By JULIE APPLEBY

Fed up with the unpredictable cost of health insurance for his small business, Mike Sarafolean last year made a dramatic change: Instead of picking a plan to offer workers, he now sends them to a “private exchange” or marketplace where they compare and choose their own insurance. And the amount his company pays toward coverage is capped.

Mike Sarafolean, CEO of Orion Corporation of Minnesota, last year joined a growing number of employers embracing a dramatic change in the way they offer health benefits (Photo by Andy King).

The move puts his St. Paul, Minn.-based company on the leading edge of a nascent trend that could shape how more employers offer and pay for their health benefits in the coming years. It is part of an ongoing evolution in job-based health benefits that is gradually shifting cost and responsibility to workers.

The private exchanges, mainly run by former insurance executives and employee benefit consulting firms, operate in more than 20 states.

While representing only a tiny fraction of workplaces, the movement may be about to grow: One of the nation’s largest employer-benefits consulting firms â€" Aon Hewitt â€" said Wednesday it will launch of an exchange aimed at large companies. It hopes to have at least 100,000 workers enrolled by early next year.

Proponents say the effort shields employers from unpredictable premium hikes because they will choose how much to increase their contribution each year and those amounts may be less than premiums actually increase. If that happens, workers would make up the difference.

Tempering such increases, proponents say, would be competition among insurers because workers would have a wider choice of plans, rather than just the one or two currently offered by many employers.

“We’re trying to create a retail marketplace that is competitive,” says Ken Sperling, who is overseeing the Aon Hewitt effort. Employees would get be able to choose among several carriers. “Insurers would have to compete for their business.”

The exchanges, which have some similarities to state-based programs mandated by the federal health overhaul law, also save employers money partly because workers, when given a variety of choices, are likely to choose less generous benefit plans, which will carry lower premiums, say proponents.

“Most companies are over-insuring their employees right now. We want to right-size that,” says Curtiss Butler, chief marketing officer at Liazon, which also operates a private exchange.

Others, including Carmen Balber of the advocacy group Consumer Watchdog, caution that private exchanges potentially could be used by insurers to “cherry pick” employers with younger and healthier workforces. Balber also said private exchanges potentially could steer workers toward policies that have low premiums, but also high annual deductibles and other charges. Such policies are more profitable for insurers, but can leave unprepared consumers on the hook for thousands in medical costs each year.

Private exchanges “absolve the employer from having any responsibility for providing benefits or getting a good deal for consumers,” says Balber.

Frustrated By Double-Digit Premium Hikes

Sarafolean, CEO of Orion Corp. of Minnesota, which provides services for people with disabilities, doesn’t see it that way.

Before he made the switch, Sarafolean said he had a limited number of insurance choices to offer his 70 workers: “I had to buy a plan that would make sense and fit for most people. Now they make choices that fit for them.”

For the past few years, his company faced “double-digit premium increases every renewal.” To slow those increases, Sarafolean said he had switched to a policy with large annual deductibles: payments of $4,500 by individuals or $9,000 by families before insurance began paying most medical costs. His employees also paid about $90 a month toward their premium.

A little more than a year ago, Orion received a 40 percent renewal increase, prompting him to move to Minneapolis-based Bloom Health, which set up private exchanges in Michigan, Minneapolis and Indiana.

Now, his company makes contributions ranging $125 a month for younger workers to $350 for older ones to special health reimbursement accounts, which workers then use to buy an insurance policy.

By making the change to a flat contribution and a private exchange, the company is saving 10 percent over its previous year’s cost of insurance, he says. Many of his workers also spend less, he says.

Gabrielle Smith, an employee of Orion Corporation of Minnesota, changed her benefit plan with the small company (Photo by Andy King).

He’s not sure what he will choose in 2014, when the state-based insurance exchanges are set to open as part of the health care law approved by Congress last year. Initially, those exchanges are aimed at individuals and small companies that are shopping for insurance. States can decide later in the decade whether to open them to large businesses.

Sperling, who is overseeing Aon Hewitt’s private exchange, compares the flat-payment change to one that gained speed in the early 1990s: Employers abandoning pensions in favor of offering workers 401(k) plans for retirement savings.

But just as 401(k) plans transferred the risk of market downturns to workers, the flat-payment model would shift risk to workers if rapidly rising health costs outpace increases in employer contributions.

“From a consumer point of view, it makes me nervous because as premiums go up, it’s simply a mechanism to cost-shift,” says Sabrina Corlette, research professor at the Health Policy Institute at Georgetown University in Washington D.C. “That said, if it allows a small employer to continue to offer insurance … it’s not a terrible compromise.”

The model has been compared to House Budget Committee Chairman Paul Ryan’s proposal to cap government payments for future Medicare enrollees, giving them a set amount to buy coverage from private insurers. Under Ryan’s plan, the government contribution would grow with general inflation, which is less than medical inflation, saving taxpayer dollars, but substantially increasing beneficiaries’ costs, according to the Congressional Budget Office.

Sperling says he expects most employers will annually set increases in their health insurance contributions to an amount approximating wage increases â€" about 2 to 3 percent annually â€" which are generally well below medical inflation. But he says the competition created by the exchanges will help slow medical premium growth.

Rejection For Health Conditions

Unlike most of the private exchanges, the Bloom Health model, which serves about 25,000 people, sends workers to buy their own policies on the so-called individual market, rather than through a group health policy.

However, insurers selling individual policies in most states can reject applicants with medical problems, a practice that will end in 2014 under rules in the health care law.

Bloom CEO Abir Sen says his company offers its services only in states where rejected applicants can qualify for special state-run, high-risk insurance programs, which generally cost at least 25 percent more.

Gabrielle Smith, a 16-year employee of Orion who has an auto-immune disease, worried that under Bloom she would be unable to get insurance “or it would be so in excess of what I could afford.”

Smith, 48, did get coverage â€" through Minnesota’s high-risk pool â€" and found that she still was able to lower her deductible by $1,500 a year compared with the former $4,500 deductible plan offered at Orion. She now pays $45 a month for her premium.

“I haven’t heard anyone who is unhappy with the current insurance because it was all individualized,” says Smith. “Some of the younger employees with no medical conditions (found low-cost plans that) don’t require any money out of their paychecks.”

Other private exchanges, including Buffalo-N.Y.-based Liazon, which serves about 25,000 employees in 23 states, and the new Aon Hewitt model send workers to group policies, which cannot reject applicants with health problems. The exchanges vary in other ways, too: While Bloom and Aon Hewitt offer a variety of insurers, for example, Liazon contracts primarily with one main health insurer in each region.

Aon Hewitt’s model would offer only five different types of policies, ranging from high-deductible “bronze” and “silver” level plans to a high-end “platinum” plan with a broad network of doctors and hospitals and minimal consumer spending on deductibles or co-payments.

All the exchanges plan to collect revenue by charging employers a monthly fee, receiving commissions from insurers, or both.

It’s unclear how the advent of state-based exchanges will affect programs such as Bloom, Liazon and Aon Hewitt, or whether there will still be a demand for their services by small businesses.

“As of 2014, why will the private exchanges be needed?” asks Paul Fronstin of the Employee Benefit Research Institute, a nonprofit research group based in Washington.

On their websites, the private exchanges say what sets them apart from future state exchanges will be their level of customer service. By opening now, private exchanges also could be in a position to bid for contracts to run state exchanges, a move Sperling says Aon Hewitt would consider.

But Balber at Consumer Watchdog counters that the state exchanges may be better for consumers than private ones because states can choose to actively monitor the quality and cost of the insurers allowed to participate. In theory, private exchanges could do the same, but Balber is skeptical.

“To presume a private exchange is going to examine trends in premium increases and pressure insurers to lower prices is unlikely,” she says.

Benefit experts say there is growing interest in the move to a flat payment model, dubbed “defined contribution.” A March survey of very large employers by the HR Policy Association found that 36 percent are considering capping contributions for workers’ insurance over the next 10 years.

Some firms already set a cap on contributions for retirees, Fronstin says. But he predicts that most employers will take a wait-and-see approach before changing their health coverage for current employees.

Aon Hewitt’s Sperling says as the health system overhaul takes effect, most employers will continue to offer coverage to workers: “They’re either going to stay in the game and be more requiring of their employees (around healthy behavior) or will look for a realistic exit strategy, which could be a corporate exchange.”

This story first appeared on Kaiser Health News in collaboration with USA Today.

July Appleby is a staff writer for Kaiser Health News.

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Filed Under: THCB

Tagged: Employers, Julie Appleby, Private exchanges Apr 29, 2011

Sometimes an older and cheaper drug beats the shiny, newer competition by being just as effective for a fraction of the cost. But it takes a lot of time and money to prove it.

A government-sponsored study released yesterday compared Lucentis, a drug approved to treat a common form of blindness in the elderly called macular degeneration, to Avastin, a cancer drug eye doctors have been using to treat the eye disease for years.

