Kaiser Permanente Researchers Exploring How AI Can Improve Care For Heart Disease Patients

Kaiser Permanente researchers exploring how AI can improve care for heart  disease patients | FierceHealthcare

Source: Fierce Healthcare, by Brian T. Horowitz

Kaiser Permanente is exploring the use of artificial intelligence to cull through doctors’ medical reports and help identify patients with aortic stenosis, a common heart valve disease, and other chronic health conditions.

As part of ongoing research into the predictors of valvular heart disease, researchers looked at whether they could train AI software to spot which patients have valvular heart disease by studying echocardiogram reports, according to Matthew Solomon, M.D., Ph.D., a physician researcher with the Kaiser Permanente Division of Research and a cardiologist.

According to the team’s research findings, published in Cardiovascular Digital Health Journal, a computer taught to intelligently recognize certain abbreviations, words and phrases was able to read through nearly a million electronic health records and echocardiograms from within Kaiser Permanente and identify 54,000 patients with aortic stenosis.

“In our case, the large data set was a giant trove of echocardiogram reports that were collated over the past decades,” said Solomon, lead author of the study.

The goal of the project was to improve care for patients with valvular heart disease, Solomon said.

Grants from the Permanente Medical Group Delivery Science and Applied Research and Physician Researcher Programs supported the work of the researchers.

Solomon noted how complex written text can appear when it is computerized, so natural language processing (NLP) algorithms helped medical professionals make sense of the data. Kaiser uses IQvia’s Linguamatics platform to construct the NLP algorithms.

“It’s a complicated problem because doctors write their reports quite differently,” Solomon explained. “They don’t always write them in the same way, and as we all know, doctors like to use a lot of abbreviations. So there was a lot to teach the computer.”

In addition, by using AI, the researchers were able to reduce the amount of time to cull a million EHRs down to mere minutes, Kaiser Permanente said in a blog post. It would take doctors years to read through this volume of medical records, according to the health system. NLP algorithms can scan through medical records just as Google can scan web pages, Solomon notes.

For the study, Solomon and his team studied the echocardiograms of Kaiser Permanente Northern California patients from January 2008 through December 2018. The team used about 1,000 of the echocardiogram reports to teach the NLP algorithms to understand various ways that doctors describe aortic stenosis and other heart findings.

NLP helped researchers overcome the limitations of procedure codes or diagnosis codes, according to the study’s senior author Alan Go, M.D., a senior research scientist at the Division of Research and the regional director of the Kaiser Permanente Northern California Clinical Trials Program.

“There are a lot of limitations to only using procedure codes or diagnosis codes to identify populations of patients with a condition of interest,” Go said in the blog post. “We were able to train the computer to do what a physician or trained abstractor would do, but on a large scale and without ever getting tired or making mistakes. Importantly, we were also able to train the system to look at the information and measurements from the exams to tell us not only whether a patient had aortic stenosis, but the severity of their condition.”

Healthcare organizations are ramping up their use of AI and NPL to analyze clinical data and aid in decision-making at the point of care. The American College of Cardiology (ACC) is planning a trio of studies that will measure whether personalized clinical guideline support delivered by an AI tool at the point of care can improve heart patients’ outcomes.

Mayo Clinic recently launched a new initiative to collect and analyze patient data from remote monitoring devices and diagnostic tools and to use artificial intelligence to accelerate diagnoses and disease prediction.

Healthcare executives at hospitals, life sciences companies, health plans, and employer organizations say they are accelerating or expanding their AI deployment timelines in response to the pandemic, according to an Optum survey published in November. For hospitals, AI is being used primarily to improve reimbursement coding, monitor the Internet of Things (IoT), and accelerate research, the survey found.

The Kaiser Permanente research team intends to train the computer to identify other types of heart conditions. If this work is successful, the next step would be to teach the computer how to analyze patterns in the medical records that could identify patients at risk for aortic stenosis, which would boost the use of AI for actual disease prevention, according to Kaiser Permanente researchers.

In the future, AI tools such as NLP will help medical professionals identify who is sick or at risk for a certain disease so they can improve treatment. They will learn from the work the team has done with people with hypertension and diabetes, according to Solomon.

