Pricing, Product and Audience: Theranos and DTC Blood Testing

Is the Population Health Blog due for a meal of humble pie?

In this prior post, the PHB was "long" on Theranos' prospects.  Since that was written, Medicare has alleged that a company lab was a "jeopardy to patient health and safety," a peer-reviewed study showed troubling test inaccuracies, the Securities and Exchange Commission (SEC) has opened an investigation, higher ups have left the company, years of test results have been "voided"  and founder Elizabeth Holmes faces the prospect of a ban from doing business with Medicare and Medicaid.

Talk about humble pie.

In this well-written Viewpoint published in JAMA, Stanford's John Ionnidis composes a Theranos requiem that ultimately questions the virtues of the company's low-cost and direct-to-consumer blood testing. He argues that while the solution of self-diagnosis and early treatment only sounds revolutionary. That pales in comparison to the far larger problem of misdiagnosis that leads to the reality of overtreatment.

Good point.  But, while Theranos' prospects are clouded, the PHB is still long on the underlying three point business model.  Theranos got one right, and the other two are within reach.

To wit,

1) The pricing is uncoupled from opaque insurer-based fee schedules and based on rational consumer-driven price points.

2) The product is health insights, not blood testing data.

3) The audience needs to understand the value-based outcomes  

 

The PHB explains:

1) Theranos stumbles over internal quality control and regulatory compliance issues will play out, and after a sufficient number of heads roll, will be addressed.  Once that's settled, consumer interest in being able to circumvent insurance and "buy" transparently-priced and OTC blood tests should remain considerable. Medicare's fee schedules are ultimately "cost-plus" which includes the costs of a highly inefficient care system. Think about that $500 stitch and it's little wonder why consumers are so willing to beat a retail path to Walgreen's door.

2) Consumer insights about screening blood tests come from combining the data with pre-test odds, sensitivity and specificity.  While a smart physician can certainly help patients navigate an abnormal liver test or a high cholesterol, distance technology combined with consumer-friendly machine intelligence (here's a simple example) can also. It's simply a matter of industrializing and democratizing what we've known for decades. And once consumers can understand tests' imperfections, things will equilibrate between under and overtreatment

3) For many reasons, healthcare is a different business. Among the many reasons for that is that "success" is particularly dependent on the need to understand the short and long term outcomes and costs (i.e. value) of any new care model. That means committing considerable resources to study, document, internalize and publicly report what was achieved at what price. An audience of scientists, regulators, providers, insurers, buyers, politicians, physicians and bloggers want to know: does open-range testing for Hepatitis C paired with education on false positive test results reduce the incidence and costs of cirrhosis or liver cancer?  Does consumer self-ordering blood glucose levels combined with post-test odds reporting increase awareness of otherwise undiagnosed diabetes and increase claims expense? Does DTC pregnancy testing.... oh, wait, we know that one. You get the picture.

 

If not Theranos, then some other company will profit from putting patients in at the center of lab testing.  The genie is out of the bottle.

Today is Your Monday to Make Fit Happen

How many Mondays have gone by without starting your fitness program? The day is here again and what are you doing to get closer to your goals? We have good intentions, want to get in shape but follow through is lacking.

It's time to put a stop to the excuses always getting in the way of our health. Health is our wealth and we couldn't be so busy without it. Think about that. Declining health equals no work, no social life, and no money. Not that money is or should be the most important thing in life.

Our priorities are skewed and our reasons to not get fit make no sense in the big scheme of life. We shouldn't wait to feel sick and tired of being sick and tired. Our lives require a priority overhaul. Living a life without health is not a quality life at all. When waking is greeted to popping pills to run our body there is something wrong. This shouldn't be an acceptable norm for society. This should piss you off and motivate change in your life.

Today is your Monday to make fit happen. Someday is no longer an acceptable excuse and doesn't qualify as a day of the week. Do you want to lose fat, look good naked, feel great, move better, and be more confident? Do you want to toss those pills prescribed from self-induced illness?

Change takes a choice and you're responsible for your health and fitness. Your busy lifestyle should include workouts and healthy food. Fitness is good time management. Make going to the gym one of your social hours and don't cancel. Take time to pack your healthy food instead of dashing to nearby restaurants.

