Category: Healthcare Reform

GOP Bill Halts in Senate

Remember back in May when the GOP health bill passed in the House? The momentum stopped there.
The Senate failed to pass a GOP-proposed Health Law yesterday. Senate Majority Leader Mitch McConnell says they’re going to try again early next week, though it doesn’t seem like this will be a promising attempt either. Analysts attribute this to many deep-rooted factors:  the Republican party as a whole not unified behind an action plan other than repealing the ACA, the taking away of funding and resources without a viable exchange, and a severe lack of public hearings and drafting.
Provisions included in a draft of the bill last week including capping funding for Medicaid, and giving states the power to opt out of insurance regulations substantiated in the Affordable Care Act. This fielded much opposition from more moderate Republicans. They cite problems  such as too “deep cuts” to Medicaid, and an insufficient means to account for the expenses of changing the insurance system. This opposition was especially strong in Republican states like Ohio that had expanded Medicaid under the ACA.
Now, Republican Senators are working on re-drafting a “repeal and delay” bill that would phase out aspects of the ACA over a two year time frame–a version of this bill passed in 2015. Of note, the draft of this bill to be debated does not include an amendment proposed by Senator Ted Cruz. According to a report conducted by the Department of Health and Human Services, this amendment might actually result in broader coverage and lower premiums. The quality and correctness of this report is already under great criticism by healthcare and insurance analysts.
Sources: The New York Times, Kaiser Health News

Caring for Our Veterans

On Memorial Day we remember the men and women who have served our country as part of the U.S. military. After concluding their service, military veterans often face substantial physical and mental health issues that require medical care. Many of these veterans choose to seek care through the Department of Veterans Affairs (or facilities with which the department contracts). According to the U.S. Department of Veterans Affairs, “The Veterans Health Administration is America’s largest integrated health care system with over 1,700 sites of care, serving 8.76 million Veterans each year.” When coordinating services and care within such a massive health care system, it is inevitable that challenges arise.


Last year, the U.S. Government Accountability Office issued a report outlining the current issues facing the veteran health care system. Because of the many issues that they identified, including risks associated with timeliness, cost-effectiveness, quality, management, and oversight, the GAO placed VA Health Care on the 2015 High Risk List. This list included other pressing national issues such as Federal Oversight of Food Safety, and Managing Climate Change Risks.


Some improvements have already been made to the VA health care system. Most notable is the Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014, which was signed into law in order to expand survivor benefits and educational opportunities and to improve care for veterans. The law also sought to address the need for increased accountability, transparency, and recruiting of high quality medical professionals at VA facilities. At that time, President Obama also announced 19 new executive actions to improve mental health services for the military, veterans, and their families.


Despite these initiatives, it is clear that more work still needs to be done to ensure that those who have served are not returning home to face the further danger of inadequate medical care.

What can healthcare learn from Uber?

Reports and news stories about the wastefulness of the U.S. healthcare system abound, but the healthcare industry may be able to combat some of that waste by embracing the growing trend of collaborative consumption or a shared economy. This new economic model is rapidly gaining traction in other industries, especially the travel and hospitality industries, where companies like Uber, Lyft, and Airbnb are changing the way that people think about consumption by tapping into unused resources and creating peer-to-peer sharing networks.

In the Robert Wood Johnson Foundation’s Pioneering Ideas podcast, Rachel Botsman, coauthor of the book What’s Mine Is Yours: The Rise of Collaborative Consumption, explained the concept of a collaborative economy and identified the potential future role it could play in the healthcare industry.

Botsman posits that the growing waste, broken trust, unnecessary complexity, and redundancy in the medical field could be mitigated by a shared economy model. Some other unused or underused resources that could be tapped into with a sharing economy model include things like excess food, unused gym memberships, and the skills and knowledge of retired health care workers.

In addition, some hospitals have already created peer-to-peer networks in which expensive medical equipment can be shared with or rented to other hospitals that need them.  Because each hospital does not need to invest the hundreds of thousands of dollars to purchase their own device, it removes waste from the system and allows new technology to be adopted and utilized more quickly and efficiently, which can mean better and more affordable care for patients.

Botsman attributes the growing popularity of collaborative consumption to the rise in peer trust that is beginning to surpass the trust people have in traditional companies, as well as people’s increasing expectation and demand for two-way interactions. These ideas echo some of the underlying principles in the growing healthcare trends of patient empowerment and shared decision making.