“In the future AI techniques might be able to identify patients who are at risk for chronic diseases, so we can intervene earlier and prevent them, rather than simply identifying those who are already sick, so we can make sure we take better care of them,” he said.

The Number Of MA Plans Offering Supplemental Benefits Continues To Rise, Study Finds

Medicare Advantage

Source: Fierce Healthcare, by Paige Minemyer

The number of Medicare Advantage plans that offer supplemental benefits continues to grow, according to new data from the Better Medicare Alliance.

The analysis, conducted by Milliman, found the number of plans offering such benefits increased across 36 out of 41 categories from 2020 to plan year 2021. That includes increases across 15 of 17 traditional supplemental benefit categories, four of five new expanded categories and 17 of 19 supplemental benefits for the chronically ill categories.

For example, 57% of plans now offer a meal benefit, and 46% will cover members’ transport to and from doctors’ visits.

The most common benefits offered, according to the report, include vision (offered by 96% of plans), hearing (93%), fitness (92%) and dental care (87%).

“This analysis provides unique insight into the ways that Medicare Advantage continues to innovate and enhance benefit offerings, even in the face of the extraordinary circumstances presented by the COVID-19 pandemic,” said Allyson Schwartz, CEO of the Better Medicare Alliance, in a statement.

“The growth of extra benefits and lower out-of-pocket available to seniors, including those particularly targeted to individuals with chronic conditions, demonstrates the value that Medicare Advantage continues to deliver for millions of beneficiaries,” Schwartz said.

For benefits targeting chronic conditions specifically, diabetics were the most targeted patient population, the study found. In the 2021 plan year, 293 Medicare Advantage plans offered lower cost sharing and/or additional benefits targeting members with diabetes, reaching close to 1.5 million people.

The number of plans offering supplemental benefits for members with behavioral health diagnoses also grew significantly in 2021, according to the analysis, growing from just five plans in 2020 to 135 plans.

In addition, benefits targeting chronic obstructive pulmonary disorder and congestive heart failure were also common, the study found.

Understanding the New Patient Preference for Telehealth Access

What are Patient Preferences for Technology, Provider Communication?

Source: Patient Engagement Hit, by Sara Heath

March 2020 brought about one of the biggest catalysts for care delivery change at Emory Healthcare. Telehealth access, which once was a key tool for the health system mostly on the hospital side, soon became the crux of the patient experience in ambulatory care, too.

This isn’t a novel story. Most healthcare organizations, big and small, saw a major problem on their hands when the novel coronavirus quarantined people in their own homes and sparked industry-wide calls to postpone non-urgent or elective healthcare. Clinics and hospitals could be a breeding ground for the virus, logic held, and so it was best for patients who weren’t urgently sick or injured to stay at home for the time being.

But also like organizations across the country, Emory Healthcare knew that would leave a major patient cohort behind. Chronic disease management, which hinges on a high-touch and communicative patient engagement strategy, would fall by the wayside of patients couldn’t get into ambulatory clinics to see their doctors.

In a short period of time, these medical facilities put up advanced telehealth access programs that helped patients receive the care they needed without going into the office.

And there’s no going back now, most experts agree.

In June, survey data from Doctor.com revealed that 83 percent of patients expect to use telehealth even after the pandemic ends and they can safely access in-person care again. In July, similar survey results from OnePoll showed that most patients expect to be using telehealth to access care into the fall.

“Customers and patients are now very, very, very comfortable with telemedicine,” Sarah Kier, the vice president of patient access for Physician Group Practices at Emory Healthcare, said in an interview with PatientEngagementHIT.

Telehealth is convenient, Kier pointed out, and patients like that they can get their treatment nearly on demand.

That’s not to say getting to this point was particularly easy, Kier quickly added. Many of Emory Healthcare’s outpatients have multiple comorbidities and are on the older side, which in some cases suggests they are not familiar with the video chat technology often used during telehealth visits. It’s in fact those factors that may have discouraged patient interest in telehealth before the pandemic.