National Eye Institute

Wet form macular degeneration occurs when abnormal blood vessels behind the retina start to grow under the macula.

It found that patients who got Avastin could read an average of 8 more letters on an eye chart after a year - while Lucentis patients were able to read 8.5 more letters after a year of treatment.

 

"Health care providers and payers worldwide will now have to justify the cost of using ranibizumab [Lucentis,]" said an editorial accompanying the study in the New England Journal of Medicine.

As we reported before, getting the trial going took years and was pretty complicated, since drug companies are loathe to pay for these kinds of head-to-head studies. It highlights the challenges the government faces in doing comparative effectiveness research.

But since Avastin costs about $50 a pop, while Lucentis costs $2,000, results like this suggest Medicare could save a bundle if people choose the cheaper option.

About 1.75 million people in the U.S. have macular degeneration, but before you get too excited, the drug is used to treat those with the wet form of the disease â€" only about 15 percent of that population.

Genentech, which makes both drugs, told the New York Times on Thursday that it still believes that Lucentis is safer and better. It's better at drying the fluid in the eye that is believed to cause the vision loss, and the trial showed it was associated with slightly fewer serious complications.

However, the authors of the study said there weren't enough patients in the trial to draw conclusions about safety.

By DAVIS LIU, MD

The New York Times recently published an article titled the Family Can’t Give Away Solo Practice wistfully noting that doctors like Dr. Ronald Sroka and “doctors like him are increasingly being replaced by teams of rotating doctors and nurses who do not know their patients nearly as well. A centuries-old intimacy between doctor and patient is being lost, and patients who visit the doctor are often kept guessing about who will appear in the white coat…larger practices tend to be less intimate”

As a practicing family doctor of Gen X, I applaud Dr. Sroka for his many years of dedication and service.  How he can keep 4000 patients completely clear and straight in a paper-based medical system is frankly amazing.  Of course, there was a price.  His life was focused solely around medicine which was the norm of his generation.  Just because the current cohort of doctors wish to define themselves as more than their medical degree does not mean the care they provide is necessarily less personal or intimate or that the larger practices they join need to be as well.

The New York Times article and many patients typically confuse high quality care with bedside manner.  Not surprising.  In the November 2005 survey by the Employee Benefits Research Institute, 85 percent or more of the public felt that the following characteristics were important in judging the quality of care received:

The skill, experience, and training of your doctors
Your provider’s communication skills and willingness to listen and explain thoroughly
The degree of control you have in decisions made regarding your health care
The timeliness of getting care and treatments
The ease of getting care and treatments

The first three items relate to the ability of a doctor to translate knowledge, training, and expertise into the ability to listen, communicate, and partner with a patient.  This is bedside manner.  The last two items relate to whether a patient can be seen quickly and easily when care is needed.

But beyond bedside manner and ease of getting care, both which are very important, does the public care about getting the right care or just assume that it is a given?  My suspicion is that they assume all medical care provided by doctors is the same, yet research demonstrates the contrary.  One study found that 75 percent of primary care doctors provided the wrong type of colon cancer screening. Those most likely to do the wrong test after a positive stool screening test?  Those who graduated from medical school before 1978, who were not board-certified, and who were in solo practice.

Personal relationships between doctors and patients are important, but that should not be the only criteria regarding high quality care.

I love primary care.  I’ve worked at Kaiser Permanente (KP) in Northern California since 2000, a “larger practice”.  The number of patients a full-time doctor cares for is about half of the 4000 patients of Dr. Sroka’s.  Doctors have access to a comprehensive electronic medical record that provides real-time information about a patient’s lab work, imaging studies, and medications 24/7.  Primary care doctors and specialists can collaborate working off a common database and eliminating the uncertainty that exists in a paper based medical system and when doctors work in isolated solo practices.  Our primary care doctors are supported with a call center which is open all year round day and night to provide patients advice on symptoms and advice on when problems can be safely cared at home, when a doctor’s appointment is needed, or when medical care is more emergent.

In other words, doctors can be doctors.

Let’s not assume or confuse the rising trend of large group practices or the implementation of more electronic medical records and technology in doctors’ offices as automatically dooming doctor-patient relationships to becoming more impersonal.  The rise of social media like Twitter and Facebook have increasingly made society more connected than ever.

If Americans and doctors want solo practices, then they will demand them.  Certainly there are successful solo practice models like the Ideal Medical Practice, which also supported by information technology, that can provide patients with a doctor who is a sole proprietor.  To say all primary care doctors should join large group practices should be absurd because doctors like patients are individuals and one type of practice does not fit all.

Yet, the fundamental problem with this New York Times piece is the implication that solo practices provide doctor-patient relationships that are more intimate and where patients have a level of trust and confidence in doctors that perhaps exceeds that of thoughtfully designed larger practices.  It offers no evidence if the quality of care delivered is as good.  Let’s not use a practice model which was prevalent in the 1960s and assume its passing is a bad thing.  It may not be up to the challenges of the 21st century.

Davis Liu, MD, is a practicing board-certified family physician and author of the book, “Stay Healthy, Live Longer, Spend Wisely â€" Making Intelligent Choices in America’s Healthcare System.” Follow him at his blog, Saving Money and Surviving the Healthcare Crisis or on Twitter, davisliumd.

Filed Under: THCB

Tagged: Davis Liu, Family doctors, Physicians, primary care Apr 26, 2011

Ringworm is a clinical condition due to infection by fungus in the skin. The same fungus can infect pets such as cats, sheep, cattle etc. too. Ringworm is known as dermatophytosis in medical term. Although it is called ringworm, it is not caused by any worm or parasite, but by fungi of different species. It is called ringworm, because the skin lesion the fungal infection produce is commonly of ring shape, but not always.

It is estimated that, presently as many as 20% of world population may be infected by different species of dermatophytes (the causative agent of ringworm), making it probably the commonest disease, although not many have symptoms serious enough to seek medical attention. Some individuals are prone to ringworm infection, such as wrestlers and athletes. Wrestlers may even be disqualified if found to have ringworm (may be for the fear that he may cause ringworm infection to other wrestlers during wrestling).

The dermatophytes, which cause ringworm, feed on the keratin layer of the skin. Keratin is the protenaceous material found in the outermost layer of skin (epidermis, which is usually a layer of dead skin cells), as well as in the hairs and nails (finger nails and toe nails). The dermatophytes survive and thrive on the skin, especially if skin is moist and warm. Dermatophytes also thrive well in the hair (may be outside of the shaft or inside the hair shaft).

What are the different types of ringworms?

There are several types of ringworms seen in humans, depending on the location mainly.

• Tinea pedis, also commonly known as athlete’s foot, occurs in the feet.
• Tinea capitis occurs in scalp.
• Tinea cruris, also known as “jock itch” occurs in groin.
• Tinea unguium occurs in fingernails and toenails.
• Tinea corporis occurs in upper limbs, lower limbs and body/trunk.
• Tinea manuum occurs in palms.
• Tinea faciei occurs in face.
• Tinea barbae occurs in facial hair, which should be differentiated from “sycosis barbae” which is a bacterial infection commonly due to injury to facial skin while shaving.

There are also other clinically similar conditions, but not true ringworm as they are not caused by dermatophytes, such as Tinea versicolor (caused by Malassezia furfur) and Tinea nigra.

Treatment of ringworm:

There are several highly effective antifungal antibiotics (topical as well as systemic) available for treatment of ringworm.

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Diagnosis & Home Remedy of Nail Fungus Infection

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Enlarge Stan Rohrer/iStockphoto.com

Faith-based groups that share health-care expenses struggle with the question of how much of the burden to share.

Stan Rohrer/iStockphoto.com

Faith-based groups that share health-care expenses struggle with the question of how much of the burden to share.

The Bible says that Christians should share each other's burdens, and for some, that means sharing the burden of medical bills. They join together in health care sharing ministries, usually paying monthly "shares" of a few hundred dollars or more to cover other members' health care expenses. They then get their own expenses covered in turn. The ministries divvy up the money to cover that month's "needs," as they're called.

Under the health care overhaul, health care sharing ministries can continue to operate, and their members won't be subject to the penalty that will be levied on individuals starting in 2014 if they don't have health insurance.

Even though the ministries aren't providing health insurance, they wrestle with some of the same issues that insurers do: What to do about would-be members who have possibly pricey pre-existing medical conditions? Just how far should burden-sharing go?

 

The answer: It depends. Medical sharing ministries â€" which have about 120,000 members nationwide â€" each have rules that limit coverage of new members' pre-existing conditions to some extent. Christian Healthcare Ministries, for example, will cover up to $15,000 in needs for a pre-existing medical condition during the first year after a new member joins, says the Rev. Howard Russell, the ministry's executive director.

At Samaritan Ministries, the policy is more restrictive: It doesn't share expenses for medical conditions that a member has upon joining, says James Lansberry, executive vice president at Samaritan. (Once a member goes for 12 months without being treated for a particular condition, however, the ministry no longer considers it pre-existing and will share those expenses.)

