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It ’ s Time to Truly Share the Chemo Decision With Cancer Patients
By MICHAEL MILLENSON
You (or a loved one) has cancer, but the latest round of chemotherapy has unfortunately had only a modest impact. While you’re acutely aware of the “wretchedness of life that becomes worn to the nub by [ chemotherapy’s] adverse effects” you’re also a fighter.
How do you decide whether to continue with chemo?
The answer to that question is both intimately personal and inextricably tied to health policy. Cancer is the leading cause of death among those aged 60 to 79, and it is the second leading cause of death for all Americans. With expenditures on cancer care expected to top $158 bill...
Source: The Health Care Blog - May 11, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Chemotherapy Millenson Oncology shared decision making Source Type: blogs
Negotiated Rates: What No One Talks About in Health Care Legislation
Last week, the House of Representatives passed legislation for the American Health Care Act, the first step in repealing the Affordable Care Act, or as some would call it, Trumpcare versus Obamacare. The American Psychiatric Association and the American Medical Association (and many other medical societies) oppose the new legislation. An enormous concern is that the new legislation won't require insurance companies to cover preexisting conditions, or require coverage for mental health treatment or prenatal/maternity care. Over the coming years, the new legislation is predicted to leave 24 million more Ame...
Source: Shrink Rap - May 7, 2017 Category: Psychiatry Authors: Dinah Source Type: blogs
Not Really Insurance: The Pre-Existing Condition Debate
By DAVID DRANOVE and CRAIG GARTHWAITE
The recent debate over the potential repeal and replacement of the ACA, with the current focus on coverage for preexisting conditions, has drawn a great deal of attention to the concept of health insurance. While our political leaders are constantly talking about it, few of them seem to understand the “insurance” component of health insurance. As a result, much of what they say about preexisting condition coverage is gibberish. We are here to set the record straight.
At its most basic level, insurance provides protection against the risk of unexpected financial losses. We focus o...
Source: The Health Care Blog - May 6, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Free Rider Insurance Pre-Existing Condition risk Source Type: blogs
A Health Plan CEO Daydreams
By MICHEL ACCAD, MD
Jim was at his desk, looking weary.
The last few weeks had been brutal. Despite working twelve-hour days, he felt that he had little to show for it. His annual board meeting was to take place the next day, and he expected it to be tense.
With a replacement bill for the ACA about to be voted on, and with Trump in the White House, the situation seemed particularly precarious. The board members had asked him to present a contingency plan, in case things in DC didn’t go well.
As CEO of a major health insurance company, Jim was well aware that business as usual had become unsustainable in his l...
Source: The Health Care Blog - May 4, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized AHCA health reform MICHEL ACCAD repeal and replace Source Type: blogs
Health Reform Must End the Harms of Prior Authorizations
By CRAIG BLINDERMAN, MD
As the White House continues to push for a revised Republican proposal to replace the Affordable Care Act (ACA), one thing is for certain, many of the sickest Americans will continue to suffer as they are denied medications and other treatments under current health insurance strategies to save costs.
Both the ACA, and the recently proposed MacArthur Amendment, do not address a well-established practice of health insurers’ use of restrictive prior authorization requirements to deny or delay coverage of medications and treatments to seriously ill patients. In my own practice caring for cancer patien...
Source: The Health Care Blog - May 3, 2017 Category: Consumer Health News Authors: John Irvine Tags: Repeal Replace Uncategorized ACA Cancer Insurers MacArthur Amendment Prior Authorization Source Type: blogs
Acupuncture: A point in the right direction, or a stab in the dark?
Acupuncture is a treatment that dates back to around 100 BC in China. It is based on traditional Chinese concepts such as qi (pronounced “chee” and considered life force energy) and meridians (paths through which qi flows). Multiple studies have failed to demonstrate any scientific evidence supporting such principles. Acupuncture involves the insertion of thin needles into the skin at multiple, varying locations based on the patient’s symptoms. Once inserted, some acupuncturists hand turn the needles for added therapeutic benefit. Although there are many uses for acupuncture in traditional Chinese medicine, in Wester...
Source: Harvard Health Blog - May 3, 2017 Category: Consumer Health News Authors: Paul G. Mathew, MD, FAAN, FAHS Tags: Complementary and alternative medicine Headache Health Pain Management Source Type: blogs
Making A Prohibition On Preexisting Condition Exclusions Effective Requires Additional Measures
One of the most popular components of the Affordable Care Act (ACA) is the prohibition on preexisting condition exclusions, eliminating the practice in which insurers exclude coverage for health problems that people had prior to enrolling in an insurance plan. People do not like the idea that an insurer does not have to pay for care that people need due to a previously known health problem. But prohibitions on preexisting condition exclusions alone are insufficient to protect those with health problems and ensure their affordable access to necessary care. Meaningful protections require a package of policies: guaranteed iss...
