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By gulfsouthb32553561, Feb 19 2019 01:05PM

COMMENTARY BY

Portrait of Robert Moffit

Robert Moffit

Robert E. Moffit, Ph.D., a seasoned veteran of more than three decades in Washington policymaking, is a senior fellow in domestic policy studies at The Heritage Foundation.

Liberals in Congress are promising Americans that their “Medicare for All” proposals for government-controlled health care will expand access to care.

As Sen. Cory Booker, D-N.J., explains,“Obamacare was a first step in advancing this country, but I won’t rest until every American has a basic security that comes with having access to affordable health care.”

Likewise, Sen. Kamala Harris, the California Democrat, predicts, “Well, the idea is that everyone gets access to medical care. And you don’t have to go through the process of going through an insurance company, having them give you approval, going through the paperwork, all of the delay that may require.”

Universal access to health care—and no bureaucratic delays.

Though it sounds too good to be true, a plurality of Americans, according to the National Opinion Research Center, actually think it is. It reports that 42 percent of respondents in a national survey believe that “Medicare for All” would increase access to doctors and hospitals, while only 24 percent expect such a program would reduce access.

This faith is misplaced. Britain and Canada provide their citizens with single-payer national health insurance, and the evidence is overwhelming: Access to government health insurance does not automatically translate into access to medical care, let alone the avoidance of frustrating and sometimes dangerous delays in medical treatment.

Consider the problem of delays. In the British National Health Service—the grand-daddy of “single payer” health care—there are more than 4 million people awaiting hospitalization. To their credit, the British media has not been shy about reporting the shabby conditions in overcrowded and understaffed British hospitals, the denials or cancellations of surgeries, and the sufferingof British patients.

For those British citizens who want to avoid care delays or denials by the National Health Service, there is the option of enrolling in British private health insurance. Such an option is especially desirable for British patients in need of highly specialized medical procedures, such as a coronary bypass or orthopedic surgeries.

In the United States, congressional liberals—in the text of their leading “Medicare for All” bills (H.R. 676 and S. 1804)—would outlaw virtually all private health insurance, including job-based health coverage. In short, they would deny every American the right to enroll in any alternative to the government plan.

American health care deficiencies are indeed serious—quality is uneven and noncompetitive markets drive up costs and undercut the affordability of care and coverage. On measures of access to care, however, researchers writing for the Journal of the American Medical Association—examining the comparative performance of 11 “high-income” nations—found that “the United States generally performed better than other countries.”

Concerning access to specialized care, for example, they found that only 6 percent of American patients reported waiting more than two months to see a medical specialist, compared to 39 percent of Canadian patients and 19 percent of British patients. The Fraser Institute, a prominent Canadian think tank, estimated that in 2018 the median waiting time for a Canadian patient to see a medical specialist on referral from a general practitioner was 19.8 weeks.

Access to high-quality care is also dependent on the availability of medical goods, as well as specialized services, including advanced medical technology. The Journal of the American Medical Association researchers found that the U.S. ranks first in the utilization of computed tomography units, and second in the number of magnetic resonance imaging (MRI) machines per million of the population (38.1), while Canada has only 8.9 MRIs per million and Britain has just 7.2

Likewise, in fighting breast cancer, the United States deploys 43.3 mammography units per million of the population, while Britain has just 21 and Canada has only 17.3.

Not surprisingly, the researchers found that screening for the prevention of breast cancer is higher in the United States than for all other high-income countries.

Americans can also celebrate stellar progress in reducing death from heart disease. In a major study for the National Bureau of Economic Research, another team of researchers report that between 1950 and 2015, mortality from cardiovascular disease declined by a stunning 73 percent.

Thank the quality American medical interventions. At a rate of 79 procedures per 100,000 in the population, according to the report, Americans lead other high-income countries in the availability of coronary bypass surgery. In comparison, Canadians have a rate of 58 procedures per 100,000 and the British just 26.

On the provision of coronary angioplasty, the United States operates at a rate of 248 per 100,000 of the population, compared to Canada with just 157 and Britain at only 128. The United States also has a much better record of reduced mortality after incidents of stroke and heart attacks than most other advanced countries.