Although the health law requires insurers to cover everyone without regard to pre-existing medical conditions starting in 2014, those provisions don't apply to health care sharing ministries, says Kansas Insurance Commissioner Sandy Praeger, who is also chair of the health insurance and managed care committee of the National Association of Insurance Commissioners. "As long as they are not regulated as insurance entities, those new rules will not apply," she says.

Noting that nearly half of the ministry's 56,000 members have incomes of 200 percent or less of the federal poverty level ($44,700 for a family of four in 2011), Lansberry says, "If we shared all needs whenever they occurred, our shares would be too high."

In addition to affordability concerns, there's another reason to restrict coverage of pre-existing conditions for new members, Lansberry says: "Human nature being what it is, people will wait to join until they're sick."

By LISA W. DREW

My ZIP code is a black hole for individual health insurance.

That’s what I recently discovered when I tried to find the coverage I want at an affordable price. What hubris I had.

My story started in 2009, when my position as a journalism professor at a small college was eliminated, and I lost my health benefits along with the job. In the ensuing months, as the clock ticked on my COBRA extension, I began to focus on finding a new health plan. I thought it would be a matter of dealing with mild sticker shock and doing comparative shopping. I was wrong.

As an experienced writer and researcher, I am used to making calls, asking questions and digging through hard-to-understand details. But it never occurred to me that the answers I uncovered about Tompkins County, N.Y. â€" a paradise of farmland, lakes and waterfalls close to the cultural attractions of Ithaca, home for me and Cornell University â€" would be so frustrating. It turns out it’s one of the state’s worst places to find good individual health coverage.

When I tell people about my dilemma, they get curious â€" even participatory. “Did you try a professional group?” they ask. “Did you try an online broker?” (Yes and yes.) Maybe they get caught up in my story because, unlike many people with tales of insurance woes, I’m in my fifties and healthy. My story doesn’t involve a medical condition that’s unsolvable or hard to talk about. Or maybe it’s just that my experience lights a path, however convoluted, through the insurance gobbledygook.

I started my quest with Aetna, my COBRA insurer. Under New York state law, I thought I had “conversion rights” â€" meaning I could convert my former employer’s group coverage, the basis for my COBRA plan, to individual coverage. Though the full monthly cost was already $565, and I worried I wouldn’t be able to afford any increases that kicked in when it became an individual plan, it was great insurance â€" providing excellent benefits and the ability to choose my own doctors. But it turned out my cost concerns were not even relevant. There is a caveat in the law: self-insured employers are subject to federal, not state, regulation. And because my former employer is self insured â€" meaning Aetna administers the plan but the college assumes all the financial risk â€" the conversion option did not exist.

After this idea evaporated, I explored possibilities on the website of The Freelancers Union, a professional association that offers its own health insurance in New York. Five plan choices popped up. Great, I thought. Then I clicked further to read about the plans’ residency requirements and up came a map. The right side of the state â€" covering 34 counties that share borders with New Jersey, Pennsylvania, Connecticut, Massachusetts, Vermont and Canada â€" was colored in blue. These counties are the lucky ones. Those on the left â€" 28 counties that border more of Pennsylvania and Canada, extending all the way to Lake Erie and Lake Ontario â€" were white, meaning no Freelancers Union health insurance. That’s where Tompkins County is.

This development was crushing. Somewhere along the way, the notion had lodged in my head that if I ever turned to freelance writing as my full-time job, I could get benefits through this type of organization. But â€" at least as far as I could tell â€" there are no such groups with health plans in my area.

I felt stupid. I also was getting curious, which happens whenever I feel stupid. The reporter in me wanted to know what the heck was going on. But the consumer in me needed a health plan. So I kept looking.

I tried other websites, starting with AARP. The site directs consumers to an AARP-branded Aetna plan. I entered my ZIP code and got the same response: the plan was “not available in your area.” Next, at a top-rated insurance broker site, my ZIP code brought up one result. The $561-a-month GHI policy covered annual physical and gynecologic exams, prescription drugs with a co-pay, hospitalization and outpatient surgery. But it did not cover, among other things, any other office visits; inpatient physical therapy; ER professional charges; diagnostic admissions; and diagnostic lab tests. To me, that seems like too much money to spend for what amounts to catastrophic coverage.

Curiosity was getting the better of me, so I did some random comparisons on the same website. Zip codes in the District of Columbia; Seattle; Fairbanks, Alaska; and New York City offered 80, 45, 56 and 16 insurance choices, respectively. I also tried random rural areas. Residents of Aladdin, Wyo., had 27 plan choices, starting at $380 a month. Residents of Amelia, Neb., had 87, starting at $133.05.

In search of clarity, I visited the New York state insurance website and discovered a whole new possibility: Healthy NY, a subsidized program for low-income people. Several different insurers offer the same basic menu of coverage through different regional HMOs, which charge different rates.

At first I ruled it out because I wouldn’t be able to choose my own doctors, which has always been very important to me. But I was starting to feel desperate. And I qualified for the plan because it just so happens that in January, I made less than $2,269. I never imagined I would be glad to have a dry spell with my freelancing.

I was not surprised to discover that, although New Yorkers in many other parts of the state can choose a Healthy NY insurer from several options, I only had one: Excellus BlueCross BlueShield. I was just glad to learn that I could get insurance. A phone call led to an additional choice, through the same insurer, that would let me see my own doctors. But it would have cost around $1,400 a month, which is the same as my mortgage. There was also a plan for sole proprietors, but I didn’t qualify.

At this point I went into full reporter mode. I called Troy Oechsner, New York state deputy superintendent for health, and asked him about my scarcity of coverage options and the high costs associated with them. He told me that some other rural areas in the state are in a similar fix, and he said, “For an insurer to get into the area of Tompkins County, where Excellus has such a large hold on the commercial market, is really difficult.”

Ah. That rings a bell. I remembered reading a very similar conclusion in a 2009 United Hospital Fund report: “Entering Central New York is entering the Excellus zone” â€" a 15-county region where “the region’s nonprofit BCBS plans vigorously defend their turf.” Who do they defend it against? Mostly for-profit insurers, which have a much stronger foothold in downstate areas, including greater New York City. Nonprofits have historically claimed upstate markets (which include Central New York). In my region, Excellus in particular dominates, with a strong record of well-established health-provider relationships.

Not only am I in the Excellus zone, said Oechsner, but I’ve stumbled into “the plight of the individual market in New York.” It’s a decades-long saga in which the state “traded the problem of a group of people who can’t get insurance at any price for another problem, which is that our individual rates are out-of-control expensive,” he said. In other words, the state gave up some of its power to regulate rate increases in exchange for guarantees of access to quality coverage for everyone â€" although as recently enacted legislation is phased in, the state is regaining more control over the increases.

I still didn’t get why the Freelancers Union insurance isn’t available to me. So I called Chief Operating Officer Ann Boger, who explained that the group’s plan in New York is linked to the service area of Empire BlueCross BlueShield. I knew from my other research that Empire can’t operate in Excellus territory without giving up the BlueCross BlueShield brand. Boger also said that offering insurance in rural areas is a challenge. “The nature of insurance is that it works best organized around large numbers,” she added.

What about those rural areas I randomly sampled on the broker website? My answer came from Peter Newell, director of the United Hospital Fund’s Health Insurance Project. It’s simple: I didn’t compare the coverage. He talked of plans that have limited benefits, ratings for gender and age that push costs much higher than advertised, and exclusions for people with preexisting conditions. Broker websites, for all their ease of use, don’t instantly compare apples to apples. “If you compare my neighborhood to someone else’s neighborhood, you’ve got to think about those things,” said Newell.

Newell told me the federal health care reform should help me eventually â€" particularly with the establishment of health insurance exchanges that should yield more choices.

But for now, time has run out. I have signed up for the high deductible option in Healthy NY, with a drug benefit, for $296.48 a month. The deductible is $1,200 a year. I’m approaching this choice as a stop-gap measure, although, as I told Oechsner, I now have a strong incentive for limiting my income.

His response: “There’s no way to sugar coat it: You’re right. If you make too much money, individual health insurance in New York gets very expensive.”

I also have one foot out the door as I weigh my professional prospects. If I move, especially if I’m making a living as a freelancer, my first criterion in choosing a location will be something I’ve never before considered: the availability of good health insurance.

This article originally appeared at Kaiser Health News.

Filed Under: THCB

Apr 23, 2011

Hemolytic anemia occurs due to abnormal breakdown of red blood cells, inside the blood vessels (intravascular hemolysis) or outside the blood vessels (extra vascular hemolysis). Usually there are two types of hemolytic anemia, inherited (genetic) and acquired. The treatment of hemolytic anemia is based on the cause of hemolysis and correction (if possible) of the cause.

What are the symptoms of hemolytic anemia?