You can achieve your goals by applying simple changes. It will be a progressive life-long journey. Life is meant to be enjoyed with a healthy, fit body. The choice is yours to make it happen. All in fitness love. Stay Healthy!

Are you living Verywell? Don't miss out on helpful articles to achieve your best healthy body. Start with this great read on "Are You Eating for Muscle".

Read: Are You Eating for Muscle? 

Thanks for stopping by my Blog and don't forget to subscribe below to never miss a free update!

             DON'T MISS MY FREE UPDATES

Be well and Stay Healthy ~ Darla :)

19th Hedda Gabler's Lessons for 21st Century Health Information Technology

It's the 17th of May, which means it's Norway's Constitution Day.  Sort of like July 4th.  Which reminds the Population Health Blog.....

If you are in D.C. in the coming weeks and have an interest in health information technology (HIT), you may want to check out the Studio Theatre production of Norwegian playwright Henrik Ibsen's Hedda Gabler. 

 

The Population Health Blog explains.

In the two and a half hour production, Hedda struggles to reconcile her human dysfunctions with the rigid etiquette of an aristocratic age. As her dilemmas unfold, her academic husband George delights in analyzing societal trends while being unable to see the disaster unfolding in his own home. George ironically delights in knowing more, but is aware of less and less. 

 

There's far more to the play, but what can this 19th century masterpiece teach about HIT?

While Hedda has her issues, she's still being victimized by a complex set of external social determinants.  The PHB suspects playwright Ibsen was intrigued by the impact of rigid social norms in late 19th century Europe.  His play examines their implications for otherwise smart people who can't and/or refuse to adapt. 

Is Hedda's resistance to be reviled, or admired?

Sound familiar?  Instead of a mansion decorated with dying bouquets, we have hospitals filled with the fading economics of piecemeal work. Physicians are working harder than ever to help their patients, but a new technocracy is advancing a new set of expectations.  And the mainstream HIT Georges are so fascinated by making meaningful use meaningful, they are likewise unable to see the forest past all the trees. 

Why some dogs (and humans) are born hungry

The brain is the central regulator of appetite and body fatness, and genetic variation that affects body fatness tends to act in the brain.  One important site of variation is the POMC gene, which codes for a signaling molecule that suppresses food intake.  A new study shows that Labrador retrievers often carry an inactive version of the POMC gene, causing them to be highly food motivated, obesity-prone-- and perhaps more easily trainable. 

Read more »

Achieve Fitness One Day at a Time

Believing anything happens quickly is not realistic. Fitness is a process of small changes creating large results over time.  No magic wand to instantly provide a chiseled physique or bikini body.  We may want that, but not how it works.  Quick fix thoughts only set us up for frustration and failure.



Achieve fitness one day at a time.  Biceps don't suddenly appear after your first day in the gym.  What does occur when you apply fitness daily is progress.  The muscle will show up but let it work, grow and build.  It's like a fine wine or great simmering stew.  The journey will be rewarding but patience is required.

One of the worst things you could do is to jump into a fad diet or take unregulated fat burning supplements thinking this is the answer.  Read the small print on any of these psuedo fitness deals.  "Best results when accompanied with a healthy diet and exercise program" is what you'll find.  All that needs to happen is to follow the small print which is the best advice on those bottles. In fact, any results achieved comes from implementing a healthy nutrition plan and exercise.  You're the one doing the work, not what's in those bottles.

Fitness done daily will take time and effort but the lifelong results are the reward. It's also a journey and not a destination.  There's no need to feel rushed or stressed about getting fit.  It's really a simple process often over-complicated. Find healthy foods and exercise you enjoy and this is what keeps you coming back for more.

Avoid jumping ahead in your mind to what you want now and focus on today. What are you doing today to reach your fitness goals?  Did you workout, eat healthy and get plenty of rest?  Awesome!  Celebrate your daily achievements.  Write them down if it helps.  Stay positive even when things aren't showing up as fast as you think they should.