But that three- to four-week stretch during which patients had no in-person care access option proved to be enough to push patients — and their providers — to adapt to the new technology.

“There was essentially a three-week period of time where, unless you were a critical case that had to see a provider in-person for some kind of physical exam, which was less than 10 percent of our appointments, telemedicine was your pathway to get into our system,” Kier explained.

In other words, patients had no other choice but to adopt telehealth.

That led to a few early wins at Emory, Kier said. Patients over the age of 80 soon became proud of their ability to learn a new technology and stay engaged in their own care, providing a great anecdotal example for others who may have been reticent.

And now, it seems unlikely that Emory Healthcare, or its peers throughout the healthcare industry, can easily transition back. Patients are extremely satisfied with the technology, Kier said, and it will not create a good situation for them to have telehealth access diminished.

“We have compelling patient testimonials saying that patients are excited about this type of care,” she reported. “Looking at our patient experience scores as measured by Press Ganey, we’re a full five percentage points higher for telemedicine visits across the first three months that we had this live, which was really interesting.”

“And a lot of it had to do with timeliness of care. Patients appreciate not having to drive and park and navigate our really complicated campus,” Kier continued.

Looking at the data in Emory’s provider search tools from Kyruus showed patients are in fact seeking out clinicians who can deliver care virtually. Once the health system determined it needed to pivot ambulatory care to telehealth, it updated its Find a Physician page to indicate which providers saw telehealth appointments and which saw only in-person.

Within a five business days, Emory could use credentialing data to flag which providers had successfully completed the health system’s telehealth curriculum and highlight them on the website.

“And we saw, especially during COVID and even now, that that filter is really heavily used and it’s clearly becoming a differentiating factor for our patients as they seek care,” Kier said.

It would be hard to return to the old normal, and Kier said Emory Healthcare is currently working under the assumption that they won’t have to, at least not entirely. Ideally, public and private payers will continue to offer some telehealth reimbursement parity that would enable the health system to continue down this path.

After all, it’s that payment parity that allowed Emory to offer telehealth access in the first place.

“We’ve been eager to do this for quite some time,” Kier said. “The trouble was we couldn’t deliver that care and remain financially soluble. We couldn’t do it for free and COVID provided the catalyst for payers and the government to become really flexible about how we were able to deliver care and maintain continuity of care with our patients as this pandemic struck.”

“At this point, the cat’s out of the bag, and frankly we are very hopeful that we’ll be able to continue to meet our patients’ needs in this way,” Kier asserted. “It would be very discouraging to have to unwind the progress that we’ve made in meeting our patients’ needs from the comfort of their own home.”

In the meantime, Kier and her team have a plan to ensure they can continue to get paid for their telehealth visits. A series of waivers with Emory’s payer partners will ideally get the health system through until at least September, she said.

“But we expect to be struggling with COVID all winter so we are working a three-tier strategy,” Kier said. “Tier number one is working directly with our payer contracts to encourage them to continue telemedicine coverage at parity with in-person visits. The second thing is working with our federal and state legislators.”

Georgia has been a slow adopter for some of the national legislation around telemedicine, Kier explained. The team at Emory is working to encourage state and federal representatives to allow telemedicine to be paid for by Medicare and Medicaid.

“And third, Emory has relationships with a number of large employers and large corporations in the Metro Atlanta area. We’re working with them,” Kier stated. “We have several contracts that are direct-to-employer. We’re working with them to see if we can exert pressure combined to both insurance companies and to direct-to-employer solutions to make sure telemedicine is carved into our existing negotiations.”

Reimbursement questions notwithstanding, telehealth has been a saving grace for Emory and its patients alike. The pandemic posed a serious threat to patient care access, with both restrictions on in-person healthcare access and the current fear some patients still experience regarding in-office care. This remote treatment option has allowed the health system to continue to connect with patients and continue to work toward wellness.

“This was a physician-led, physician-supported initiative,” Kier concluded. “It has just been so remarkable how much our providers have leaned into this very quickly and how much our patients have grown to appreciate and then to rely on this channel of care. It really has been one of the most rapidly evolving landscapes I’ve ever seen in my almost 20 years of healthcare experience. And it’s been just so exciting to be a part of.”