The symptoms of hemolytic anemia are same as that of the symptoms of iron deficiency anemia with additional symptom of jaundice (yellow discoloration of skin and mucous membranes). Jaundice in hemolytic anemia occurs due to breakdown of red blood cells. When red cells are broken down, it liberates hemoglobin, which is further broken down to form bilirubin, which is responsible for yellowness of skin and mucous membranes and manifest as jaundice. Jaundice can cause long term complications such as formation of gall bladder stones (gall stones) and pulmonary hypertension.

Important features of hemolytic anemia:

• Abnormal and increased destruction of red blood cells and their precursors in some cases.
• Increased breakdown of hemoglobin which is released from broken red blood cells, which cause increase production of bilirubin and jaundice results. Fecal and urinary urobilinogen also increase. Hemoglobinanemia, methaemalbuminaemia, hemoglobinuria and hemosiderinuria occurs if there is increased intravascular hemolysis.
• Bone marrow tries to compensate increase breakdown of red cells and increase production of red cells and there is increase number of red cell precursors such as reticulocytes.
• The balance between compensatory mechanism of bone marrow and red cell destruction decides the severity of hemolytic anemia.

Treatment of hemolytic anemia:

Definitive treatment of hemolytic anemia is based on the cause of the disease. Symptomatic treatment includes blood transfusion (if there is significant anemia). If hemolytic anemia is due to some immune related problem, steroid therapy may be indicated. In some selected cases such as extra vascular hemolysis (or in cases where extra vascular hemolysis is predominant), improve if splenectomy (surgical removal of spleen) is done, as most red cells are removed by spleen.

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Enlarge Maggie Starbard/NPR

On this week's podcast, Nancy Shute follows Sam Thayer as he forages for wild greens near NPR's Washington, D.C. headquarters.

Maggie Starbard/NPR

On this week's podcast, Nancy Shute follows Sam Thayer as he forages for wild greens near NPR's Washington, D.C. headquarters.

It's spring break for the podcast â€" and that means our regular hosts are off somewhere relaxing. This week, Scott Hensley and Adam Cole do their best to fill in, with stories about everything from organ donation to deceptive online ads for Acai berries.

We'll hear about efforts to develop a new, all-natural bug repellant based on compounds found in grapefruit, and we'll follow Nancy Shute as she learns how to forage for wild greens in the city.

We'll listen as Michele Norris speaks with Jon Hamilton about new guidelines for diagnosing Alzheimer's patients earlier and more accurately. And we'll learn why human beings aren't nocturnal, no matter how hard we try.

You can find the podcast at the bottom of the page under the podcast heading. To subscribe to the Your Health podcast, click here.

By JOHN M. GROHOL

While doing some research the other day on personal health records (PHRs), I came across this article, describing Revolution Health’s announcement â€" without much media attention â€" about dropping its PHR at the beginning of 2010. (Disclosure: I worked for Revolution Health in 2005-2006, and now have a business relationship with the company that acquired them, Everyday Health.)

The most interesting statement I found in this brief news article was, “The e-mail did not indicate why the company decided to terminate its PHR service. The company advised users to download their PHR as a .pdf file and save the document for their records.”

Ah, a PDF. Yes, that’ll make it extremely easy to get that data into some other PHR (sarcasm alert).

And that led me to understand the underlying problem with all PHRs today, and the problem PHRs have always had â€" nobody trusts the companies who offer them, and few people understand what they are or why they should care.

And that led me to understand the underlying problem with all PHRs today, and the problem PHRs have always had â€" nobody trusts the companies who offer them, and few people understand what they are or why they should care.

I kind of chuckle when I hear a company describe that a part of its business strategy is the personal health record. I first heard of a PHR back in 1999, when I worked for drkoop.com, at that time competing for the #1 spot as the leading consumer health website with WebMD (drkoop.com lost). Drkoop.com’s management had this brilliant idea that everybody would want â€" and pay for â€" a personal health record online. In fact, this was the founding principle of the company that eventually became drkoop.com (as seen in one of their SEC 10k filings from that time):

To say that the idea of a personal health record (or personal medical record, as they called it) has been kicking around the Internet for a long time would be an understatement. (Drkoop.com dropped the idea altogether after a falling out with their PHR development partner, HealthMagic.)

Our company was founded in July 1997 as Personal Medical Records, Inc. During 1997 our primary operating activities related to the development of software for Dr. Koop’s Personal Medical Record System.

But nobody pays much attention to history on the Internet. One of the most frustrating components of consulting for companies today is their inability and unwillingness to listen and to learn from the companies who’ve come before.

Had the folks who were running Revolution Health at the time really dug into the market for personal health records, they would’ve seen exactly what we’ve seen now for well over a decade â€" nobody’s clamoring for them. Nobody is going to their doctor and saying,

“Gee doc, if only I had some way where I could manually enter in all of this data and try and keep it updated on a regular basis, and ensure that the company I choose to enter all this data in with is (a) going to be around 5 years from now and (b) is going to allow me to export it in a way that is actually helpful, I would be so much happier and healthier!”

Of course, let’s assume that I’m wrong. Let’s assume the 2011 IDC Health Insights’ survey of 1,200 consumers done earlier this year showing only 7 percent of respondents ever having used a PHR, and less than half still using one â€" which is virtually unchanged from when they conducted the same survey 5 years ago. Let’s say consumers are chomping at the bit for this kind of personal tracking ability.

What will they find?

Poor quality systems that haven’t undergone real-world testing with real-world data. As we discussed back in April 2009, PHRs simply don’t work as intended with real-world data. If one of the largest companies in the technology world with some of the brightest engineering talent on Earth can’t get this right â€" Google Health, in this case â€" what hope do we have?

Well, it seems, not a whole lot.

A March 30 article over at eWeek describes how Google is unlikely to move forward with Google Health. Instead, it’s likely to be relegated to the backburner, along with all of its other failed experiments. Of course, Google won’t comment on this, and they never will. Every company trumpets to every media outlet possible when they release a product, but mum’s the word when it comes time to acknowledge the product was unsuccessful and they’re shutting it down (or worse, putting it into a static state with little future development).

This is exactly the lack of transparency and openness consumers are fed up with, and one of the primary reasons patients are leery of trusting their personal health data with a single company. You don’t know whether it’s going to go under, sell your health data (even in aggregate form), or simply decide to quietly stop supporting its service in any meaningful way (without actually shutting it down). You may get your data out, but it may only be as a PDF. Today, there are still no widely-implemented standards for sharing health data records (although that is changing, slowly).

There are some notable exceptions, which I should call out here so that we can end on a positive note. PatientsLikeMe.com â€" which just opened up to everyone for any health condition â€" is quite transparent about what they do with your data. They aggregate it, they sell it, that’s how they make their money. And apparently it’s working, since they’ve been around now for many years.

Electronic medical records, like Microsoft’s HealthVault, are also a different animal, because they have tended to focus on addressing more of the needs of the provider, health care systems and hospitals, rather than just consumers. Paying attention to both sides of the equation â€" how data enters the system and how data gets out â€" is so important, yet something a lot of products in this space underestimate or pay nothing but lip service to.

I think it’s time to finally put the idea of a global personal health record to bed, permanently. We already have lots of individual personal health records floating around out there, tied directly to our personal health interests. And while it would be nice and more convenient to have them all somehow communicate with one another, companies who own all these individual records seem reluctant to explore the possibilities of enabling such communication. There are a lot of reasons â€" some valid, some not â€" for this reluctance.

Perhaps this will change in a more open and transparent future. But I won’t be holding my breath.

Also check out Denise Amrich RN’s article on the Google Health rumor mill, Have rumors of Google Health’s death been greatly exaggerated?

John M. Grohol, Psy.D, is one of the pioneers in online mental health education and support, getting his start on the Internet in 1992 with depression support groups and advocacy efforts. He founded and is the publisher of the Internet’s leading mental health and psychology network, Psych Central.

Filed Under: Tech

Tagged: Google Health, Health Vault, John Grohol, PHRs Apr 18, 2011

Peptic ulcer is ulcer in the stomach and duodenum. Peptic ulcer occurs due to exposure of these parts of gastrointestinal tract (stomach and duodenum) to gastric acid and pepsin. The exact cause of peptic ulcer is not clearly defined, but it is generally due to imbalance between aggressive factors (acid, pepsin, H. pylori etc.) and protective factors (gastric mucous, bicarbonate secretion, prostaglandins, nitric oxide, innate resistance of the mucosal cells of stomach and duodenum etc.) due to bad health state of the individual. There are also many more factors which can cause peptic ulcer such as psychosomatic factors, vascular derangements etc.

The dietary modifications in peptic ulcer for maintaining optimal health state should be as the following:

Energy:

Patients of peptic ulcer may be malnourished and need extra nutrition for increased calorie intake to maintain patients’ health.

Proteins:

The protein content of diet should be adequate for proper (fast) healing of ulcer. The protein content of diet should not be very high, as high protein intake may increase acid secretion, but low protein intake will delay healing of ulcer. Milk protein should be avoided as much as possible, because the high calcium content of milk can stimulate secretion of acid. Eggs and other high protein foods should be used to meet protein requirement.

