In this issue:
Census reports expected to show more uninsured Americans than a year ago.
The Wall Street Journal reports that "the Census Bureau will release two reports detailing the poverty rate, income, and the number of Americans without health insurance" on Tuesday. Although "predicting numbers is a dangerous business," the Census report "will almost certainly show that there are more uninsured Americans than there were a year ago," given increased healthcare costs and "more employers [that] cut back on benefits." The report is expected "to show that the poverty rate stayed essentially flat from a year ago, and inflation-adjusted median earnings increased slightly." The Journal predicts that both Sen. Barack Obama (D-Ill.) and Sen. John McCain (R-Ariz.) will use the Census report as "a springboard to tout their very different healthcare plans." Sen. McCain's plan "would change the tax treatment of health insurance to help people even if they don't get insurance from their employer." Meanwhile, Sen. Obama's plan features "a government-organized insurance marketplace in which private companies would compete with a medicare-like plan." Based on "a shaky economy and rising prices," the Journal states that "the report would seem to benefit Sen. Obama over Sen. McCain."
"The truth is that no one knows just how many people in the United States are without health insurance," the Minnesota's Journal Sentinal added. The results of the Census survey are expected to "conflict with the estimates from two other main surveys done by the federal government and with surveys done by Wisconsin and other states." But, all of the surveys found that "more than 30 million people have been uninsured for a full year." Notably, "the vast majority of the uninsured -- more than half by one estimate -- are people who simply can't afford health insurance. Most work in low-wage jobs, but they increasingly include middle-class families."
Study indicates uninsured will spend $30 billion out of pocket in 2008 for care. The Wall Street Journal reports, "Americans who lack health insurance will spend about $30 billion out of pocket on medical care this year, but others -- mainly the government -- will end up covering another $56 billion in costs," according to a new study by "researchers at George Mason University in Fairfax, Va., and the Urban Institute think tank in Washington, D.C." The study, published in the online journal Health Affairs, found that it would cost $208.6 billion to cover all of the uninsured, "$122.6 billion more than this year's projected total -- mainly because people with insurance tend to use more healthcare services." In addition, the study showed that the government covers an estimated "75 percent, or $42.9 billion, of the amount uninsured patients can't pay -- through Medicaid, the federal-state health-insurance for the poor and Medicare, the federal program for the elderly and disabled, as well as state and local taxes."
Source: NAHU Newswire, August 25, 2008
GAO criticizes auditing of private Medicare drug plans.
“Nearly three years into the Medicare drug benefit, federal officials have yet to ensure that private drug plans enacted programs to deter fraud and abuse" according to a Government Accountability Office (GAO) report. The drug "plans are required to develop programs to stem improper spending, but the Centers for Medicare and Medicaid Services has not conducted audits to ensure those programs were up and running properly." As a result the GAO report said that the "lack of oversight 'risks significant misuse of funds in this $39 billion program.'" In its report, the GAO also "recommended that Medicare officials make timely audits of the plans' fraud prevention programs." For their part, "Medicare officials replied that, while they have not yet conducted onsite audits, they asked plans to complete a self-assessment survey. They also noted that Congress capped funding for its auditing programs at $720 million in 2003. So, they've focused on addressing complaints."
Source: NAHU Newswire, August 25, 2008
Blue Cross proposed consolidation may lead to acquisitions by large insurers.
In continuing coverage from previous editions of NAHU Newswire, the Wall Street Journal reports, "Proposals to convert a major nonprofit Blue Cross Blue Shield plan into a publicly traded company and to merge two others could lead to further consolidation in the increasingly concentrated managed-care industry." While some Blue Cross organizations are "feeling the pressure to merge or to convert to for-profit status," the Journal predicts that Blue Cross will "pave the way for acquisitions by large insurers such as WellPoint." Blue Cross plans are seen as attractive targets "because they have the best operations and the most people covered. According to a WellPoint spokesman, "smaller health insurers are finding it harder to compete against larger players for many reasons, including the need for economies of scale and greater investments in expensive technologies and tools to comply with laws or help members in so-called consumer-directed health plans."