We're all different in how our bodies respond to change.  Comparing to friends or people we see at the gym is the thief of joy.  We're not here to be or look like someone else.  Our job is to become our best healthy self through daily choices. Who cares if your friend lost 5lbs and you didn't reach that mark. Fitness is not about who is faster at achieving results.

The goal is getting fit and loving ourselves through the process.  The days are going to pass anyway so focus on adopting a healthy lifestyle the right way. Today is what we have, tomorrow isn't promised and yesterday is gone.  Be in the now with your fitness and you'll get there one day at a time. Be well and Stay Healthy!

Are you living well or Verywell?  Read my articles and others to help you achieve your fitness goals the right way!

Read My Article on Verywell Health

Thanks for stopping by my Blog and don't forget to subscribe below and never miss a free update!

             DON'T MISS MY FREE UPDATES

Darla Leal, Fit-over-50

The Latest Health Wonk Review Is Up

"If elected, I'll....."

Wright on Health pivots to an excellent "general election edition" of the Health Wonk Review.  After reading it, you'll be better informed than either Hillary or The Donald about health policy. 

Too bad you can't do anything about it, but enjoy, eh?

My Recent Paper on Linoleic Acid in Adipose Tissue

Linoleic acid (LA) is the predominant polyunsaturated fat in the human diet, and it's most concentrated in seed oils such as corn oil.  LA accumulates in fat tissue, and as with many of the nutrients we eat, it is biologically active.  In a new paper, we systematically review the studies that have measured the LA concentration of fat tissue in US adults over time.  We show that the LA concentration of fat tissue has increased by approximately 136 percent over the last half century.

Susan Carlson, PhD

In 2011, I posted a graph on my blog in which I summarized some of the studies that have measured the LA content of fat tissue in US adults over time (1).  It showed a remarkably consistent upward trend.  Last year, a University of Kansas nutrition researcher named Susan Carlson contacted me and asked if I had published my findings in a scientific journal, because she wanted to cite the trend in one of her papers.  I said I hadn't published them, but that I would love to do so together.

Read more »

Governance Advice for Hospital Boards: Population Health

"For 60 or 90 days of post-discharge care?"

Writing in the April 26 issue of JAMA, Michael Jillinek of Lahey Health has some important advice for healthcare organization boards of directors.

As income shifts from fee-for-service to global payments, the insurance risk transfers that underlie much of "population health" are an important threat to these enterprises' viability.

After a compact and well-written summary of the growth of population health, he offers six suggestions for these boards:

1. Plan on having "forthright discussions" about the difficult tradeoffs between still-remunerative fee-for-service activities (such as high-dollar imaging, lucrative surgical services) and having to invest in the Triple Aim (care coordination personnel, improving quality measures for persons with chronic illness).

The Population Health Blog suspects most boards will ask why they can't have both the FFS cake and the global payment icing. If that's the case, these boards need to plan on having forthright and very lengthy discussions. It's organizationally difficult to have one mission on the 4th floor of the hospital and another in the emergency room.

2. If the organization's employees are enrolled in a "self-insured" health plan, bring them into a population health program sooner rather than later.

Not only is this an important opportunity for a board to understand the revenue versus savings versus expenses involved in driving the clinical and care experience outcomes of population health, its only right to take this for a personal test drive before subjecting your patients to it.

3. Look for common ground between old fee for service and new global payment arrangements.  The author suggests reducing readmissions is a good start.

The PHB suggests boards ask their management teams to also pursue the care coordination "chronic care management" payments offered by CMS.

4. Start demanding population health metrics from your management team, "such as details of total medical expenditures."

More details on the work of measurement can be found here.  The PHB has also humbly suggests here that health organizations should be prepared to invest significant resources - and discipline - into the process.

5. Invest in primary care, care coordination teamwork and pursue "population health pilot programs."

Since the PHB believes well-intentioned CMS' programs are star-crossed (see here and here), it suggests working with local commercial insurers for starters.  As it reviews resources like this, they seem to have a better track record. 

6.  Ask your management team to be open population health contracting.

Hear hear, says the PHB.  But it also cautions that the board needs to have individuals with the kind of industry knowledge necessary to provide oversight of these contracts.  