Federal Court Temporarily Halts California Dialysis Profits Law

Image result for Federal Court Temporarily Halts California Dialysis Profits Law images

Source: Healio

A federal court in California has granted a preliminary injunction to prevent Assembly Bill 290, which is aimed at limiting dialysis provider profits and premium assistance, from taking effect.

“Considering both the likelihood that A.B. 290 will abridge plaintiffs’ constitutional rights and the extreme medical risks it poses to thousands of [end-stage renal disease] patients, the court finds it obvious that the public interest favors a preliminary injunction, and that the balance of the hardships tilts strongly in plaintiffs’ favor,” the court said in its ruling released Dec. 30.

“I am extremely disappointed to read the court’s order granting the plaintiff’s motions for a preliminary injunction of A.B. 290,” California Assemblyman Jim Wood, D-Santa Rosa, said in an email statement to Healio/Nephrology. Wood is the author of the legislation that was signed by California Governor Gavin Newsom on Oct. 13. 2019.

“It has been my goal to ensure that every Californian has health care, and to do so requires our efforts to contain increasing health care costs that are making coverage unaffordable for many. This injunction is consequential because it emboldens the corporate duopoly of Fresenius and DaVita to continue to gouge the health care system in order to increase their profits,” Wood said.

The court order also provides a reprieve for the American Kidney Fund. The organization had sent letters to patients on dialysis in California who receive premium assistance through its Health Insurance Premium Program, which is funded by dialysis providers, that it would no longer cover those premiums starting Jan. 1, 2020. A.B. 290 required the AKF reveal the names of patients and the providers who were covering the premiums.

The legislation would have restricted payment to dialysis providers by commercial health plans for patient care to no more that the current Medicare rate. Dialysis providers Fresenius Medical Care and DaVita Inc. had spent more than $1 million during the last 2 years trying to defeat the bill, along with a ballot measure in November 2018. That measure was defeated by California voters.

“We are pleased that the court has issued an injunction enjoining A.B. 290, which will enable our patients, who need charitable assistance to afford their health insurance premium, to continue to access such resources,” Brad Puffer, spokesperson for Fresenius Medical Care North America, said in a statement emailed to Healio/Nephrology. “Our focus remains on providing the highest quality of care for our patients and we will continue to advance those efforts despite work by the California legislature to restrict financial assistance.”

“Today, the American Kidney Fund (AKF) joins 3,700 low-income Californians living with kidney failure in applauding the decision by Judge David Carter in the U.S. District Court for the Central District of California to grant an emergency injunction preventing A.B. 290 from becoming law,” LaVarne A. Burton, president and CEO of the American Kidney Fund, said in a statement. “This is important news for patients with kidney failure who depend upon AKF to ensure access to the health care that they must have to survive.

“Because this injunction prevents A.B. 290 from becoming law, pending the outcome of a trial, AKF can continue to serve California’s low-income dialysis and transplant patients who depend on AKF for charitable premium assistance. We will also immediately re-open the program to new grant applicants who qualify for assistance.”

In November, the AKF, Dialysis Patient Citizens (DPC) and two patient plaintiffs filed a suit in federal court in California asserting numerous constitutional challenges against A.B. 290. Fresenius, DaVita and U.S. Renal Care have separately filed suit in the same court, also challenging the constitutionality of A.B. 290.

“On behalf of our patients, we are pleased that the court took the important step of putting a hold on the implementation of Assembly Bill 290, a law that threatens to harm nearly 4,000 low-income, primarily minority Californians on dialysis,” DaVita Kidney Care said in a statement. “While this is a temporary victory for California dialysis patients, we will continue to advocate on their behalf and remain focused on providing high-quality care.” The California Medical Association and the California State Conference of the NAACP filed amicus briefs in support of enjoining A.B. 290 as unconstitutional.