What are some health or healthcare issues that you think could be addressed by a shared economy system? Share your thoughts in the comments!

The Costs and Benefits of Full-Time Employment: ACA Challenges

As the enrollment deadline for health coverage through the Affordable Care Act (ACA) has recently passed, more Americans will be eligible to receive heath care that is affordable and consistent, regardless of their pre-existing conditions. Obviously, this is a plus for many on the consumer side of the spectrum, but what does it mean for struggling employers now having to pay more to offer coverage to more of their workers?

The beginning of 2016 marked an ACA requirement that all employers with 50 or more full-time workers offer health coverage, or otherwise pay a steep penalty. In some cases, this has had unintended consequences, forcing employers to downsize, to both cut health costs and/or avoid the requirement altogether.

Some smaller employers are learning the hard way and are making staffing adjustments just to stay afloat. This is especially the case among the fast food industry, where most employers have decided to avoid the steep ACA penalty by making more of their workers part-time, precluding these employees from the option of employer-based coverage. Obviously, this isn’t doing any favors for the employees, so is cutting corners like this really worth it?

Another aspect of this situation is that when employers decide to make more workers part-time, the more workers they have to hire to do the job. As a result, there are usually scheduling headaches and frequent turnover, and as a result, many managers and business owners complain the quality of their establishments has declined.

And this makes sense. If workers who are already earning minimum wage aren’t going to be rewarded in other ways for their work, what incentive do they have to remain loyal to their employer? With less loyalty come fewer skills. It’s a problem that is unfortunately on the rise as ACA mandates — although intended to support the consumer, actually end up not only being ineffective to the employee, but also hurting the employer as well.

In the end, in many cases, the workers end up paying the most severe penalty. Workers who desire to work more hours — to be full-time — yet can’t because their employer can’t afford it. And, as a result of the workforce being flooded with part-time workers, some areas are seeing an increase in their numbers of Medicaid recipients. For many, there is nowhere else to turn, despite their desire to be independent. And for others, they say they come out better by working part-time and receiving health coverage through the state.

So, what do you think? Do you think Obamacare is fulfilling its promise to make Americans safer and more secure through health coverage, or have the unintended consequences caused more problems?


Photo credit: Bloomberg News

Changing Our Thinking: Quality Over Quantity for a Better Health System

For many of us covered by a health insurance plan, the thought of how much we spend on the services we receive — whether it’s a routine procedure, such as a mammogram, or a monthly medication for anxiety — is unlikely to cross our minds. The most we might think about the cost incurred lies with our copay, the reduced amount we pay for the service we utilize under our plan. Copays can vary—from $10 to $45—depending on the type of service used.

But what about the actual cost of those services and medications? What does a mammogram really cost? Surely 30 tabs of a common antidepressant don’t cost just $45. Folks without insurance might be more aware of the realities of this, although they are less likely to obtain these types of services and medications for that very reason alone — cost.

While the average cost of a mammogram is around $100, the cost of other preventative services, such as a colonoscopy, can cost upwards of around $5,000. Medicare recipients usually don’t have to feel the sting of such a bill since they’re likely to also receive a special type of coverage called Medigap, which pays for the services Medicare doesn’t cover.

But does that mean we still shouldn’t be concerned with keeping our healthcare expenditures at a minimum or is the sky the limit? And even if you are concerned, will your doctor know how much things cost before you choose to undergo them? Most physicians say they know very little about medical pricing since they received very little or no formal training at all regarding healthcare spending or cost-effectiveness when it comes to tests and treatments.

Instead, most providers were taught the American rationale of healthcare — to focus on the best treatment they can offer, regardless of the cost. But in a world where many individuals are no longer able to afford insurance coverage due to ever-rising expenditures, should our nation continue with this way of thinking? Or should we become more mindful of costs, even if we aren’t the ones bearing the burden of them?

Fortunately, the Affordable Care Act is bringing attention to the long overdue subject, forcing medical equipment companies and the pharmaceutical industry — known as Big Pharma — to take a hit through higher taxes. Those dollars are now being shifted to help fund many new enrollees to receive the coverage they need to remain healthy.

But as more people enroll, will they, too, become less likely to bear in mind the cost that remains for the services they receive? Unfortunately, for those physicians who are interested in helping their patients make informed decisions, there isn’t much help available; however, smartphones have made obtaining this knowledge easier, through apps that link to health insurers’ price databases.