Fats:

Fat should be used in moderate amounts. Emulsified fats like butter, cream, etc. are better than other fats.

Carbohydrates:

The energy needs during peptic ulcer is mainly met from carbohydrates. But foods containing harsh and irritating fiber should be avoided.

The objective of dietary modification in peptic ulcer:

• To provide adequate nutrition by providing a balanced diet.
• Continuous neutralization of gastric acid.
• To provide desired rest to the digestive tract for proper healing of the digestive tract.
• To reduce acid secretion to a desired level.
• To reduce mechanical, chemical and thermal irritation to the lining of the stomach and prevent further damage.

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What is Peptic Ulcer & Causes of Peptic Ulcer

Symptoms & Diagnosis of Peptic Ulcer

Dietary Advice for Hepatitis

Dietary Advice for Diarrhea

Dietary Advise for Hypertension

Dietary Advice during Pregnancy

Protein Requirement for Us

All about Urea Breath Test

Factors that alter Energy/Nutrients Need

Some Dietary Advises on Constipation

Enlarge AFP/Getty Images

Indonesian officials burned poultry and bird cages, believed to be infected by the H5NI virus, in Jakarta on March 25, 2009.

AFP/Getty Images

Indonesian officials burned poultry and bird cages, believed to be infected by the H5NI virus, in Jakarta on March 25, 2009.

The World Health Organization has brokered a deal resolving a long-running dispute between poorer countries and developed nations over access to emerging flu viruses and vaccines against them.

Under the agreement, finalized Saturday after an all-night final bargaining session, vaccine manufacturers commit to setting aside at least 10 percent of the world's flu vaccine production for developing nations when the next flu pandemic strikes. Poorer countries would either get vaccine free or pay reduced prices for it.

In return, developing nations agree to routinely share samples of mutating flu viruses with the WHO. That's an essential piece of the world's surveillance mechanism for viruses with pandemic potential and is critical to the development of effective vaccines.

The dispute was triggered back in 2007, when Indonesia refused to share samples of the highly lethal H5N1 bird flu virus because, it said, there was no assurance it would get access to vaccine developed as a result.

 

Indonesia's fears were borne out in the pandemic of 2009-2010. That pandemic was caused, as it turned out, by a new swine flu virus rather than H5N1. Mexico, where the pandemic virus first emerged, "had a terrifically difficult time getting access to the pandemic vaccine," Dr. Keiji Fukuda, the WHO's top flu expert, tells Shots. "It was really a problem for them."

That's because rich countries had signed agreements with vaccine manufacturers that tied up virtually the entire planet's flu vaccine output.

It took four years of negotiations to break the deadlock over the no-vaccine/no-virus issue. Recent history was a catalyst. "We went through a pandemic not so long ago, so the issues were no longer theoretical," Fukuda says.

In addition, Fukuda says nations realized that the opportunity to reach an agreement might slip away. That added pressure because without continuous sharing of notoriously mutable flu viruses, the world could be surprised again by a new pandemic strain. And the next one could be far more lethal than the 2009 H1N1 strain.

The agreement, which the World Health Assembly is expected to ratify next month at its annual meeting in Geneva, commits pharmaceutical companies to choosing two of six options.

Manufacturers can donate at least 10 percent of "real-time pandemic vaccine production" to WHO, or they can reserve at least that much "at affordable prices" for WHO to distribute.

They can donate an unspecified number of antiviral treatment courses to WHO or reserve some quantity of antivirals at reduced prices.

Manufacturers can grant licenses to companies in developing countries on "fair and reasonable" terms to make flu vaccines, antiviral drugs, diagnostic tests or adjuvants (immune-boosting vaccine additives).

Or manufacturers can grant royalty-free licenses to counterparts in developing countries to make such products.

The aim of those last two options is to spread flu vaccine manufacturing capacity more broadly. Now it's almost entirely based in developed nations.

Fukuda says manufacturers have also agreed not to file patents on flu viruses they obtain from laboratories working with WHO. He says the agreement "recognizes that if you are sharing something for public health purposes, the labs will treat it as a public health good," not a marketable commodity.

Manufacturers have also committed to funding half the WHO's Global Influenza Surveillance and Response Program, which had a 2010 budget ot $56.5 million.

As with all WHO agreements, the new document is studded with terms such as "should urge" and "may grant." But Fukuda says Indonesia, which forced the whole issue, was "overall quite pleased" with the outcome.

A couple of weeks back Andy Cohen, CEO and Founder of Caring.com stopped by Health 2.0’s offices to give us an update on the site. having established itself as a (Andy would say the) go-to site for caregivers needing to figure out what to do when a loved one needs help, Caring has now branched out to develop assessment tools and communities for caregivers. In this video interview you’ll get to hear and see a a bit about that, and get more information about the company’s plans to be the “Babycenter” for the other end of life

Filed Under: Health 2.0, THCB

Tagged: caring.com, Elderly Apr 15, 2011

There are certain points a person suffering from high blood pressure should remember regarding dietary management of high blood pressure for maintaining good patients’ health of the hypertensive patient. Most important aspect he/she (the hypertensive patient) should know is that the cause of hypertension is generally not clearly known and he/she should avoid factors which may add or aggravate hypertension and increase blood pressure. He/she should understand what hypertension is and learn how to control it through diet and adequate physical exercise.

It is important to understand by the hypertensive person that the treatment of hypertension is lifelong and only lifestyle modification can be of long lasting. Hypertension unlike other diseases is a chronic disease and there is no cure for the disease. The person suffering from hypertension needs to take medication for life. If you have hypertension and if you think you will take medication for hypertension and after the blood pressure comes down to normal, you can stop taking medication, than you are wrong, absolutely wrong. You need to take medication lifelong and good lifestyle modification can reduce the need of medication, but can not supplement the medication.

The following points should be kept in mind:

• Diet of hypertensive person is more or less normal and with proper understanding of hypertension patients’ health can be maintained at desired health state.
• Salt (sodium chloride) is one of the most important causative factors in high blood pressure and should avoid as much as is practicable. Restriction of common salt is one of the most useful non drug management of hypertension.
• Alcohol in moderation (approximately 30-50 ml per day) is beneficial in high blood pressure and heart diseases.
• Regular aerobic exercise to reduce weight is essential part of treatment of high blood pressure. It is possible o reduce blood pressure to some extent only by reducing body weight to normal or slightly below ideal body weight.
• Healthy lifestyle with regular physical exercise, intake of high fiber diet with fresh fruits and vegetables and restriction of fast foods or refined food is essential. Lifestyle modification should be permanent and not for few moths or few years. You should make healthy lifestyle a habit (habit is second nature).

N.B.: There is a saying about habit. If you remove “h”, ‘a bit’ remains. If you remove “a”, ‘bit’ of it still remains. If you remove “b”, still ‘it’ remains. So make healthy lifestyle a habit, and it will remain life long. If you have hypertension only good dietary habits can be helpful, as you need to follow good dietary habits lifelong.

Related posts:

Diet and High Blood Pressure

Dietary Advise for Hypertension

What type of Diet should be taken in Hypertension

Diet Plan for Patient with Hypertension

Diet to be avoided in Hypertension

Nutrition facts about Mediterranean Diet

Obesity: an open discussion

Loading Factors in Osteoarthritis

Solve Obesity Problem by Pills

Some Important Points about Anal Fissure

Enlarge Joe Raedle/Getty Images

A bartender mixes a Red Bull energy drink with vodka in Key West, Fla. A can of Red Bull has more than double the caffeine of a can of coke. "It changes how you experience the drink," a psychologist says.

Joe Raedle/Getty Images

A bartender mixes a Red Bull energy drink with vodka in Key West, Fla. A can of Red Bull has more than double the caffeine of a can of coke. "It changes how you experience the drink," a psychologist says.

The vodka Red Bull, or VRB, has become a favorite cocktail among some young revelers. (One fan even made a video homage, to the tune of Rupert Holmes' 1979 hit "Escape:The Piña Colada Song.") But scientists say that tipplers of caffeine-laden energy drinks mixed with alcohol may have a tougher time knowing when to stop than those who imbibe booze alone.

Researchers at Northern Kentucky University tested students' reaction times while drinking Red Bull with vodka. The students who drank the buzzy cocktail felt more alert and peppy than students who were just quaffing vodka, but were just as bad at controlling their actions as an old-fashioned drunk.

"When you consume alcohol plus an energy drink, you're still as impaired" as someone drinking just alcohol, says Cecile Marczinski, an assistant professor of psychology at Northern Kentucky University. She is lead author of the study, published online in Alcoholism: Clinical and Experimental Research.

 

In the study, the Red Bull and alcohol drinkers said they felt twice as stimulated and alert as those drinking alcohol alone.

"That sets up a risky scenario for the drinker," Marczinski told Shots. "You're not accurately assessing how drunk you are."