Source: NAHU Newswire, August 25, 2008
Aetna Introduces Powerful, Interactive Personal Health Record
Powered by ActiveHealth’s Patented CareEngine® System, Aetna’s Personal Health Record provides personalized alerts to members and physicians about opportunities to improve care
CareEngine System-powered Personal Health Record pilot available February 2007 provides personalized alerts and interactive functions; all Aetna subscribers to receive an online Health History Report in January 2007.
Aetna announced the launch of its new CareEngine® System-powered Personal Health Record (PHR) that provides members with online access to personal information, including individual personalized messages and alerts, detailed health history, and integrated information and resources to help members make informed decisions about their health care.
Aetna’s PHR is the first to utilize the CareEngine System, which is a proprietary technology platform developed by ActiveHealth Management, a branded, standalone business of Aetna. CareEngine continuously scans an individual’s health data and claims information against highly respected sources of medical literature, and alerts consumers and doctors about possible urgent situations and opportunities to improve care. The CareEngine-powered PHR automatically combines detailed, claims-driven information gathered across the health care spectrum - such as physician office, lab, diagnostic treatment and prescriptions – to generate a comprehensive personal health record. This information is processed by CareEngine to generate personalized health care alerts and messages that are delivered directly to the member.
"Aetna is working to personalize and simplify how members navigate the health care system, and this personal health record is a major step forward in that effort," said Mark Bertolini, Executive Vice President, Aetna. "The PHR will provide members with secure, reliable and current information that they can share with their doctors so that together they can make the best informed decisions about their health care needs."
Aetna’s PHR allows consumers to add personal information about their health history, such as a specific disease or condition in the family, or whether they take over-the-counter medications. As consumers add more personal health information to enhance their PHR, CareEngine evaluates this additional information for opportunities to improve care for themselves and their families.
"Claims-based PHRs, personalized by members, can greatly increase patient safety and improve health care quality," said Troyen A. Brennan, Aetna’s Chief Medical Officer. "The CareEngine technology will scan information from claims and self-reported information to find opportunities where evidence-based care may have been missed, and show areas for improvement. Ultimately, this new tool will allow physicians to benefit from improved information about each patient, and members and doctors can share that information to make the best decisions concerning their health care."
The Aetna PHR is the latest addition to Aetna’s award-winning disease management programs and online consumer tools that integrate and provide access to health information. Earlier this year, Aetna unveiled Aetna Health ConnectionsSM, the company’s new portfolio of medical management programs that provide information and health counseling to help each member achieve optimal health regardless of life stage or health status. The CareEngine technology is the backbone of the Aetna Health Connections portfolio and the PHR, providing an important link between the medical management programs and online member resources. The company continues to refine a full suite of consumer tools that include the nationally recognized transparency initiative to provide consumers with detailed information about doctor and procedure costs, as well as the company’s expanding wellness offerings (Simple Steps To A Healthier Life®) and health care information site, Aetna InteliHealth®. These interactive tools are integrated by the CareEngine-powered PHR to provide a seamless online resource for members.
Beginning in January 2007, all Aetna subscribers will have access to a basic Health History Report automatically populated by each member’s Aetna claim activity. The Health History Report can be easily printed and shared so members can better coordinate care across multiple health care providers. The CareEngine-powered PHR will be available to a select group of large customers, including United Parcel Service of America (UPS), beginning in February 2007. Those employers are interested in testing this innovation and will be asked to provide feedback to further refine Aetna’s CareEngine-powered PHR, which will then be made available to additional employers in July 2007 and can be offered to entire employee populations regardless of health care provider.
Developed with Consumer & Physician Input
Aetna’s PHR is the result of comprehensive industry-wide research and conducting extensive work with focus groups of both consumers and physicians. It is anticipated that consumers will share the information from their PHR with their physicians so that members and doctors have the full range of information from which to base their decisions. Importantly, the PHR automatically maintains the individual’s information – thereby simplifying record keeping for the member and his or her family. The information contained in the PHR is portable.
About the Care Engine
The CareEngine System is a patented clinical decision support technology developed by ActiveHealth Management. CareEngine compiles member data from medical, pharmacy and lab claims. This data is then analyzed against the latest findings from highly respected sources of evidence-based medical literature, to find opportunities for better care, potential medical errors and gaps in care. Once pinpointed, CareEngine generates a patient-specific clinical alert called a Care Consideration. Care Considerations are communicated to physicians and members and propose adding or stopping treatment or suggest a procedure that has not been conducted. CareEngine has proven to significantly improve clinical outcomes, reduce medical errors and lower health care costs. More than 13 million patients nationwide currently benefit from programs powered by CareEngine.
