Healthcare in a Minute – April 2017

By George W. Chapman

Social media.

Social media (SM) is having more and more of an impact on consumers and their behaviors every year. 40 percent say information gleaned from SM affects how they deal with their health. 19 percent of smartphone owners have at least one health related app. 41 percent of us say SM influences our choice of providers and hospitals. 30 percent of healthcare professionals use SM for networking. When it comes to sharing health info via SM, 43 percent of us are comfortable sharing with hospitals, 47 percent with physicians, 38 percent with insurers and 32 percent with pharmacies. 60 percent of physicians report SM actually improves the quality of health in their patients.

Dementia & Sleep

46 million people worldwide suffer from some sort of dementia. In the US, 5 million people have Alzheimer’s disease. One in three seniors will die from dementia complications. Dementia costs us about $236 billion a year. Researchers at Boston University School of Medicine found that people who sleep more than nine hours on average are twice as likely to develop dementia than those who sleep less than nine hours on average.

Telehealth

More and more insurance companies are paying for telehealth. The immediate benefits are easier access, enhanced doctor/patient communication and remote monitoring of incapacitated patients. It will take more time and experience to determine whether or not the increased utilization of physician services via telehealth is eventually outweighed by cost reductions in other areas like inpatient care and drug utilization. A study published in Health Affairs followed three years of claims for respiratory infections. The study concluded that nine of 10 telehealth visits (for this condition) represented new or additional utilization versus visits that substituted for an in-person encounter. The authors of the study recommended insurers or even providers might want to increase patient out-of-pocket costs to prevent frivolous or unnecessary telehealth utilization and that telehealth might have more of a positive impact for those patients with traditionally undertreated conditions like diabetes and mental health.

Affordable Care Act

A bill to replace the ACA, called the “American Healthcare Act,” has just passed the Ways and Means committee in the Republican controlled House. The bill would: eliminate many of the taxes that support expanded Medicaid and the premium subsidies on the exchanges and replace them with consumer tax credits, provide block grants to the states for Medicaid, and discontinue the individual mandate requiring all to have insurance or pay a penalty. The bill would continue, however, the basic cornerstones of the ACA: allow children to remain on a parent’s plan until age 26, no lifetime monetary caps on illnesses, and insurers cannot deny coverage for pre-existing conditions. Rather than going through a disruptive and highly political repeal and replace process, many industry observers wonder why the changes proposed in the new bill were not simply introduced in Congress, over the last six years, as amendments to the ACA. The insurance lobby (AHIP) has expressed approval of some of the changes, but it has expressed concern about the potential decline in coverage and the negative impact on our most vulnerable populations. The American Medical Association flat out will not support the new bill. The hospital lobby says the probable increase in the uninsured will cost hospitals billions. Washington observers and healthcare policy experts believe the bill, as written, will not garner enough support in the Senate. The Congressional Budget Office still has to determine if the new bill’s numbers add up. The CBO has estimated that 15 million people could lose their insurance.

Mega merger drama

Critics of the ACA have maintained many consumers really don’t have choices because one in three markets has only one insurance company left on the exchange. Consequently, consumers, physicians and hospitals could potentially be at the mercy of monopolistic pricing. Insurance companies maintain that mergers (resulting in less choices) will allow them to reduce costs and increase efficiencies which would benefit the consumer. The Department of Justice isn’t buying that and has blocked the mega merger of Anthem and Cigna, the second and third largest commercial insurers in the nation. Incredibly, Cigna is now suing Anthem to end the merger agreement and for damages. Anthem has countersued. The AMA has expressed its strong concern over the possibility of politically driven settlement negotiations between Anthem and the DOJ that could result in Anthem closing the deal with Cigna.

Accountable Care Organizations

ACOs were established by the ACA to cut costs and improve access and quality. More than 850 ACOs across the country care for over 28 million people. Hospitals, physicians and insurers have been collaborating the past six years. The majority of ACOs participate in shared savings programs with Medicare and commercial insurers. Industry experts are confident ACOs will survive any changes in the laws of the land.

Obesity

In a study published in Cell Metabolism, researchers found that a dopamine deficit may be the major cause of physical inactivity which has often been blamed on obesity. Lab mice were divided into two groups. The first group was fed low-fat food while the second received high-fat food. The mice on the high-fat diet naturally gained more weight, but researchers noted all mice were inactive — due to low dopamine levels — to start. So weight gain itself did not lead to inactivity in these mice.

Really?

And finally this. “Nobody knew that healthcare could be so complicated.” President Donald Trump, Feb. 27, 2017.

George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at gwc@gwchapmanconsulting.com.

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