Alcohol acts like a stimulant when people first start drinking it; that happy buzz makes alcohol the world's most popular recreational drug. But as people keep drinking, they start getting tired and sleepy. "That's the cue to stop drinking," Marczinski says. But when amped up on caffeine, "the cue to tell you to stop is not there."

While there's been lots of anecdotal evidence that the combo is more dangerous than alcohol alone, there hasn't been a lot of science nailing down the difference in behavior.

Last November, the manufacturers of Four Loko agreed to strip the caffeine out of the potent alcohol drink after the Food and Drug Administration made noises about regulating sales of alcoholic energy drinks. Four Loko is a sweet and fruit-flavored caffeinated beverage with a hefty 12 percent alcohol content; it had been linked to hospitalizations and deaths among young drinkers. At the time, the co-founders of Phusion Projects, makers of Four Loko, said their product was no different than a rum and Coke or an Irish coffee.

But drinking alcohol and an energy drink together is different, the researchers say, because the caffeine content in most energy drinks is higher than that in soft drinks, and the high schoolers and college students who favor and are marketed the combo are more likely to drink a lot. An 8.3 ounce Red Bull has 76 milligrams of caffeine, compared to 35 milligrams in a 12-ounce can of Coke.

"It changes how you experience the drink," Marczinski says.

The bottom line: Drinkers shouldn't trust their judgment, and drinkers who include energy drinks in the mix should be even more skeptical.

Health 2.0 is supporting and I’m attending The Health Data Initiative Forum on June 9, 2011 at the National Institutes of Health in Bethesda, MD, and you should too. The Forum aims to accelerate momentum for the public use of data and innovation to improve health as part of The Health Data Initiative, a collaborative project of the Institute of Medicine and the Department of Health and Human Services.  The Forum will feature more than 45 fast-paced demonstrations of cutting-edge health apps that developed using health data, a series of panel discussion sessions on important health topics, and a data and apps expo.  You’ll be able to interact with developers, as well as investors, venture capitalists, and federal, state and local government officials. A provisional agenda is available online.  Space is limited and the registration is filling up fast!  Take a moment to register today, and let me know if you have any questions….and yes this was written by an IOM PR person not me, but it’s all true!

Filed Under: micro

Apr 13, 2011

Coffee, a caffeine based stimulant is one of the only legal stimulants approved by the FDA. Considering the Pentagon serves up roughly 50,000 cups of coffee per day, it’s no wonder the FDA allows the rest of America to drink it without caution. So what about energy supplements?

Some of the top pre-workout supplements can equate to 2-3 cups of coffee per serving! So the question is, can these be used in place of coffee for that added extra boost? Think expresso, but in fruit flavor that makes your lips pucker! Both are legal, so why not carry around a little pouch of powder rather than a big cup of dark mocha that can stain your clothes? It makes sense.

Coffee is widely used as drink which stimulates nerves and gives you a feeling of freshness. Coffee also has some calories in it depending on the way it is prepared and preferred by the drinkers of the coffee. Generally coffee is prepared with milk and sugar, both of which contain calories, so the more quantity of sugar (which provide approximately 4 Kcal of energy) and milk is used the higher will be value of calorie per cup of coffee. So, coffee can provide you refreshing feeling as well as some calories. But black coffee, as some individuals like it, generally have little (if any) calorie and can not replace the work-out energy supplements.

Pre-workout supplements are made for the purpose of supplying energy requirement of workouts and formulated to provide adequate calories, as well as high protein. A drink with adequate calories and high quality protein is always preferable to refreshing drinks for work outs and I do not see any reason why pre-workout supplements can not replace coffee. In fact I think pre-workout supplements are better than coffee for various advantages mentioned above.

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Energy (Calorie) Requirement for Us

Advantages of Use of Exercise Bikes

Diet Plan for Patient with Hypertension

Know about Advantages of Breast Feeding

Fat, Carbohydrate and Water Requirement

Diet Plan for NIDDM

Know about Unintentional Weight Loss

What is Recommended Daily Allowances?

Factors that alter Energy/Nutrients Need

Enlarge Janice Haney Carr and Jeff Hageman/CDC

Keeping MRSA bacteria like these under control in hospitals remains a challenge.

Janice Haney Carr and Jeff Hageman/CDC

Keeping MRSA bacteria like these under control in hospitals remains a challenge.

Antibiotic-resistant staph infections can be deadly for hospital patients.

One way to curb them is with better hospital hygiene. A new study found that hand-washing, and wearing gowns and gloves, cuts the number of infections with methicilln-resistant Staphylococcus aureus, or MRSA. But another study found that even with all those precautions, the bacteria can still be tough to wipe out.

In 2007, the VA hospital system launched a huge effort to reduce the number of MRSA infections by ordering all 150 of its acute-care hospitals to change how they do business. For starters, patients were screened for MRSA when they were admitted. And about 14 percent of them turned out to carry MRSA in their noses, even though they weren't sick.

 

Hospital employees were told to wear gloves and gowns when treating those carriers, and to be sure to wash hands before and after treating patients. That lowered MRSA infections of patients in intensive care units by 62 percent over three years.

But when a second group of researchers used similar tactics to try to stop the spread of MRSA in 18 academic medical centers, it didn't stop the bacteria from traveling from patient to patient. "We looked at weather the health care workers wore clean gloves and did hand hygiene," says W. Charles Huskins, an infectious disease specialist at the Mayo Clinic and lead author of the second study. "We didn't find a correlation between those behaviors and the outcomes. You would expect units with lower adherence to have worse outcomes, and we didn't."

Huskins tells Shots that workers were less careful about hand-washing and proper use of gloves and gowns when they were just touching objects in a patient's room. So it may be that hospitals will need to come up with better ways to clean hospital rooms to keep the bug at bay. Or, Huskins told Shots, it may take another intervention, like swabbing patients with antimicrobial rinses, to stop MRSA.

Both studies appeared in the latest issue of the New England Journal of Medicine.

The number of MRSA infections has been dropping overall, down 28 percent in 9 cities over four years, according to a study published last year in the Journal of the American Medical Association. So it could be that we're getting better at battling MRSA. But as that second study shows, the bug has hardly called it quits.

PatientsLikeMe goes big, doesn’t stay home

PatientsLikeMe has, since before we first featured them at Health 2.0 in 2007, been the patient online community continually pushing the boundaries for patients with rare diseases. It started with MS, ALS and Parkinson’s and slowly moved towards mental health. And along the way PLM developed some of the most unique reporting tools both for patients and for third party (read: pharma) researchers. However, it always stayed away from the really big disease categories, like diabetes. No longer. As of today anyone can start a community for any condition at PatientsLikeMe. As of right now there are 182 patients with type 2 diabetes. Of course this is minuscule compared to Diabetic Connect or dLife, but given PLM’s reputation and press coverage, the gloves are well off in the patient community contest.

The evolution of THCB

It’s been a couple of months since we moved THCB to Wordpress and added the channels you see at the top. As you may have noticed there have been some teething troubles, and for all its power Wordpress does have some problems. We’re still working on fixing the right hand columns. However, we’re able to do some things that we couldn’t beforeâ€"including this little mini-blog microbrew that allows me (Matthew) to write little pieces that I like without having to write enough for a whole post. Wordpress also does much better on spam trapping;I literally just went through 1,000 spam comments and only 3 were false positives. If youve had problems posting comments try taking OUT any links (that tends to trigger the spam filter).

But overall you can expect more and better from THCB in the coming weeks…and we’ll be keeping you updated.

The Kaisingers link up

A while ago at an IOM meeting I mis-spoke and called Geisinger, “Kaisinger” and it kinda sounded right. Well now those two Epic users with another similar Epic user (Group Health) have teamed up with Mayo (home grown IT) and InterMountain (3M + homegrown + GE) to share patient data.  Now it hasn’t happened yet â€" this is the announcement of what is to come (although KP is inter-operating with the VA in San Diego). But they’re going to use NHIN standards. My understanding is that they’re going to start with moving data using CCD (a subset of the records) and then move to access full patient data via common medical identifiers. Of course while this is great news, the chances of a typical California Kaiser patient showing up in rural Pennsylvania isn’t that high. But if they can do it across the country, why can’t they and others do it across the street? In other words resolve what Jonathan Bush calls the Paper Aeroplane method of interoperability. After all that type of random showing upâ€"even for Kaiser patients in a Sutter run ERâ€"is a big deal. Let’s hope this announcement is a big spur, and allows others to join.

Brief discussion on commonly used hormonal oral contraceptive pills:

Oral contraceptive pills are very widely used by women who want to avoid pregnancy temporarily. The most commonly used and widely known oral contraceptive pills are hormonal contraceptives, containing an estrogen and progesterone. Hormonal oral contraceptive pills are widely used because they are most extensively studied and promoted for contraception. The mechanism of action and potential side effects are well understood by doctors and women taking the hormonal contraceptive pills. Doctors and users know what to expect as side effects. Due to extensive studies, hormonal content of these contraceptive pills has been reduced to bare minimum required for contraception and due to reduction in the hormonal contents, the side effects are very little and usually of mild nature which do not need discontinuation of oral contraceptive pills. As hormonal contraceptives are promoted by Governments and health care professionals, they gained popularity and most widely used.