Source: www.aetna.com/news
Obama campaign considers making healthcare a top priority.
In a front-page story, the Wall Street Journal (8/26, A1, Davis, Farnam) reports that, currently the campaign for Sen. Barack Obama (D-Ill.) "is debating which economic policy to push first after a victory: climate change or healthcare." Compared to climate change, the "other major Obama priority, extending healthcare coverage to millions of the uninsured, is even more daunting, conceptually and politically. Sen. Obama would create a new government health-insurance plan and subsidize those who can't afford it, as well as issue regulations for private plans that wanted to compete with the government plan." A federal-level overhaul means it "could take many months to put together a specific plan, making it less likely to be the first priority. Obama advisers say the concept is similar to one started in Massachusetts under former Republican Gov. Mitt Romney." Obama has indicated he would increase taxes on the wealthy to fund the program, and the "prospect of a tax fight and healthcare battle rolled into one might prompt an Obama administration to push climate change first."
Democratic candidates' healthcare reform proposals discussed. In the Wall Street Journal's (8/25) Health Blog, Sarah Rubenstein discussed "the presumptive Democratic vice-presidential nominee," Sen. Joe Biden's (D-Del.), "views on health policy." Last fall, when Sen. Biden "was still running for president," his healthcare plan aimed to "expand the federal government's role in health insurance." His plan featured "sliding-scale premiums and co-pays based on income," that would allow "all families to buy into the State Children's Health Insurance Program (SCHIP)." Sen. Biden also wanted to give all "people aged 55 to 64" the opportunity "to buy into Medicare" and expand coverage of federal employees to include uninsured individuals. According to his Senate website, Sen. Biden would "allow the government to negotiate drug prices directly with manufacturers, and he'd like to eliminate that notorious gap in coverage known as the 'doughnut hole.'" Rubenstein noted that Sen. Barack Obama's (D-Ill.) healthcare proposals also call "for expansion of eligibility for SCHIP...and government negotiation on Medicare drug prices."
Experts discuss ways in which next president could reform healthcare system. The Denver Business Journal (8/25, Mook) reported that in Denver, "sixteen healthcare experts from around the country shared their thoughts about how the next president could reform the system Monday morning during an event that coincides with the Democratic National Convention." The event was "moderated by former Senate Minority Leader Tom Daschle." The experts "concluded that fixing the system would involve a greater focus on nutrition and exercise, preventative care, providing coverage for the country's 47 million uninsured, upgrading the sector's information technology, and getting more federal dollars for research for new drugs." A number of "panelists concurred that reforming the system is an expensive proposition."
MedPage Today (8/25, Walker) added that "the panelists included two hospital CEOs, a member of Congress, two city mayors, a biotech company leader, a device maker vice president, two insurance company execs, and several other business figures." According to "Bruce Bodaken, chairman, president, and CEO of Blue Shield of California...the mere recognition the nation's healthcare system is falling short would be an important first step" for the next president. Meanwhile, "Samuel Nussbaum, M.D., executive vice president and chief medical officer of WellPoint, said the next president needs to ensure improved health information technology and that he should provide every American with full access to care."
Source: NAHU Newswire, August 26, 2008
Employers may see smallest annual healthcare cost increase since 1999
“Over the next 12 months, employers can expect to see another double-digit increase in healthcare spending." But, data from Aon Consulting indicates that "corporations will pay 10.6 percent more on healthcare in 2008, which is the smallest annual increase since 1999." Healthcare consultants attribute corporate wellness and disease management programs to the slight decrease in healthcare costs for employers. Such programs are now "standard practice at most companies -- numerous surveys show that anywhere from 70 percent to 90 percent of employers have at least one type of program in place." Still, wellness programs "actually add to a company's healthcare expenses at first," with some consultants estimating that "it takes at least two years for a company to see any real return on its investments in wellness." Ultimately, the success of wellness programs depends "on employees' participation -- and...whether participating leads workers to alter any unhealthy behaviors."