Access and quality problems in government-controlled health care are not far from home. Just ponder the scandalous delays and denials of care at the “single payer” Veterans Administration, Obamacare’s notoriously narrow provider networks, and the historically poor record of patient access to doctors, quality care, and medical outcomes in the Medicaid program.

A National Opinion Research Center survey reports that most Americans are “somewhat” or “very” concerned about their access to doctors and hospitals. Not surprisingly, therefore, the Kaiser Family Foundation reports that 70 percent of Americans would oppose “Medicare for All” if it would “lead to delays in people getting some medical tests and treatments.”

Experience is the best teacher. The lesson: Liberal promises do not match “single payer” performance. Looking at the record, ordinary Americans can know the truth.

By gulfsouthb32553561, Feb 12 2019 04:43PM

The Trump administration’s proposed new rule taking aim at healthcare costs by eliminating hidden drug rebates is a positive step that would increase transparency and eliminate conflicts of interest — and better serve both employers and employees in the process.

That’s the view of one of the largest employer groups, after the Trump administration proposed a major change last week to how the U.S. drug pricing system works, in an effort to bring down the cost of prescription medications for patients. The proposed regulation from Health and Human Services Secretary Alex Azar would eliminate behind-the-scenes discounts among drugmakers, insurers and go-betweens and instead require that the rebates be paid directly to consumers when they buy their medications.

“This is one of the most transformative health reforms we’ve seen in the past few years,” says Mike Thompson, CEO of the National Alliance of Healthcare Purchaser Coalitions. “Rebates sound good in [theory], but the reality is they’ve disrupted [the marketplace] and have created a market that is non-transparent and more focused on rebates than value.”

This proposal would increase pricing transparency for pharmaceutical consumers and will help eliminate conflicts of interest, ultimately leading of greater competition based on value from the eye of the employer, employer groups argue.

“The push for more straightforward, simple and streamlined supply-chain pricing and contracting models is reaching a tipping point,” says Brian Marcotte, president and CEO of the National Business Group on Health.

Employers have been calling for change in the drug industry and long argued that drug rebates are an ineffective strategy: 84% say the pharmaceutical supply chain needs to change and 35% believe it needs to be more transparent and that drug manufacturers rebates should be reduced, according to a National Business Group on Health survey.

Three-quarters of large employers do not believe drug manufacturer rebates are an effective tool to drive down pharmaceutical costs, and more than 90% of employers would welcome an alternative to the rebate-driven approach to managing drug costs.

If the rule goes into effect, the transition will be critical for employers, as many of them have three- to five-year contracts with their pharmacy benefit manager, Thompson says.

“Obviously those contracts would quickly become null and void if the rebates were eliminated,” he says. “I suspect there will be some sort of transitional rules that will allow employers and PBMs to transition to the new rules.”

The move also will give employers more power when it comes to drug pricing, he adds. “Ultimately we’re going to have greater transparency at the individual drug level and employers will be able to be much more effective and influencing the practices and drug pricing of PBMs and ultimately the pharmaceutical industry.”

Thompson says that under the proposed rule, employees would get the benefit of the discounts that were previously behind the scenes. “That will be at the expense of the employer, but they’ll have other ways they can balance their financial needs,” he says.

For employers that have fixed copays, there’s no real effect financially, he says, assuming those rebates get translated into the net prices for the pharmacies. While employers in the end will come out even, they just won’t see these big rebate checks; instead they’ll see the actual costs on the front end.

“But for employers who offer percentage coinsurance, today, very few of them would have passed back the value of the rebate in how the employees were getting charged the coinsurance,” he adds. “For those employers, the employees will start getting the benefit of their share of those discounts.”

As PBMs play an important aggregation role for employers, Thompson says, the proposed rule does not spell their demise.

However, the rule will lead to more transparency and greater competition among PBMs, including non-traditional PBMs, he says. “It will help to eliminate what many have perceived as conflicts of interest in how formularies and drug management have been performed in recent years,” Thompson says. “From that perspective, this is critical to the long-term sustainability of this industry.”