Image from Wikipedia

Fitness Goals Are Meant to Be Maintained

Reaching your fitness goals is an accomplishment to be praised.  Are you maintaining them is the question?  Fitness is not meant to be a temporary fix to get into a bikini or attend a wedding.  It's a lifestyle of health and wellness.  Sure, you will rock that suit and look good in those pictures but is that all fitness means?



True fitness success is when you live it daily.  Healthy foods are being consumed consistently and exercise is part of your normal routine.  In fact, getting off track for too long will make you feel like crap.  Fitness becomes a priority and excuses no longer get in the way.  You refuse to return to being overweight, sick and nearly dead.  You get the point.

I've seen too many people succeed at reaching goal weights, reduced body fat and improved health and throw it all away.  The belief system we can get away with returning to a few old habits snowballs.  The purpose of dumping old ways is to learn and keep new and healthier methods.  This is lacking and maintaining our health is suffering.

We need to focus not only on reaching our fitness goals but keeping them for life. Life is the event we are getting in shape for not bikini season.  Forget the clothes and stand naked in front of your mirror.  This will let you know if you're doing a great job of maintaining your fitness. I'm not talking about body and skin changes naturally occurring with aging.  We all know the difference and also if we're not living a healthy life.





We show outwardly how we live inwardly.  Not recording in your food journal thinking your body doesn't know is craziness.  Your body keeps the most accurate record of what you're eating and drinking.   Reaching fitness goals is possible because you have done it and maybe more than once.  Instead of having to repeat getting back and shape, why not just stay in shape.  Real talk all in fitness love.  Be well and Stay Healthy!

About.com has launched it's stand alone Health Page - Verywell!

"Think of us as your friend who also happens to be a doctor. Or personal trainer. Or dietitian. Verywell is your source for reliable, understandable information on hundreds of health and wellness topics that always keeps the reasons you come to us in mind.

Know more. Feel better."

Darla Leal, Stay Healthy

Enjoy my Sports Nutrition articles at Verywell and start reaching and maintaining your fitness goals for life!

Read My Articles at Verywell

Stop Accommodating Unhealthy In Your Life

We know when we feel off, not right, and unhealthy.  This can be physically or emotionally.  Yet, we continue to accommodate and even accept the situation. Our body and mind can only take so much before it breaks.  Sometimes we don't even realize this is happening until we are lying face down in our own hopelessness.


Other times, we are very aware of what's happening and we tough it out day after day. Another scenario where the body will take you down eventually.  We can't out-fight a crappy mental or physical game.  Stress is a killer and maintaining an unhealthy lifestyle is just as bad.

How often do you take inventory of your life?  Are you accommodating joint pain and illness from eating unhealthy foods leading to being overweight?  Are life's circumstances so stressful to the point of causing depression and anxiety? What's going on at home in your personal relationships?  Is your home a peaceful sanctuary or a war zone?  How about the job? Are you happy and doing what you've always envisioned or burdened by the thought?

We are meant to live a happy, healthy life.  The unfortunate truth is we choose to accommodate unhealthy. We eat and drink things we shouldn't, become couch potatoes and drown in our own self pity.  Isn't it time we stop accommodating unhealthy and start fixing the problem?  If you don't know where to begin, ask for help.  No shame or stigma about needing assistance sometimes.  We've all been there.  Society puts "shaming" on every human topic ad nauseam. If seeking help from a professional gets you on the right track, then go for it.  I suggest an expert in the area of your struggle.

If you want to adopt a healthy lifestyle, consult with a qualified personal trainer, nutritionist, or registered dietition.  Making a doctor's appointment to discuss your stress and seeing a licensed counselor or therapist may be helpful. Check out your local church and talk to a pastor.  If the marriage is suffering, sometimes all you need is a little help from a licensed marriage and family counselor.  You have choices!

What it boils down to is changing your life for the better.  It requires recognition of the problem and a willingness to fix it.  There is nothing healthy about accommodating unhealthy.  You can either sit and wallow where you are, or put on your "fix-it" attitude.  Straight talk in fitness love!  Stay Healthy~

Read some of my other published articles for helpful information on nutrition and fitness:

Are You Eating for Muscle?