But the question still remains — “Will knowing the price of a colonoscopy have any affect on those that are considering one?” Of course, I’m by no means suggesting patients and providers forego services if they are truly needed, as in cases where there’s a family history or pre-existing conditions occur. But I would like to see more concern placed on the quality of care providers give and patients receive. Making the patient more a part of his/her health plan is key to garnering an interest in what services cost and whether or not they are truly needed.

Perhaps as the ACA makes it’s way into history books and more folks get insured, we’ll see a shift in priorities, with a stronger emphasis on quality care at reduced cost, for that’s the only way we’ll truly begin to see equality for all in the game of the healthcare sector.

who contributes to the poor care coordination in the U.S. health system?

The organization of the private health sector contributes to the poor care coordination in the United States health system.

Firstly, with different purposes to provide health care service, it’s difficult for public and private health sector to cooperate. Unlike public health care providers, the purpose of private providers is to make a profit. The payment of private providers is not transparent and the health care costs rise rapidly, leaving patients with little choice but to go into debt to pay for the care. As a result, private health care is too expensive for Americans. Some patients may decide not to seek help because of the financial problem. However, with the goal of promoting health status of entire population, the payment for public health sector is relatively law with the comparison to private health sector. Due to the existing inconsistency of the payment, the care coordination is a serious challenge.

Secondly, due to the disparate competitors, the cooperation between public and private health sector is difficult. Private health care provider needs to compete with other providers. Thus, in order to attract more consumers, several health services with low price but poor health care quality will be created. However, the competitor for public health care sector is health problem. With the purpose of addressing health problem successfully, the public provider will provide high health care quality with relatively high price. Therefore, a potential competition of price between private and public health care may harm the care cooperation.

In general, the private health sector makes care coordination a serious challenge by largely fragmenting the health care delivery system. This fragmenting leaves patients with poor-quality health care outcomes. Medical errors can occur as a patient moves from one care setting to another, or is prescribed different medications that interact.

James R. Knickman and Anthony R. Kovner (2011). Jonas and Kovner’s health care delivery in the United States. Springer Publishing Company.

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Dewey Mooring on Three Simple Rules for Marketing Success

Earlier this week, the writers of Upstream had the pleasure of hearing Dewey Mooring, the Vice President of Jennings: Healthcare Marketing talk about three simple rules for marketing success.

Mooring, a UNC alumni, graduated with a B.A. in Radio, TV and Motion pictures in 1993. He started his career in communications at WCHL, a local radio station in Chapel Hill, by helping with the broadcast of Tar Heel basketball and football games.

Fifteen years ago, he decided to join the advertising world, and now as the Vice President of Jennings, he leads the account team, authors strategic plans, creative briefs, and oversees research for various clients including Vidant Health, Cooper University Health Care, Southwestern Vermont Medical Center, and Darmouth-Hitchcock Medical Center, among others.

As aspiring health communicators, we all benefited from Mooring’s valuable advice about successful marketing. He offered these three simple rules to follow:

1.) Know

Get to know your audience. If you don’t understand who you’re talking to, you won’t be successful in talking to them. Mooring suggests creating a persona for your audience in order to best market to them. Give that person a name, an age, a salary, and find out their media interests, like what they watch on TV, what magazines they read, and what brands they like.

2.) Engage

Once you get to know your audience, it becomes important to use this information to engage them. In the world of healthcare, peer-to-peer communication has become a huge trend, especially among online health information seekers. Because of this, finding ways to use social and digital media to connect brands with their target audiences can be a successful strategy. Mooring exemplifies this by talking about the company’s use of a blog for Lowell General Hospital & Floating Hospital for Children titled, Our Circle of Moms, that engages moms in the hospital’s brand by allowing them to connect and share with other moms in the community.

3.) Measure

When working with clients, it is important to not only show them what you spent their money on, but also to justify the money spent with measured results. This can be done by keeping track of visits to websites, how many people signed up for a program after information sessions, and radio and digital reach. Mooring points out that while measuring results is easier than it was before, it can still be difficult in the area of healthcare, as the majority of hospital services and treatments do not lend themselves to immediate action by consumers.

What are Community Health Workers (CHWs)?

Going to a doctor’s appointment, I often feel a variety of emotions: anxiety, apprehension, worry, confusion, and, hopefully at the end, relief. And I’m a student in a health profession! While this may not be the case for everyone who uses health services, imagine if English wasn’t your first language or your literacy skills were limited, if you had a cultural distrust of doctors, or you had other challenges and barriers you had to face in order to receive health care.