“We are truly grateful to the court for grating so many vulnerable dialysis patients this temporary reprieve,” the CEO of DPC, Hrant Jamgochian, JD, LLM, said in the release. “We know that A.B. 290 still threatens more than 3,700 of the poorest and sickest dialysis patients in California. Health insurance coverage is absolutely critical for patients to continue their dialysis treatments, and if they can’t maintain it, their lives are literally on the line. That is why DPC joined as a plaintiff in this critical litigation, and why we hope this repugnant law never takes effect.” – by Mark E. Neumann

Trump Administration Moves to Shift Patients’ Chronic Illness Costs to Insurers

Image result for Trump Administration Moves to Shift Patients’ Chronic Illness Costs to Insurers images

Source: The Wall Street Journal

Millions of Americans in high-deductible health plans may find it easier to access insulin, inhalers and other treatments for chronic health problems under guidance released Wednesday by the Trump administration.

Currently, people in high-deductible plans with pretax health-savings accounts have to pay down their deductible before their insurance covers treatment for chronic diseases such as diabetes or high blood pressure.

The change will allow insurers to begin providing coverage for those treatments, such as glucose or blood-pressure monitors, before the deductible is paid. Insurers have pushed for this flexibility because people who don’t get ongoing treatment for a disease can have their condition worsen, leaving insurers paying even more for their care.

The guidance was issued by the Internal Revenue Service and the Treasury Department and is specific to high-deductible health plans linked to special pretax health savings accounts, or HSAs. These savings accounts have taken off in recent years and now are used by more than 20 million people facing steep deductibles.

Under the new guidance, patients in these plans with HSAs could save money because insurers would provide coverage for treatments for chronic conditions such as regular diabetes vision screening or medications even if people haven’t paid down their deductible, which can sometimes be in the thousands of dollars, senior White House officials said.

The change has long been sought by employers, insurers and patient advocacy groups.

“Failure to address these chronic conditions has been demonstrated to lead to consequences, such as amputation, blindness, heart attacks, and strokes that require considerably more extensive medical intervention,” according to the guidance.

Because the change is being issued as a guidance, it doesn’t require a formal rule-making process and could be incorporated into health plans being offered in 2020.

Some critics have said changes could spur the spread of high-deductible plans with the pretax health savings accounts. They say the trend is hurting consumers because they force them to pay more for their own care or put off treatment. But support for easing the restrictions on what the plans can pay for, pre-deductible, has been strong and building in recent years from those who say people with chronic conditions are unfairly bearing the financial brunt under the plans now.

The change will benefit some of the 133 million people who have ongoing medical problems such as diabetes and marks the second phase of a broader push the Trump administration announced last week to improve kidney disease treatment.

The goal is largely to ensure consumers in these plans can afford and obtain treatment for chronic conditions such as diabetes and heart disease to stave off more costly, debilitating health problems, senior administration officials said.

“It’s a really smart way to decrease the out-of-pocket costs for millions,” said Katy Spangler, co-director of the Smarter Healthcare Coalition, which has pushed for the change.

High-deductible health plans have become increasingly commonplace and have shifted more of the financial burden for health care to consumers. The IRS defines the plans as having a deductible of at least $1,350 for an individual in 2019 or $2,700 for a family. The idea behind the plans is to help curtail spending by requiring patients to have more of their own money at stake.

Accompanying HSAs were created in 2003. Employers, workers and others can contribute to the account with pretax dollars. People in high-deductible plans can then use their HSAs to pay for eligible treatments or care at any time without federal tax liability or penalty.

Critics of HSAs have said they largely benefit higher-wage workers who can afford to contribute to the accounts. Republicans have pushed to increase the use of HSAs, saying they are a possible fix for the burden of high health-care costs in the U.S. People can invest in the accounts and grow them over time.

The guidance is likely to enjoy some bipartisan support. Sens. John Thune (R., S.D.) and Tom Carper (D., Del.) have introduced legislation that would let high-deductible high plans used with HSAs cover chronic-disease care prior to consumers reaching their deductible.

The guidance means certain medical treatments or services for people with chronic conditions will essentially be considered preventive, according to the senior White House officials.

There will be some conditions: The service or item must prevent a health condition such as diabetes from getting worse. It must be low-cost, such as testing strips. Patients would have to be facing a strong likelihood they would encounter significantly more health costs to treat a condition if the service or item isn’t provided.