You Can Get Lean Eating Full-Fat Foods

Thanks for stopping by my Blog and don't forget to subscribe below and never miss a free update:

             DON'T MISS MY FREE UPDATES

Be Well and Stay Healthy ~ Darla 

Medicare's Comprehensive Primary Care Initiative - A Two Year Report

After all the buzz (for example) around the coming launch of CMS' Comprehensive Primary Care "Plus" program,  the New England Journal of Medicine (or NEJM) just published a "special article" on the original Comprehensive Primary Care (CPC) initiative.

This is important if you think CMS' approach to supporting primary care is the fix for what ails the U.S. health care system.

Population Health Blog readers may recall that two years ago, CMS launched CPC. This is a still ongoing four-year multi-payer study to determine whether primary care that is "turbocharged" with medical home-style capabilities (see here, here and here - see page 8) would increase quality and lower health care costs. 

The term "multi-payer" is important, because CMS recognized that clinics struggled with providing medical home care to some, but not all, patients on the basis of their insurance.  Better to have one standard of care to all patients.

The NEJM article is an analysis of CPC's results after two years. 

To summarize how CPC was set up, 502 clinics (from 978 applicants) across 8 states participated along with a total of 39 other insurers.  In addition to the usual fee schedules, the Medicare and the other insurers paid a per patient severity-based "care management fee" that, on average, ranged from $8 to $40 per beneficiary per month (PBPM). Practices were also promised an additional bonus if, after two years, they reduced health care costs (i.e., shared savings) and improved various quality measures and performed well in surveys about the patients' experience of care.

These CPC practices' outcomes were compared to a propensity matched group of non-participating practices with a similar electronic health record (EHR) infrastructure that cared for a set of patients with similar levels of disease and baseline costs. 30% of these practices had applied but were not accepted in the initiative. The total number of comparison practices was 908.

Results?  Not good.

Aft the end of two years, there was no statistically (p > .05) significant difference in the growth of health care costs between the CPC and control sites.  This was true whether just claims costs were examined (a negligible difference of $11 per patient per month favoring the CPC sites), or whether claims costs plus the additional fees were examined (a difference of $7 favoring the comparison sites).

When patient costs were examined by the burden of disease, there was no indication that more costly patients achieved any savings. 

CPC sites had a statistically significant reduction in outpatient office visits, but not in hospitalizations.

While the difference in claims expense failed to be statistically significant, the total additional fees collected by the participating sites amounted to a financially significant $389,000. This represented a 15% increase in their income. 

Was quality of care improved?

Patients with diabetes and a high burden of illness were more 3% more (p<.05) likely to receive the recommended follow-up measures to manage their disease. Otherwise, "the initiative did not have significant effects on the processes used as measures of the quality of care for the full sample."

Patient experience of care?

While surveys showed small increases in patient support, "there were no significant effects on other composite measures: ability of patients to obtain timely appointments, care, and information; how well providers communicate with patients; provider’s knowledge of care patient received from other providers; and overall rating of providers by patients."

Yikes. Ouch. Egads.

The authors correctly point out that CPC is a four year program and that it still may be too early to see the impact of the medical home turbocharging.  That was pointed out in the negative one year evaluation.  Maybe something will turn up at three or four years.

In addition, CMS has a lot of other value-based initiatives underway, which may have biased the results.  There may be a "ceiling effect" among the participating sites as well as the control sites, which were already working to reduce (for example) rehospitalizations or pursue the fee schedule modifiers.

It's also important to note that the impact on the other insurers' costs and patient quality was not reported.  It's possible that they saw a benefit.

The PHB's take?

1.  Many care management programs achieve claims reduction with savings (for example) within one to two years.  If CPC hasn't succeeded by now, it probably won't.  And if the just-announced CPC Plus is modelled after this, it's hard to see how that program will turn out any differently.

2. It is possible that, within all the statistical noise, there were some primary care sites with particularly robust approaches to care that did bend the cost curve.  CMS should seek these sites out and find out more about their secret sauce.  More on that in a future post.