Apart from commonly used hormonal oral contraceptive pills, there are also some less known contraceptive pills, which are not hormonal and devoid of side effects (whatever mild side effects they may be) of hormonal contraceptive pills. One such non-hormonal oral contraceptive pill is centchroman. The non-proprietary name or generic name of centchroman is ormeloxifene.

Centchroman is a Selective Estrogen Receptor Modulator (SERM) drug and act on estrogen receptors. It is non-hormonal, non steroidal oral contraceptive. As it is non-hormonal, non steroidal oral contraceptive, there are no hormones or steroid related side effects in centchroman, although the combined oral contraceptive pills have very little side effects.

Centchroman is used in India more commonly than any other country (Centchroman was developed in India). In India centchroman is available as Saheli (brand name). It is also available as Centron, Novex-DS, and Sevista etc.

Dosing of centchroman as oral contraceptive:

Centchroman is taken at the dose of 30 mgs twice a week for first three months and 30 mgs once a week thereafter for as long as contraception is desired.

Other uses of centchroman:

Centchroman is also (other than contraception) can be used for dysfunctional uterine bleeding. This medication is also proposed for use in menorrhagia, fibro adenoma etc.

Related posts:

What are the causes of Secondary Amenorrhea?

Treatment of Amenorrhea

NSAIDs in Treatment of Osteoarthritis

Treatment of Nail Fungus Infection

Estrogens & Osteoporosis Treatment

Fungal Infection of Toenails & its Treatment

Enlarge Dave Weaver/Associated Press

A nurse uses an alcohol-based hand gel. A new $1 billion proposal from Health and Human Services aims to cut down on preventable hospital infections and patient readmissions.

Dave Weaver/Associated Press

A nurse uses an alcohol-based hand gel. A new $1 billion proposal from Health and Human Services aims to cut down on preventable hospital infections and patient readmissions.

Finally, something health-related that everyone can agree on.

Well, almost everyone.

Health and Human Services Secretary Kathleen Sebelius on Tuesday pledged "up to $1 billion" for a new "Partnership for Patients." The initiative aims to reduce preventable hospital infections and patient readmissions after they have been discharged.

"Every time a patient gets an infection in the hospital, or is readmitted because they didn't get the right follow-up care, our nation's health care bill goes up," Sebelius said at a news conference at the National Press Club in Washington, D.C.

 

The proposal builds on existing rules for Medicare hospital payments, which impose financial penalties against hospitals for patients who experience preventable complications. Among the types of complications hospitals will be asked to examine are those associated with adverse drug reactions, bed sores, childbirth and surgical site infections.

The billion dollars is to come from the Affordable Care Act, last year's health overhaul. According to HHS, if health care professionals are successful in reaching the goals laid out in the initiative, the initial $1 billion investment could reap as much as $35 billion in savings over the next three years, including $10 billion for Medicare alone.

"As the country's largest payer for care, Medicare has a powerful ability to be a catalyst for change," said Sebelius.

The proposal already has the backing of lengthy list of 'who's who' in health care, including hospital, physician, nursing, insurance, consumer and employer groups. In a statement, Rich Umbdenstock, president of the American Hospital Association, said his group "will be an active partner with HHS in this effort." Karen Ignagni, president and CEO of America's Health Insurance Plans, echoed that enthusiasm, pledging "to work together with the public sector and other stakeholders."

Noticeably absent from the list of people praising the initiative, however, were GOP lawmakers. That's likely because they are still intent on repealing the health overhaul law that will provide the funding.

The announcement comes as a new poll finds most Americans are not very impressed with the quality of the nation's health care system.

The poll, conducted last month for the Robert Wood Johnson Foundation by the Harvard School of Public Health, found only a third of those polled rated the system as deserving an A or a B, while 28 percent said it rated only a D or an F. A plurality, 38 percent, said it deserved a grade of C.

By VINCE KURAITIS

My guess is you’ve probably never asked yourself this question. A quick preview:

Technical barriers aren’t the limiting factors to Facebook becoming a care coordination platform.

Facebook’s company DNA won’t play well in health care.

Could Facebook become the care coordination platform of the future? If not Facebook, then what?

1) Technical barriers aren’t the limiting factors to Facebook as a care coordination platform.

Can you imagine Facebook as a care coordination platform? I don’t think it’s much of a stretch. Facebook already has 650 million people on its network with a myriad of tools that allow for one-to-one or group interactions.

What would it take to make Facebook a viable care coordination platform?

• More servers to handle the volume â€" not a problem
• Specialized applications suited for health care conditions â€" not a problem
• Privacy settings that made people comfortable â€" more on this later
• A mechanism to identify and connect the members of YOUR care team â€" really tough, BUT this is NOT a technological problem, but a health system one

Suppose you are a 55â€"year-old woman who is a brittle diabetic. Your care team might include a family physician, an endocrinologist, a registered dietitian, a diabetic nurse, a ophthalmologist, a podiatrist, a psychologist, and others. Ideally you’d have one care plan that coordinates the care among members of the team, including you.

What’s the reality of today’s health care non-system?

• There is no formal designation of “your team.”
• There is no mechanism to designate one “plan” that coordinates the plays among your team members.
• It’s possible that multiple quarterbacks are calling the plays for your care.
• It’s possible that members of your team have no knowledge THAT you are being treated by others and HOW you are being treated by others.

Care coordination today is in the stone ages â€" there is no system for care coordination.

Supplying a modern Facebook-type technology platform doesn’t change this. The major limiting factors in Facebook’s becoming a care coordination platform aren’t technological.

Let’s look a bit deeper.

2) Facebook’s company DNA won’t play well in health care.

Facebook CEO Mark Zuckerberg’s definition of an open social graph doesn’t fit well with people’s expectations of privacy in health care. Here’s how Zuckerberg described his views:

“You have one identity,” he emphasized three times in a single interview with David Kirkpatrick in his book, ‘The Facebook Effect.’ “The days of you having a different image for your work friends or co-workers and for the other people you know are probably coming to an end pretty quickly.” He adds: “Having two identities for yourself is an example of a lack of integrity.”

IMHO, Zuckerberg’s notion of a single identity isn’t going to fly with people’s private health care information. Sharing everything about yourself might be an idealistic goal for a 26 year old gazillionaire, but when it comes to most medical information, people will want to share information with their care team, not with the world. Zuckerberg doesn’t recognize that the default for medical information for almost everyone is “don’t share,” not “share”.

In contrast, LinkedIn is a platform built for business networking. It assumes that people will want to share different types of information with business colleagues than with their friends. This strikes me as a much more realistic notion of identity, but you can certainly disagree.

Here’s another example of how Facebook’s company DNA would violate trust. Facebook has a reputation for pushing privacy boundaries, and then falling back only if/when people complain (and they must complain loudly).

Since its founding, Facebook has done a 180 degree turn on its business model. The company started with the premise that default for your information was “private” unless you specified otherwise. By May 2010, the default had become “public” unless you specifically modified privacy settings. Why? …because they realized that the valuation of the company was driven by the quantity and quality of data about YOU.

So how would this work in health care? “Oops, we changed privacy settings on you and revealed your HIV status…won’t happen again, sorry.” Disaster!

3) Could Facebook become the care coordination platform of the future? If not Facebook, then what?

Let’s circle back to the original question “Could Facebook be a platform for care coordination?”

My answer is NO!

What are alternatives?

Its pretty much wide open. Here are some possibilities:

• A new specialized company will become a dominant player in care coordination
• The market could fragment â€" companies might specialize based on patient conditions, geographic concentration, other factors.
• Existing healthcare technology companies, e.g. EHR (electronic health record) companies, could extend their care coordination functionality
• Your local ACO or integrated delivery system could position itself as YOUR platform for care coordination
• An existing social platform (e.g., Facebook, LinkedIn) MIGHT turn the corner and add care coordination functionality
• or ??

Hope you’ve enjoyed going through the thought process. Let’s continue the conversation.

Vince Kuraitis JD, MBA, is a health care consultant and primary author of the e-CareManagement blog, where this post first appeared.

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Filed Under: THCB

Tagged: Care coordination platform, Facebook, Vince Kuraitis Apr 11, 2011

Brief discussion on commonly used hormonal oral contraceptive pills:

Oral contraceptive pills are very widely used by women who want to avoid pregnancy temporarily. The most commonly used and widely known oral contraceptive pills are hormonal contraceptives, containing an estrogen and progesterone. Hormonal oral contraceptive pills are widely used because they are most extensively studied and promoted for contraception. The mechanism of action and potential side effects are well understood by doctors and women taking the hormonal contraceptive pills. Doctors and users know what to expect as side effects. Due to extensive studies, hormonal content of these contraceptive pills has been reduced to bare minimum required for contraception and due to reduction in the hormonal contents, the side effects are very little and usually of mild nature which do not need discontinuation of oral contraceptive pills. As hormonal contraceptives are promoted by Governments and health care professionals, they gained popularity and most widely used.