The guidance stems from President Trump’s June 24 executive order on price disclosure in health care. The order called for guidance to expand HSAs to maintain the health status of people with chronic conditions.

The administration has wanted changes to plans that qualify for HSAs for some time. Last year, the White House said any plan to shore up the Affordable Care Act should include changes to high-deductible plans with HSAs so they can cover treatment for chronic conditions before deductibles are met.

40 Percent of Employees Struggle with Health Care Costs

Pie chart with dollar image

Source: BenefitsPro

Forty percent of Americans with employer-sponsored health insurance struggle to pay for their health care costs, according to a new survey, and those with chronic conditions are especially hard hit.

The survey, conducted by the Kaiser Family Foundation (KFF) and the Los Angels Times, suggests a growing affordability problem, not for those on government programs or in the Affordable Care Act’s individual market, but with employer-sponsored health insurance, long considered the most stable and desirable type of insurance coverage.

To be sure, this survey, like others, show that the majority of respondents rate their health plans “excellent” or “good,” but cautions that a growing number of Americans are experiencing affordability challenges—especially those on high-deductible health plans (HDHPs).

Higher deductible = higher dissatisfaction

One striking finding of the study is that those employee with negative feelings toward their health plan are much more likely to be on a HDHP. A strong majority of respondents with no or lower deductibles described themselves as “grateful” (78 percent) or “content” (77 percent) with their health plans. Those with higher or the highest deductibles had majorities that described themselves as “frustrated” (62 percent) or “confused” (52 percent). In the highest-deductible category, 40 percent of respondents said they were “frustrated,” 34 percent said they were “confused,” and 23 percent described themselves as “angry” with their employer-sponsored plan.

“The experiences and attitudes of people with employer coverage differ vastly depending on whether they are in a higher or lower deductible plan,” the report said. “The higher the deductible, the more likely an individual is to have negative views of their health plan, and the more likely they are to experience problems affording care or to put off care due to cost.”

The impact of affordability issues

Among the 40 percent of the survey respondents who reported affordability issues, 31 percent said that medical bills incurred before meeting their deductible were the biggest problem; 23 percent said unexpected, or surprise, medical bills were the biggest problem; and co-pays for drugs and doctor visits came in at 11 percent and ten percent, respectively. Eight percent said their monthly health insurance premium was their biggest problem.

To deal with health care costs, those who struggled to afford care reported that they put off vacations or major purchases (66 percent); cut spending on food, clothes or household items (65 percent); increased their credit card debt (50 percent); used up all or most of their savings (46 percent); took out an extra job/worked more hours (34 percent); borrowed money from friends or family (20 percent); or took money out of long-term savings (24 percent). Five percent of those with affordability issues used the Internet to raise funds.

In addition, 51 percent of all respondents in employer-based plans said someone in their family postponed or skipped needed care or medications because of cost concerns.

Chronic conditions add to the challenge

More than half of all respondents (54 percent) said someone who is covered by their employer-based plan has a chronic condition. And 49 percent of enrollees who have chronic conditions say they have affordability issues.

This category of respondent has the usual stressors—more of them report taking steps to pay for medical costs like the ones listed above—but they are less confident that they will be able to pay for their medical care.

“The combination of a chronic condition and a high deductible can also lead families to worry about affording health care in the future,” the report said. “For example, among those with a chronic condition in the family, about half of those in the highest deductible plans say they are not confident in their ability to pay for the usual medical costs they and their family require, and almost two-thirds are not confident they could pay for a major illness.”

The emergence of a new health care crisis

In its coverage of the survey, the Los Angels Times said the findings showed a new crisis in health care affordability, adding that American families are being pushed to the breaking point. “In the last 12 years, annual deductibles in job-based health plans have nearly quadrupled and now average more than $1,300,” the article noted. “The explosion in cost-sharing is endangering patients’ health as millions, including those with serious illnesses, skip care … And it is feeding resentments and deepening inequalities, as healthier and wealthier Americans are able to save for unexpected medical bills while the less fortunate struggle to balance costly care with other necessities.”