2.  If CPC's approach to care is ultimately shown to not bend the curve, what's the problem? 

The PHB continues to believe that one size doesn't fit all and not all patients benefit from care management. Many patients, even those with chronic conditions are quite stable and need minimum attention; some patients are so sick that no intervention will keep them out of emergency rooms and hospitals. As pointed out here, as more and more patients are enrolled in care management, the return on investment can paradoxically go down. Better to focus on patients who are not only at risk, but have "impactable" condition profiles.

In addition, CPC is based on a 5 year-old model of care. Things have changed since then: modern population health brings many more resources to the table.  That not only includes in-depth analytics support (for example, to define those patients who are at greatest risk) but mHealth. For example, there is one innovative company (the PHB's Shameless Commerce Dept. over on the right side of your screen) that provides recently discharged patients with an app-enabled handheld configured to provide close follow-up.  And so on.

3. It may be that care management works best in a managed care setting.  CPC is a study of classic fee-fore-service Medicare beneficiaries with access to any participating Medicare provider. In Medicare managed care, the insurers and their providers have an even larger incentive to maximize quality and lower cost.  If that's the case, CMS - despite their commitment to innovation - may want to get out of the care management business, because they just don't know how to do it.

The Latest Health Wonk Review is Up!

Peggy Salvatore of the Health System Ed blog has posted a Spring Edition of the Health Wonk Review.  This brainy compendium offers links to the latest health policy insights on topics that include big pharma, pay-for-performance, the ACA, physician governance on hospital boards, commercial health insurance, extending insurance to undocumented immigrants, ACOs, primary care, and occupational medicine.

Be the early bird and catch this worm here.

Open Access to Health Care Research: Good Intention, Bad Idea? Thoughts from an Industry Insider

Readers interested in the $25 billion economics of peer-reviewed published research may have seen this article posted in the March 30 issue of The Wall Street Journal. Author Richard Aslin argues that the discoveries from federally supported medical research shouldn't be hidden behind the paywalls or subscription fees of scientific publishers. 

As the volume and scope of funded research has grown, says Dr. Aslin, libraries, medical schools and hospitals are paying more and more for access to study results that are ultimately the property of the U.S. taxpayer. He argues for versions of an "open access" model, in which the authors - and not the taxpayer - ultimately bear the cost of getting their findings into the public domain.
 
The Population Health Blog contacted a colleague in the medical-scientific publishing industry and asked her for her reaction.  Here's her reply:
 
Interesting, but frustratingly one-sided.  It leaves out the critical point that someone has to pay for a CRUCIAL service that the publisher is providing - peer-review, editorial expertise, and career-making reputations for authors after the published results appear in a trustworthy, sound, and respected journal.
 
This is also fueled by complaints from researchers who have benefited for decades from federal subsidies (most notably student loans) who have suddenly found their inner-Reagan and cry foul when the system doesn't suit their needs.
 
Without the publishing industry to ensure that the science those taxpayers paid for is sound, we'd probably all be drinking Gatorade to cure Alzheimer's, because the incentives would ultimately award sponsorship to the highest bidder. Research misconduct would likely be rampant.

To me this argument sounds like being angry that you pay taxes that the government puts towards highways and then you still have to buy a car from a reputable manufacturer.
 
Lots of medical journals are Open Access and the publishing industry supports it. But we're also not just slapping it on the internet. Researchers are welcome to do that with their own work, free of charge. And I wish them luck with that. I'm sure they'll need it.

Coda: The PHB - who has authored approximately 50 peer-reviewed publications - tongue-in-cheek offers another potential upside to the status quo: because the ability of mainsteam news media to truthfully and objectively report research findings is highly questionable, lack of open access offers added consumer protections from spin, bias and innumeracy.  If you think it's bad now..... 

But seriously, it's also not unusual for authors to share a copy of manuscript to individual colleagues who, in the interest of advancing scientific knowledge, request it.

Image from Wikipedia

When You Start Stopping is When You Start Getting Older

I heard this today and was immediately inspired.  Think about how you feel when health and fitness aren't part of your life.  Stressed, sluggish, ill and feeling old, right?  When you start stopping is when you start getting older. I am talking on the cellular, emotional and physical level.