Some critics warn the proposed rule could lead to higher premiums for consumers.

Employee benefits

“We are concerned that eliminating the long-standing safe harbor protection for drug manufacturer rebates to PBMs would increase drug costs and force Medicare beneficiaries to pay higher premiums and out-of-pocket expenses, unless there is a viable alternative for PBMs to negotiate on behalf of beneficiaries,” says Pharmaceutical Care Management Association President and CEO JC Scott.

“While we are reviewing the proposed rule, we stand ready to work with the administration to achieve our shared goal to reduce high drug costs,” Scott adds. “PBMs are part of the solution to high cost prescription drugs. Drugmakers alone set and raise prices.”

By gulfsouthb32553561, Feb 12 2019 04:38PM

Microsoft Corp. is releasing a service to help health-care companies move vast amounts of patient data to its cloud and connect with other related systems in a bid to offer clinicians, individuals and researchers a more comprehensive view of patient health.

The tool, based on Microsoft’s Azure cloud platform and a national standard for exchanging health records, will let disparate health systems talk to each other, for example hooking up patient records with pharmacy systems, fitness devices and others more seamlessly.

Health care lags behind some other industries in moving data to internet-based storage, and while health records have mostly gone digital, they are often stored in different databases that can’t share information easily. That makes it hard to create systems that use new artificial intelligence and data analysis techniques to track patient well-being and find new targeted therapies. A better-connected health-care system would provide clinicians with more complete profiles of their patients, researchers with more data to study and individuals with more information to take control of their health, according to Microsoft. It’s also an attempt to help Microsoft attract companies to Azure over market leader Amazon Web Services.

Microsoft will also continue to add new health-care tools to Azure, said Peter Lee, vice president of Microsoft Healthcare, in an interview. “It’s hard to think of data standards for interoperability as a sexy topic,” he said, but it’s critical to a host of new healthcare applications.

The software giant has been pushing into health care in fits and starts over the past several years. Recently it has been working on cloud and artificial-intelligence products to help reduce data-entry tasks for doctors, triage patients and provide more-targeted cancer care. Last month, Microsoft announced an Azure deal with Walgreens Boots Alliance Inc. The drugstore company said it will use Azure for services that connect patients’ health-care data with clinicians and pharmacists, among other things.

To be successful in health care, Microsoft must train its software and artificial intelligence tools to be familiar with medical needs and terminology and must comply with a complex set of privacy requirements around healthcare data. Microsoft will announce the new Azure service next week at the HIMSS healthcare conference in Orlando, Florida. One example the company will show is using the service to create an app for scheduling hospital nurses. Microsoft also plans to announce about three dozen organizations that are already trying the new tool, Lee said.

In other health-care initiatives, Microsoft is making its health-care bot more widely available. The tool helps health-care organizations build their own chatbots and virtual assistants. After being introduced in 2017 as a research project, the service is already in use by customers like Premera Blue Cross for helping customers get general information on insurance claims and benefits. Children’s Healthcare of Atlanta developed an app for patients to ask questions about medication or details of their schedule. About 350 new organizations have began building their own bots since an initial preview a few months ago, Lee said

Microsoft also has a pilot project to use the health bot in the future to help patients find clinical trials for new drugs and therapies, Lee said. The idea is to combine work Microsoft is already doing on using artificial intelligence to scan complex medical documents related to clinical trial information with a bot interface. A patient could, for example, search for breast cancer trials and answer some questions from the bot that would then recommend trials that might be appropriate. Right now trial documents can be hard to comb though and understand, Lee said.

The health bot can also be used to help customers stick with prescriptions and ask them questions via text if they don’t fill their prescriptions to detect problems. Sometimes patients forget what a particular drug is if they’ve removed it from the container – Microsoft’s computer vision software could let patients scan the pills and identify them, Lee said.