Source: NAHU Newswire, August 26, 2008
Appeals processes may overturn insurers' denial of coverage
Private insurance companies "in ways often hidden and arbitrary, have the authority to deny coverage." Citing "various reasons, some of them technical, such as not meeting filing deadlines or failing to get pretreatment authorizations," insurers typically deny "an estimated 10 to 15 percent of claims." Although the most disputed denials are those where insurance companies "judge the care to be unnecessary or unproven," they have "the legal right to manage a patient's care, including denying it," giving "them the final say, if challenged." But, insurance companies are also "mandated to have an internal appeals process, though there is little openness to help those seeking reconsideration, such as information on similar appeals and their outcome or the data used for denial." Nevertheless, people who complete "the formal written internal appeal," are "eligible for an independent external review in 43 states and the District of Columbia." And, "state reviews overturn about half of insurers' decisions, and in most states that's final."
Source: NAHU Newswire, August 26, 2008
Researchers say California's anti-smoking program saved $86 billion in personal healthcare costs.
California's "state-funded program aimed at cutting smoking can...save a lot of money," according to findings published in the August issue of PLoS Medicine. Lead author James Lightwood, of the University of California, San Francisco, and colleagues, compared the California Tobacco Control Program, which "was created in 1989," to "a set of control states the authors determined had no comprehensive tobacco control program before 2000." The authors compared "cigarette sales, the price of cigarettes, tobacco control spending, and per capita personal healthcare spending, a broad set of costs including hospital care, prescription drugs, nursing home care, and even dental care."
The data showed that the "estimated total savings from the California anti-smoking program was $86 billion in personal healthcare between 1989 and 2004," WebMD. The program was also "associated with 3.6 billion fewer packs of cigarettes sold between 1989 and 2004." The authors noted that this "translates to a big loss for tobacco companies -- an estimated $9 billion loss, before taxes."
Source: NAHU Newswire, August 26, 2008
Enlarging Pre-Approval Trials Could Improve Drug Safety Cost-Effectively
Requiring larger pre-approval clinical trials could be a cost-effective method of reducing post-approval injuries and deaths caused by new medications, according to a study published today on the Health Affairs Web site.
Drug safety has been a much-discussed topic recently, but most of the attention has been focused on strengthening post-marketing surveillance of prescription drugs. In their paper, Shelby Reed and her colleagues from Duke University point out the potential for strategies at the pre-approval stage -- before the Food and Drug Administration has cleared the drug -- to detect adverse events caused by new medications.
In a Perspective on the Duke paper, Stanford's Alan Garber suggests that the appropriate strategy for ensuring safety and efficacy will vary from drug to drug.
Source: Health Affairs, August 10, 2008
Experiences of Immigrant Health Care Providers
Twenty-five percent of the physicians, 10 percent of the nurses, and uncounted numbers of home health workers and nurse aides in the United States are immigrants. This is a huge but largely silent factor in American health care; despite the numbers, the voices of these health care workers are seldom heard in narrative or policy writing. What does this massive migration of talent mean for America and for the countries left behind? How does the legacy of the old country live on-and what about stigma, language, pride of accomplishment, and guilt of departure? What is it like to be an immigrant caregiver?
In "Narrative Matters" essays in the July/August issue of Health Affairs, two physician-writers with immigrant roots ponder their experiences. Transplant surgeon Pauline Chen retells the folk tale of Urashima Taro and reflects on how it has bound three generations of her Taiwanese family together in their migration to America and her entrance into medicine. http://content.healthaffairs.org/cgi/content/full/27/4/1148 Then, in oncologist Alok Khorana's essay, personal, cultural, and medical values jostle one another as he tells the story of his first night on call at a hospital in New York State after arriving from India three weeks into the start of his residency. http://content.healthaffairs.org/cgi/content/full/27/4/1154.
Source: Health Affairs, August 10, 2008
Best Fuel for your Workout
When planning your exercise sessions, it’s important to factor in how you’ll fuel those workouts beforehand and how you’ll replenish lost energy afterward.
You don't want to eat too much food before exercising, because if you become sluggish, nauseated or throw up, you've lost that workout.
But if you don’t eat, you might be too weak to lift the weights or too sapped of energy to swim laps.
Good food choices to fuel your workout include high-carbohydrate, low-fat snacks such as:
- a banana with yogurt;
- a whole-wheat toasted bagel with fruit spread; or
- a quick bowl of instant oatmeal.