Fitness is the fountain of youth.  If we don't make time for it, we will eventually be making time for illness.  Our body ages daily, but there are things we can do to slow this process.  Studies link eating healthy and exercise to longevity.  I don't know about you, but I want to maintain the best body for life.

When we start stopping is the same as giving up.  We get so caught up in believing fitness is a difficult process.  We also become frustrated without instant results and begin shutting down.  The negatives seem to outweigh the positives in our minds and ultimately lead to unhealthy choices.

Colin Cook, Shark Attack Survivor

You may believe the inability to lose 3lbs this week is a tragedy but how does that compare to someone who has lost a leg and still pushing?  We all need to fight for our fitness.  This comes in different ways for each of us, but stopping is not an option. As long as we are taking positive steps toward our health goals, changes are happening.  Have faith in the unseen and hold onto daily progress. Strength comes from the inside out. Don't start getting old and crumpled, feeling sorry for yourself because you decided to quit.


Age is just a number but we also create how we feel at every age and circumstance.  Stop and suffer the consequences of aging more rapidly or continue and enjoy the vitality of youth.  Life is full of choices and we are ultimately responsible for the outcome that is within our control.

Quality Ingredients

I was recently contacted by Carve Bar to sample and review their product.  I am always happy to give a shout out for quality products committed to giving back. Carve has created PROJECT ONE to support avid surfer Colin Cook during his recovery from losing his leg in a shark attack.

Protein is added to quality ingredients you know

More on protein bars with my must read article: "Weird Ingredients in Protein Bars".  

"Protein bars are popular and claim to help you lose fat, gain muscle and improve workouts. Everyone seems to feel good eating one but have you ever wondered about those weird ingredients?   Most articles will tell you how to choose the right protein bar but leave out the gory details lurking beneath the wrapper."

If You're Going to Eat It, Buy the Right One

Thanks for stopping by my Blog and don't forget to subscribe below and never miss a free update:

             DON'T MISS MY FREE UPDATES

  

A Presidential Politics-Free Health Wonk Review

Welcome to the Health Wonk Review, a compendium of the latest insights from more than two dozen health policy blogs. Each HWR issue is hosted at a different participant's blog, with topics that include health policy, delivery infrastructure, pharma, insurance and information technology.

Your HWR host, the Population Health Blog, uses a skeptical physician's perspective to write about "systems" of care.  Lately, it has focused on mHealth interventions that influence clinical and economic outcomes at a "population" level, as well as the effective governance of health enterprises.

 

It's also been a proud HWR participant for more than eight years.

The PHB is pleased that NONE of this issue's participants chose to mention any of the appalling lead candidates for U.S. President. Readers could use a break from the campaign cacophony, so the PHB welcomes you to the  Presidential Politics-Free Health Wonk Review.

The Affordable Care Act - What are the numbers?

Charles Gaba of ACASignups has been tracking the progress of the Affordable Care Act. This ongoing labor of love led him to comb through too-numerous-to-count public domain sources to provide an original-sourced summary (with links galore) of the health insurance status for the entire U.S. population in one chart.  He calls it "ambitious."  The PHB calls it gloriously detailed, credible and superb. KHN, you've met your match.

Medicaid

Hank Stern of the InsureBlog reminds us that Medicaid fails to meet the true definition of "health insurance." While beneficiaries get their health bills covered, this payment system is a government program that is ultimately paid for by taxpayers. As this form of income redistribution program expands, the opportunity for the "real" commercial insurance market dims. Ʀєfùsєηíκ indeed!

#mHealth - or the PHB is going to need an app to manage all its patients' apps.....

Peggy Salvatore of the Health System Ed Blog provides a summary of the ePharma Summit 2016 and regales readers with descriptions of how eHealth is helping persons who have gastrointestinal disorders, cancer or complex medication regimens be placed at the center of care.  "eHealth" is reaching critical mass without the help of any government mandates or meaningful use requirements. Imagine that.

David Harlow of the HealthBlawg takes a bite of Apple's CareKit Platform by unpacking the first app entrant from Iodine dubbed "Start."  Start promises to help users to individually manage both the benefits and side effects of anti-depressant medications. The app relies on a validated depression survey to assess progress, promising to take the guesswork out of treatment.

