consider.
The U.S. IRS defines a High-Deductible Health Plan (HDHP) as a health plan with an annual deductible that is not less than $1,500 for self-only coverage or $3,000 for family coverage, and for which the annual out-of-pocket expenses (deductibles, co-payments, and other amounts). About half of all Americans with employer-sponsored healthcare insurance plans have deductibles to satisfy before the insurance covers much although some employers provide Health Reimbursement Accounts (HRAs) to help offset the deductible. That said, the IRS has also ruled that an HDHP can cover certain types of " preventive " care without a deducti...
Source: Scott's Web Log - August 24, 2023 Category: Endocrinology Tags: 2023 Ascensia CGM E3 Eversense HDHP Senseonics Source Type: blogs

Why Amazon Pharmacy's Recent Insulin Move is Helpful, But Not Groundbreaking
On August 15, 2023, Amazon Pharmacy (fka PillPack) announced (seehttps://www.aboutamazon.com/news/retail/amazon-pharmacy-insulin-coupons/ for the announcement) that it would begin automatically applying various manufacturer coupons to more than 15 common insulins and diabetes devices (including Dexcom, which offers a coupon for up to $200 per month athttps://www.dexcom.com/en-us/savings-center-cgm-without-insurance/ even without insurance). So far, no coupons from Abbott on Freestyle Libre 3 sensors, but the longer wear-time of 14-days means those cost about one-third less than Dexcom ' s 10-day Some products, such as bloo...
Source: Scott's Web Log - August 22, 2023 Category: Endocrinology Tags: 2023 Amazon Amazon Pharmacy coupons insulin prices Source Type: blogs

THCB 20th Birthday Classic:  As I’ve always suspected, Health Care = Communism + Frappuccinos
By MATTHEW HOLT Our 20th birthday continues with a few classics coming out. Back in 2005 I was really cutting a lyrical rug, and would never miss a chance to get that Cambridge training in Marxism into use. This essay about whether health care should be a public or private good has always been one of my favorites, even if I’m not sure Starbucks is still making Frappuccinos. And 18 years later the basic point of this essay remains true, even if many of you will not have a clue who Vioxx or Haliburton were or why they mattered back then! Those of you who think I’m an unreconstructed commie will correctly suspec...
Source: The Health Care Blog - August 15, 2023 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Matthew Holt Communism Frappuccinos Source Type: blogs

Increased Medicaid Coverage Is Not Improving Low Birth Weight
Marc JoffeWith so many people obtaining Medicaid coverage in the wake of the Affordable Care Act and during the pandemic, it is worth investigating whether this expanded eligibility is improving health outcomes. Overall, decreases in theproportion of uninsured individuals over the last decade are not being matched by improved life expectancy. Indeed, life expectancy at birth in 2021was lower than it was when the Affordable Care Act passed. But this fact tells us little about the benefits of Medicaid coverage since the decline has been driven in large part by COVID-19 deaths among elderly patients (often not on Medicaid) as...
Source: Cato-at-liberty - June 13, 2023 Category: American Health Authors: Marc Joffe Source Type: blogs