Why Proposition 8 Is One of the Most Contentious, and Confusing, Ballot Measures in Play

Rich Pedroncelli / AP Photo

Source: Capital Public Radio

Roughly 140,000 Californians spend the equivalent of a part-time job — 12 to 20 hours a week — in a dialysis clinic, where a machine functioning as a kidney filters waste out of their blood.

It’s a tricky procedure — and right now it’s at the center of a heated political battle between labor unions and dialysis companies.

Californians will vote in November on Proposition 8, which would regulate dialysis clinic spending. It’s a move that could either improve patient conditions or degrade them, depending on who you ask.

So far, it’s the most expensive proposition on the ballot, with supporters putting in $20 million and opponents fighting back with $99 million as of October 11.

The measure would cap what clinics can spend on overhead and administrative costs, versus actual care.

One of the largest health care labor groups on the West Coast — Service Employees International Union – United Healthcare Workers West — put it on the ballot. Their members say clinic owners are overcharging for low-quality care, and that Prop. 8 will force dialysis companies to spend more on patients, including hiring additional staff.

The opposition campaign, backed by two of the state’s largest dialysis companies, argues that spending limitations could make it harder for clinics to stay afloat.

Los Angeles resident Tangi Foster, who’s working with the “Yes on 8” campaign, said she’s visited multiple dialysis clinics over the last decade and that employees seem overwhelmed and exhausted. She says this makes her feel unsafe.

“These people have to save our lives,” she said. “ I don’t think it’s fair to them, nor is it fair to us as patients, for them to carry this kind of workload.”

Opponents of the measure argue it is a power-play by labor groups trying to unionize dialysis workers.

They also worry that, if the measure passes, funding for certain positions would be in jeopardy. That’s because it would create two categories for dialysis company spending: “allowable” and “other” costs. Anything that goes over the limit in the other category would have to be paid back to insurance companies.

“These things are going to result in the closure of clinics, and they are going to result in less access for patients,” said Dr. Luis Alvarez, a practicing physician and board member for a dialysis clinic group called Satellite Healthcare. “To me, that is really a terrible, terrible thing.”

The allowable category would include “non-managerial” staff that provide direct care to dialysis patients. Opponents say jobs that are key to delivering patient care, such as medical director or nurse manager, could be excluded and face a funding cut.

Prop. 8 would also require clinic operators to report spending to the state, and forbid them from turning away patients based on their insurance payer.

The California Department of Public Health received 577 complaints about dialysis clinics and found 370 deficiencies during a two-and-a-half-year period between 2014 and 2017 — roughly 18 complaints and 12 deficiencies per month, according to an analysis by nonprofit journalism site CalMatters.

Those included complaints that patients’ vital signs weren’t checked by staff every 30 minutes, as required by law, and that translation services were not provided to non-English-speaking patients.

One grievance accused staff members of failing to check the connection between a patient and machine, even though blood was inappropriately oozing from the patient’s medical port, according to the CalMatters story.

DaVita, one of two major dialysis companies in California, has faced multiple lawsuits in recent years from the families of patients who died at their clinics.

If the measure passes, the decision on how clinics can spend their budgets will fall to the state and to the courts. The nonpartisan Legislative Analyst’s Office said in its assessment that the measure’s vague language makes its fiscal impact difficult to determine.

“If the measure is ultimately interpreted to have a narrower, more restrictive definition of allowable costs, the amount of rebates chronic dialysis clinic owners and operators are required to pay would be greater,” the office wrote in the California voter guide.

The office said clinic groups might need to “scale back operations in the state.”

Ken Jacobs at the UC Berkeley Center for Labor Research and Education pointed out that just two dialysis companies control 70 percent of all clinics in California. And because very few laws require them to be transparent about their costs, prices will just continue to climb.

“I think we’re going to see a lot more attention on these issues in the future,” he said. “The ballot initiative specifically addresses [market consolidation] in a particularly profitable industry in terms of the dialysis centers. But the issues its raising are issues that go well beyond this particular case.”