Outcomes

Brad Flansbaum of The Hospital Leader not only summarizes "the best (peer-reviewed) study on (hospital) readmissions to date," but interviews the lead author. As many have suspected, a significant proportion of preventable readmissions are outside the control of the institution and practically all of the current public-reporting measures fail to take that into account. Two insights are that 1) readmission rates will never go to zero, nor should they and 2) innovative interventions to minimize the risk of readmission are just now being developed. The PHB predicts that soon, no at-risk patient will leave the hospital without a dedicated app and telehealth-linked handheld device.  Given the dollars at stake, perhaps those patients without handhelds should be given one.....  

Pharma Misbehavior

Roy Poses from Health Care Renewal pulls aside the curtain and exposes the persons ultimately responsible for the OxyContin fiasco. Members of Purdue Pharmaceutical's C-suite had to pay hefty fines for the company's allegedly misleading advertising, but the upstream owners seem to have escaped scrutiny with their gazillions intact. If any of this is true, we've learned nothing about combatting corporate misdeeds.

Health Savings Accounts

Jay and Louise Norris of the Colorado Health Insurance Insider Blog take a look at some of the arcana and paranoia emerging around health savings accounts (HSAs).  First the arcana: HHS has a BPP about the HSA designation from QHPs that have otherwise been contrived to get around other regulations, likely promulgated in other BPPs. The paranoia is from wary conservatives, who are wondering if the liberals are unable to limit themselves to just "the nine words" by using BPPs to ultimately undermine HSAs.  What could possibly go wrong?  

Dual Eligibles

Tom Lynch of Worker's Comp Blog reviews the history of the successful Commonwealth Care Alliance.  This non-profit HMO currently serves over 17,000 "dual eligibles" in Massachusetts; these persons have significant disabilities and therefore qualify for both Medicare and Medicaid.  Despite huge claims costs, this HMO has been ably served by leadership who understands how money and mission underlie successful health insurance.

A Minimum Wage A Day Keeps the Doctor Away

California's Anthony Wright of the Health Access Blog is not only unapologetic about his home state gradually increasing the minimum wage to $15, he argues that that level of income correlates with better insurability, out-of-pocket affordability, higher health status, improved social determinants and less need for Medicaid.  What's there not to like, especially since the 48 other states can see how this ultimately works out.

Drugs: You Don't Get What You Don't Pay For

David Williams of the Health Business Blog has some thoughts for the pharmaceutical industry's efforts to justify its drug pricing policies. He recommends that pharma not only embrace cost-effectiveness, but lead the fight to include that methodology in all things healthcare.  They also need to help the public understand that you don't get good stuff for free: someone has to pay.

Speaking of Drugs....

Joe Paduda of the Managed Care Matters blog attended the Rx Drug Abuse Summit and has posted some of the more scary data that was presented there. The vast majority of heroin users started with prescription opioid drug abuse and a lot of smart concerned people are mobilizing to address the problem.  Awareness is the first step in addressing this unmitigated disaster.

Food, er Flu Fight

And saving the best for last, in the Health Affairs Blog, Peter Doshi, Kenneth Mandle and Forence Bourgeois scrutinize the CDC's recent recommendations on the treatment of influenza with antiviral drugs. After contrasting the recommendations with the FDA's and others' more detailed analyses on the subject, the authors find the CDC's promotion of a drug of questionable effectiveness to be "problematic."  In academic speak, them's fighting words. This ain't over, so sit back and enjoy while the flu fur flies.  

Your next Health Wonk Review will be hosted by the Health System Ed blog on April 21.

Health Wonk Review Blab

That's right, "Blab."

Plan on joining some of the Health Wonk Review’s “usual suspects” for a live video chat discussion of the latest edition above on Blab – you can watch it live right here next Tuesday, April 12, at 1 pm ET – or you can watch the replay right here if you can’t make it then; you can “subscribe” if you have a Blab account (you’ll need a Twitter account to sign up for one), and you can follow David Harlow (HealthBlawg) on Blab if you want to be automagically notified of future editions.