The Redmond, Washington-based company is also working on getting health-care teams on to its Microsoft Teams chat software — which competes with Slack Technologies Inc. – in order to better coordinate care, particularly when there are as many as 20 people caring for a single patient and most rely on mobile phones as they walk around hospitals. New capabilities will allow electronic health records that comply with the Fast Healthcare Interoperability Resources standard to be integrated with Teams, so that hospital staff can access patient records in the same app where they take notes, message with other team members and manage care. Microsoft would also like to enable health-care teams to add parents of hospitalized patients to these chat groups, in order to keep them up to speed on their child’s care, Lee said.

By gulfsouthb32553561, Feb 1 2019 07:58PM

Two Republican lawmakers are calling for further investigation after a Louisiana Medicaid audit showed that extremely high numbers of recipients may make too much money to qualify for the program.


Sen. Ron Johnson (R-Wis.) and Rep. Jim Jordan (R-Ohio) sent a letter to Seema Verma, administrator for the Centers for Medicaid and Medicare Services alerting her of the findings and asking for answers about what CMS plans to do about it.


"If these improper (over) payments are occurring in one state, it is logical to assume overpayments are occurring in other states," the two wrote in their letter. "We respectfully request information about what the Centers for Medicare and Medicaid Services (CMS) plans to do to determine where overpayments are being made, steps CMS will take to recover overpayments, and controls CMS will put in place to ensure federal Medicaid dollars are only paid to those who qualify."


What did the audit reveal?

According to the congressmen's letter, Louisiana auditors first identified nearly 20,000 Medicaid recipients whose income was higher than the amount to qualify for Medicaid.



So, the auditors took a selection of 100 single-person households receiving Medicaid under expansion created by Obamacare. of those 100 households, 93 of them were ineligible for benefits between 2016 and 2018, and 14 of them were making more than $100,000 per year.


Next, auditors took a random sample of 100 more Medicaid expansion recipients, and 82 of those were ineligible sometime between 2016 and 2018.


According to the auditors, the state may have paid as much as $85 million for ineligible Medicaid recipients from 2016 through 2018.


How does that happen?

The auditors reported that Medicaid expansion recipients may be "lowballing their income" and then failing to provide updated information when they start making more money.


Louisiana apparently "relies on Medicaid recipients to self-report their wages," and there are questions about whether that policy violates laws that require states to ensure Medicaid beneficiaries provide up-to-date information.

By gulfsouthb32553561, Dec 21 2018 03:01PM

As this year comes to a close, we all tend to find ourselves striving to finish one last task (but if you are like me the one last thing turns into one more and then one more - and it never ends).

However, I am working on implementing a new system. Each day I email my business coach three things. I tell her what I am grateful for that day, what I accomplished, and what my top priorities are for the following day. This keeps me balanced and focused. I have to stop and reflect each day, instead of running through my day like a tornado, rushing home, cooking dinner, helping with homework, washing clothes, then falling into bed exhausted without a clue what I have actually accomplished that day, and wondering what was left undone for the next day.

This sounds simple - almost too simple to do. But I challenge you to make it a habit. Find someone to be accountable to, and send that email every day. It helps me in many ways, some I had not even expected. One afternoon as I was about to get on the internet and look something up (not work related I am sure), I thought to myself, “Oh no - I need to see if I have done everything I told Amy I would do today!”. I quickly went through my sent emails to see what I had committed myself to for the day, and realized I had not finished two of my top priorities. So I got right to work!

This tool is a godsend for those of us who may have a little bit of ADD somewhere inside. I can start a task, and easily wander from it to something urgent that pops up, but that may not truly be important. We often hear about judging between what is urgent and important. This tool helps decipher which task is moving us toward our desired end, and which is merely compelling us to immediate action, without real productivity. When I am setting priorities the night before I am not rushed or being pulled in multiple directions. I am simply looking at what is most important for me to accomplish the next day, and I move that direction.

I am certainly not where I need to be, but I am learning to look back at my day in reality. Sometimes we spend a whole day “feeling busy”, but we have not really done anything. So, I am learning to be grateful, count my wins, and prioritize for the next day.

Need direction prioritizing your financial future? Give us a call today at Gulf South Benefits 337-656-3255

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