You’ll want your food to be mostly digested before exercise so it’s not sitting like a lump in your stomach. It may take little experimenting to find out the right amount of time to eat before a workout that feels best for you. Bear in mind that large meals can take as long as five to six hours to digest and empty from the stomach, whereas a smaller snack may take an hour.
After your workout, it’s essential to refuel your body with a carbohydrate-protein blend, such as:
- a peanut butter sandwich;
- a small handful of walnuts or almonds; or
- a fruit smoothie with some protein powder.
Of course, don’t forget to drink water before, during and after your workout to avoid dehydration.
And remember that eating a low-fat, well-balanced diet the rest of the day will help ensure that your motor is running efficiently both during exercise and at rest.
Source: The Fit List, June 17, 2008
5 Sack Lunches Kids Love
Distract finicky eaters by putting together a meal that’s so much fun to eat, they won’t be thinking about whether it’s on their short list of “likes.”
Fun foods don’t have to be deep-fried or full of preservatives. Just think bite-size, dippable, and varied. Natural foods aisles in many grocery stores have a lot of healthier products, such as snacks sweetened only with fruit juice or packaged with fewer trans-fats and preservatives.
Here are five ideas for health-conscious meals that are easy to prepare and fun for kids. Whether your child is a try-anything eater or has the pickiest appetite ever seen, these lunches are sure to please.
MONDAY: Deconstructed Sandwiches
Instead of buying prepacked sets of crackers, cheese, and deli meats, put together a homemade version. Your child can even help out the night before, picking out the crackers, meat, cheese, and a small dessert. Another fun idea is to use mini cookie cutters (about the same size as the crackers) to cut the lunch meat slices into fun shapes. (The leftovers make a good mid-morning nibble for you!)
Some options:
- veggie or water cracker rounds
- chicken or turkey deli meat, cut into roughly cracker-size pieces
- part-skim mozzarella or cheddar slices, cut into roughly cracker-size squares
- fruit cup (packed in juice) or unsweetened applesauce
TUESDAY: Grilled Cheese Pockets
As a variation on the standard pan-browned cheese sandwich, try using a sandwich maker; some machines even make the crispy triangles sealed around the edges. Use whole-grain bread and low-fat or part-skim cheeses, which are healthier than their whole-milk counterparts and melt better than completely fat-free versions. Include a couple of fruit leathers and a handful of baked pita or potato chips in the lunch bag, too.
WEDNESDAY: Turkey-Cran Tortilla Bites
Instead of packing a bulky wrap or burrito, slice up a tightly rolled tortilla and fillings. The trick is to spread all the ingredients evenly, rather than pile them into the middle like in a traditional wrap sandwich.
Lay the tortilla flat, then spread a thin layer of cranberry sauce over the whole surface. Top with one layer of lettuce leaves, then with pulled turkey (in smallish pieces) or deli meat slices. Roll tightly, then cut into one- or two-bite pieces, holding each piece closed with kid-safe toothpicks. (For vegetarian kids, try it with a thicker spread of hummus, thin slices of peppers and cucumber, and lettuce.) Toss in a box of raisins and a few animal-shaped crackers on the side.
THURSDAY: Dipping Day
Everything in this lunch is bite-size and gets dunked. Pack them loosely in separate containers for younger children, or in rows on “skewers” for older ones.
- Chicken nibblers with honey mustard
- Baked tortilla chips and tomato salsa
- Baby carrots and cut-up celery sticks with light ranch dressing
- Sliced apple, banana, and peach with fruit yogurt (or plain yogurt stirred with all-fruit jam)
FRIDAY: Layered Lunch
Turn the traditional sandwich on its head—literally—by piling the halves onto one another. It even works without the crusts! (Just cut them off before building.) This is a great way to liven up old standards like peanut butter and jelly, or try a club sandwich variation.
Cut two whole-grain bread slices diagonally in half, then line up the four resulting triangles. Spread a little bit of mustard on the first triangle and top with one piece of deli meat and cheese. On the next triangle, use mayo and a different kind of deli meat. The third triangle gets sliced veggies, such as tomato and cucumber, and lettuce. Stack these three, covering them with the last triangle. Spear the tower with two kid-safe toothpicks and cut in half. Include some pretzel sticks and chopped dried fruit.
Source: www.schoolfamily.com, August 30, 2008