That’s often the case with more vulnerable members of the population, such as immigrants, who are also susceptible to significant health disparities compared to the rest of the population. As a way of reaching traditionally underserved individuals and “combatting ethnic and racial disparities in health care,” Community Health Workers (CHW) are being utilized more and more frequently. According to the American Public Health Association, CHWs are defined as: a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community being served. CHWs are recognized in the Patient Protection and Affordable Care Act (ACA) as “important members of the health care workforce” and are meant to bridge the gap between community health and the traditional medical system. CHWs are able to communicate and connect with patients more deeply than many physicians may be able to by speaking the same language and often having shared experiences.

Some may be concerned over the fact that CHWs don’t have formal medical training, but they coach patients on their diagnoses. However, they often get several months of training, including on background on disease management, medications, and behavior change. This means CHWs can benefit patients by scheduling follow-up appointments and making sure they take their medications. Medicaid now reimburses for providing preventive services as long as a licensed practitioner (such as a physician) recommends the use of a CHW.

Recently, the American medical system has experienced rising costs, mediocre health outcomes, and isolated medical specialties. Interdisciplinary teams employing community health workers are a great way to better reach vulnerable patients and improve the quality of patient care, and states around the country should follow in the footsteps further develop the CHW workforce.


Read more from the Kaiser Health News story on L.A. Community Health Workers 

Photo source: Community Eye Health via 

Bias on using HIV-blocking drug

The Boston attorney, as a gay man, thought he was discriminated for having HIV-blocking drug.

The attorney tried to ask his doctor to prescribe Truvada, an HIV-blocking drug, to be responsible for preventing himself from being infected by HIV. But he failed to get long-term care insurance from Mutual of Omaha. The reason why Mutual of Omaha turned him down is it does not cover anyone who takes the drug. As a result, the man will sue the insurer for the discrimination of being gay. He already filed a complaint with the Massachusetts Commission Against Discrimination this Wednesday.

According to the article published in the associated press, the man said:”I thought maybe they misunderstood me. I’m HIV-negative. I’m not HIV-positive. I was taking Truvada as a prophylactic.” The objective for him to sue the insurer is to ensure that people like him will not be worried about the discrimination for using Truvada.

Truvada, a preventive drug, was approved for reducing the risk of being infected by HIV among uninfected people by FDA. Moreover, in accordance with the data published by CDC, Truvada is able to largely reduce the risk in people at-risk.

However, there are a group of critics of Truvada claim that the use of Truvada may increase the prevalence of risky sexual behavior such as condom-less sex, though it is effective to some extent.

What do you think about the advantages and disadvantages of HIV-blocking drug? Will it really increase risky sexual behaviors in people at-risk?

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Wellness Wednesdays: What is ‘Wellness’?

Exploring the Idea

‘Wellness’ – the word itself conjures positive feelings of energy and youth, self-efficacy and joy.  But wellness is more than simply the ‘absence of illness’ – to me, it revolves around the pursuit of a balanced physical, mental, emotional, and spiritual life. Beyond that, however, I believe everyone has their own definition of wellness, their own concept of what it looks like when applied to their lives.


Today’s Reality

The healthcare system in the United States was designed to diagnose and treat disease – in the early 20th century people were largely healthy, and relied on the healthcare system to cure them when they fell sick. Today, however, the needs of our population have shifted. A significant proportion of Americans are burdened with at least one medical condition, and our struggle is now focused more on how to maintain and improve our collective health.


More than Willpower

I think many of us try very hard to live ‘well’ – but as the saying goes, ‘the best laid plans of mice and men often go awry’. It is incredibly challenging to follow the lifestyle advice that we know is associated with good health, like ‘eating a plant-based diet’ or ‘getting two and a half hours of moderate physical activity every week’. Do we all just lack the willpower necessary to accomplish these deceptively simple goals? I don’t think so.


How ‘Free’ Are We?

Our environment constrains our individual behaviors – it can make these behaviors either easier or harder to achieve, depending on how the environment is structured. However, America was built on the values of ‘freedom’ and ‘personal responsibility’, which can often seem at odds with this idea that ‘context’ can have so much influence on our choices.


What does wellness mean to you? Where do you fall on the continuum of health? Do you feel you are closer to ‘healthy’ or ‘sick’? How ‘free’ do you consider yourself to be? Please help us continue this important conversation by sharing your responses to some of these questions in the comments section below.