Source: Health Affairs Blog - May 2, 2017 Category: Health Management Authors: Linda Blumberg and John Holahan Tags: Costs and Spending Featured Following the ACA Insurance and Coverage Quality ACA repeal and replace American Health Care Act community rating Essential Health Benefits preexisting conditions Source Type: blogs
Health Datapalooza 2017 Day 1: Data Liberation, Sharing, and Analytics
Welcome to Medgadget‘s coverage of Health Datapalooza 2017, an AcademyHealth event, in Washington, DC. The now annual event was launched in 2010 by the Obama administration as a hackathon-style program where attendees were challenged to deve...
Source: Medgadget - May 1, 2017 Category: Medical Equipment Authors: Michael Batista Tags: Exclusive Source Type: blogs
Pre-Existing Conditions: How the New Proposed Healthcare Plan Could Deny You Coverage
Congressional Republicans are dead-set on repealing and replacing the Affordable Care Act, seemingly without regard for making improvements to the system. The President’s promise was more people covered with better care at less cost. That is not what the new GOP proposal would provide.
The main criteria for GOP proposals seems to be to make plans cheaper by eliminating access to care for millions of Americans. The latest iteration of the Republican healthcare proposal is to remove protections for “pre-existing conditions” from health insurance policies. This is the most disastrous of the Republican proposals to dat...
Source: Cliffside Malibu - May 1, 2017 Category: Addiction Authors: Constance Scharff PhD Tags: Abuse Addiction Recovery Addiction to Pharmaceuticals Addiction Treatment and Program Resources Alcoholism Behavioral Addictions Current Events Drug Rehab Information Drug Treatment Mental Health addiction treatment center drug treat Source Type: blogs
Managing The Beginning Of The End: Advanced Disease Management And Concurrent Care Under Current Financing
Editor’s Note: This is the second Health Affairs Blog post from the author on End of Life & Serious Illness. His first post “Why Now? Concerns About End-Of-Life Health Care Policy” was published on December 19, 2016.
The Medicare hospice benefit was passed in 1982 as part of the Tax Equity and Fiscal Responsibility Act, the same bill that instituted diagnosis-related groups (DRGs) for hospital reimbursement. Since it was passed with a sunset provision, there was only modest growth in the number of beneficiaries until the hospice benefit was made permanent in 1986. Other changes included in the bill h...
Source: Health Affairs Blog - April 28, 2017 Category: Health Management Authors: Vincent Mor Tags: Costs and Spending End of Life & Serious Illness Long-term Services and Supports Medicare Organization and Delivery Quality advanced disease management End-of-Life Care Hospice care Palliative Care Source Type: blogs
Health Policy ’s Gordian Knot: Rethinking Cost Control
Medical spending has resumed its long-term rise. After several years of deceptive stability in the last, deep recession’s wake, health spending rose by 3.7 percentage points more than general inflation in 2014, then by 5.8 percentage points more in 2015, to a 17.8 percent share of the US economy.
Not only does this spending rise threaten the United States’ fiscal stability and capacity to address other needs; it is undermining the promise of health care for all. To manage rising costs, insurers are hiking premiums, narrowing their networks, and raising deductibles and copayments, making purchase of coverage less appeal...
Source: Health Affairs Blog - April 26, 2017 Category: Health Management Authors: Gregg Bloche, Neel Sukhatme and John L. Marshall Tags: Costs and Spending Drugs and Medical Technology Health IT Insurance and Coverage Payment Policy intellectual property patents Research and Development value-based payment Source Type: blogs
The MacArthur Amendment Language, Race In The Federal Exchange, And Risk Adjustment Coefficients
For a number of days negotiations have apparently been underway with respect to an amendment to the Republican American Health Care Act (AHCA) that has been proposed by Congressman Tom MacArthur (R.N.J.) A summary of this amendment became available on April 20, 2017 and was analyzed here. On the evening of April 25, the actual language of the amendment became available.
As described in the summary, the amendment would repeal the enigmatic language included in a March 23, 2017 amendment to the AHCA that would have allowed states, beginning in 2018, to define the essential health benefits for purposes of determining premium ...
Source: Health Affairs Blog - April 26, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Source Type: blogs