Opponents feel the measure is too drastic and doesn’t belong on the ballot. Supporters have tried legislation before — bills to require staffing ratios in dialysis clinics and impose a revenue cap on clinic operators failed in prior legislative sessions.

Still, much of the Prop. 8 debate brings into question whether the voters should be the ones to decide how to fix these problems.

Wellness Programs Aren’t Generating Medicare Savings

Image result for wellness programs imagesSource: Modern Healthcare

Seniors in wellness programs targeting obesity, falling and chronic conditions are not sparking healthcare spending decreases, according to a federal analysis released Friday.

The Affordable Care Act required the CMS conduct an independent evaluation of wellness programs that targeted various health conditions experienced by Medicare beneficiaries, and that study found no evidence of cost savings.

“Utilization and expenditures actually increased among (chronic-care management) program participants,” the report said.

The findings are based on spending data for Medicare enrollees in fall prevention, weight loss and chronic care initiatives. The CMS followed beneficiaries one year after they joined a wellness program.

The results mirror those found in the corporate world, where companies are increasingly funding wellness programs meant to improve employees’ health.

Corporate wellness spending hit $8 billion in 2016, up from $1 billion in 2011, according to researchers The Harris School of Public Policy at the University of Chicago.

Researchers have also found that these efforts have aided in employee retention, but not changes in employee behavior or cuts in healthcare spending.

Although the wellness programs didn’t save money, the CMS found that Medicare enrollees in wellness programs were more aware of their mental health needs and had increased engagement with physicians and ancillary services.

“So, while it didn’t reduce healthcare expense or utilization, it seems to have had a positive impact,” said Steve Wojcik, vice president of public policy at National Business Group of Health. These programs “prevented or delayed normal deterioration that comes with age.”

Wellness initatives also take time to become successful, according to Cheryl Larson, president and CEO at Midwest Business Group on Health.

Wellness programs “may or may not result in short-term outcomes, but if it helps identify one case of cancer or diabetes in at-risk populations, they can achieve positive outcomes down the road,” Larson said.

Commentary: Critical-illness insurance can protect savings

A critical-illness insurance policy can help “bridge the gap” in health coverage, writes Rod Rishel of AIG Consumer Insurance. Such policies offer a lump-sum payment that can help guard retirement savings and also provide continuity for small businesses, Rishel writes.

ThinkAdvisor (free registration) (3/28)

Humana Leaves ACA Exchanges

After its merger with Aetna was called off, Humana Inc. said that it will stop offering commercial health insurance to individuals on state exchanges and buy back $2 billion in stock. Humana, which said it is owed a $1 billion breakup fee from Aetna, said it will focus on care for people living with chronic conditions moving forward. The company said it will give up its business of offering individual commercial medical coverage on the 11 state exchanges in which it currently operates as of Jan. 1, 2018.

“As an independent company, we will continue to innovate and sharpen our focus on the local healthcare experience of all our members, especially seniors living with chronic conditions,” Chief Executive Bruce Broussard said in the announcement. Humana plans to repurchase $2 billion worth of shares, with an accelerated repurchase of $1.5 billion in the current quarter.

Last Updated 12/01/2021

Arch Apple Financial Services | Individual & Family Health Plans, Affordable Care California, Group Medical Insurance, California Health Insurance Exchange Marketplace, Medicare Supplements, HMO & PPO Health Care Plans, Long Term Care & Disability Insurance, Life Insurance, Dental Insurance, Vision Insurance, Employee Benefits, Affordable Care Act Assistance, Health Benefits Exchange, Buy Health Insurance, Health Care Reform Plans, Insurance Agency, Westminster, Costa Mesa, Huntington Beach, Fountain Valley, Irvine, Santa Ana, Tustin, Aliso Viejo, Laguna Hills, Laguna Beach, Laguna Woods, Long Beach, Orange, Tustin Foothills, Seal Beach, Anaheim, Newport Beach, Yorba Linda, Placentia, Brea, La Habra, Orange County CA

12312 Pentagon Street - Garden Grove, CA 92841-3327 - Tel: 714.638.0853 - 800.731.2590
Copyright @ 2015 - Website Design and Search Engine Optimization by Blitz Mogul