Apart from commonly used hormonal oral contraceptive pills, there are also some less known contraceptive pills, which are not hormonal and devoid of side effects (whatever mild side effects they may be) of hormonal contraceptive pills. One such non-hormonal oral contraceptive pill is centchroman. The non-proprietary name or generic name of centchroman is ormeloxifene.

Centchroman is a Selective Estrogen Receptor Modulator (SERM) drug and act on estrogen receptors. It is non-hormonal, non steroidal oral contraceptive. As it is non-hormonal, non steroidal oral contraceptive, there are no hormones or steroid related side effects in centchroman, although the combined oral contraceptive pills have very little side effects.

Centchroman is used in India more commonly than any other country (Centchroman was developed in India). In India centchroman is available as Saheli (brand name). It is also available as Centron, Novex-DS, and Sevista etc.

Dosing of centchroman as oral contraceptive:

Centchroman is taken at the dose of 30 mgs twice a week for first three months and 30 mgs once a week thereafter for as long as contraception is desired.

Other uses of centchroman:

Centchroman is also (other than contraception) can be used for dysfunctional uterine bleeding. This medication is also proposed for use in menorrhagia, fibro adenoma etc.

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Enlarge Dr. A. Harrison and Dr. P. Feorino/CDC

HIV viral particles as seen under an electron microscope.

Dr. A. Harrison and Dr. P. Feorino/CDC

HIV viral particles as seen under an electron microscope.

If you're infected with HIV, you're no long automatically ruled out for an organ transplant.

But whether you need a new liver, kidney or other body part, the wait can be a long one. Now some doctors from Johns Hopkins say that ending a ban on the use of donor organs from people infected with HIV could help. A lot.

By their estimate, about 500 HIV-positive people in need of replacement livers and kidneys could get them each year if a law dating back to 1984 didn't forbid their use.

 

Back then, AIDS was still shrouded in a lot of mystery. Since then people with HIV have been able to live long lives by keeping the virus in check. As they age, some need organs because of kidney or liver disease.

And HIV-positive transplant recipients of HIV-positive organs have done pretty well elsewhere.

"If this legal ban were lifted, we could potentially provide organ transplants to every single HIV-infected transplant candidate on the waiting list," Dorry L. Segev, a Hopkins transplant surgeon said in a statement. "Instead of discarding the otherwise healthy organs of HIV-infected people when they die, those organs could be available for HIV-positive candidates."

The figures and assumptions were published online by the American Journal of Transplantation.

The paper notes that there are some concerns that HIV-positive organs could be mistakenly implanted into someone free of HIV. But there are already systems in place to minimize the risk. And transplantation of organs from people with hepatitis C is already allowed.

While selection of donors and care of recipients of HIV-infected organs "will require careful clinical judgment," the paper concludes, "a legal ban on the use of these organs seems unwarranted and likely harmful."

By ROGER COLLIER

A year after the passage of health care reform, fewer than half of Americans support it, a similar percentage believe that it has already been found unconstitutional or soon will be, health care costs are continuing to rise far faster than the CPI, and the Republican Party has seized on the issue as a sure election winner.

The Obama administration and congressional Democrats, now thoroughly on the defensive, are clearly surprised at the public and political reaction. But should they be? This postâ€"on the reliance on Massachusetts as a modelâ€"is the first of three that will look at some of the miscalculationsâ€"and sheer bad luckâ€"that have helped to undermine reform. When Governor Mitt Romney signed Massachusetts’ reform bill into law in 2006, it was widely regarded as a bipartisan political triumph, and one that was supported by the public and by most of the state’s insurers and providers. Massachusetts would be the first state to require virtually all legal residents to have coverage (with tax penalties imposed on those not complying), while providing subsidies for lower-income individuals not eligible for government programs, as well as to implement a state-administered brokerage function (the Connector) to allow competitive selection of health plans. By the fall of 2008, as congressional efforts to design national health care reform moved into overdrive with the election of Barack Obama, the Massachusetts legislation was widely regarded as a success. Public reactions were generally positive, the numbers of uninsured had fallen, and there had been no dramatic increase in costs. It was scarcely surprising that the Massachusetts model emerged from the field of competing proposals as the favorite of most Democratic lawmakers.

Unfortunately, the elected officials in Washington DC failed to recognize that Massachusetts was an exceptional state in terms of health care. Even before the state’s reform bill was enacted, the percentage of uninsured was very low. It was also a socially very liberal state, far more likely than most to support reform efforts (in fact, Massachusetts had passed, but then revoked, a slightly different version of health care reform a dozen years earlier). And, of course, the economy was still in its boom period when the new law was passed. Massachusetts had other advantages that would not transfer to national reform. As a small state, with only a small percentage of the population likely to be directly affected by reform, implementation could be much fasterâ€"less than a year for most provisions of the state’s new law.

Similarly, interfaces between programs like Medicaid and the state subsidy program could be handled at the state level, without federal involvement. In fact, even some of Massachusetts’ apparent success proved illusory or at least oversold, presaging criticisms that would later be leveled at national reform. Although Massachusetts does now have the highest rate of insured in the country, the goal of universal coverage has not been achieved, with some five percent of the state’s population still without insurance. The Connector has failed to influence costs for either public or private payers, and government program expenditures are creating an ever bigger hole in the state budget. The Connector also has had only marginal success in attracting non-subsidized enrollees (although a revamped small business offering is finally showing some gains). And, of course, along with the rest of the nation, Massachusetts has continued to suffer from the effects of the prolonged recession.

Massachusetts clearly has some value as a prototype for national reform, but the Accountable Care Act might have been very different if its authors had recognized just how small a percentage of the state’s population had gained coverage (and added to overall expenditures), or realized that the state’s efforts had had no discernable cost control effect.

Roger Collier was formerly CEO of a national health care consulting firm. His experience includes the design and implementation of innovative health care programs for HMOs, health insurers, and state and federal agencies.  He is editor of Health Care REFORM UPDATE.

Filed Under: THCB

Tagged: Affordable Care Act, Healthcare reform, Massachusetts, Roger Collier Apr 10, 2011

You should have health (medical) insurance to be benefited by taking advantage of the insurance cover. Most individuals (including myself) think health/medical insurance is costly, if you have to buy it for your own (and not by your employer). But in the long run for most individuals the purchase of health insurance becomes less expensive than not buying health insurance and remaining uninsured. It is simply not wise to remain uninsured these days, due to escalating/skyrocketing of health care costs. If you do not have health insurance, you pay the bills of your sickness from your pocket and I am yet to find a person who does not get sick or who is not going to suffer from illness, so get health insurance for your own benefit and mental peace.

If you are uninsured (no health insurance cover) you pay bills from your pocket. You may be able to pay easily if you have minor illness such as common cold, diarrhea etc. But imagine you are not insured and you suffer a heart attack and you need to undergo heart by-pass surgery. How many of us can pay from our own pocket if you have to undergo complex heart or brain surgeries. I think not many of us and here is the risk of not having health insurance cover.

Do not think superficially, think deep and you will certainly able to see the advantages of having insured yourself for health problems. Initially you may think medical insurance as expensive affair, but ultimately you end up benefited.

If you do not have health insurance cover and you get sick, there is high chance you may delay seeking medical attention, which may result in worsening of your health condition and your ultimate expense goes up very high. So the idea of getting health insurance cover is to simply avoid all the risks involved with not having health insurance for you and your family.

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Jewek Samad/AFP/Getty Images

So are abortion-related policy add-ons really preventing Democrats and Republicans from reaching a deal on a spending bill to keep the government running past midnight Friday?

It depends who you ask.

Democrats say absolutely. "Mr. President, the Republicans want to shut down our nation's government because they want to make it harder for women to get the health services they need," said Senate Majority Leader Harry Reid, D-Nev.

Reid was referring to a proposal passed by the House to defund the Title X family planning program, which in addition to providing contraceptive services also provides primary health care services to more than 5 million women and men annually.

 

At a news conference off the Senate floor, Democratic women didn't mince words. Said Sen. Barbara Boxer, D-Calif.: "Republican colleagues are more interested in playing to their extremist supporters who care more about hurting women's health care than reducing the deficit."

But Republicans say Democrats aren't being straight. "Almost all of the policy issues have been dealt with," House Speaker John Boehner told reporters shortly after the Senate allegations were made.

And did that include the defunding of Title X, and a separate proposal to defund Planned Parenthood, whose affiliates are the largest single organizational recipient of Title X funds?

"Almost all of the policy riders have been dealt with," Boehner replied. "Our goal is not to shut down the government. Our goal is to cut spending."

House Republican women, who held their own news conference late Friday afternoon, echoed Boehner's line.

"I might submit that folks on the other side are trying to distract all of you," said Cathy McMorris Rodgers, R-Wash. "The bottom line is it's about cuts. It's about spending reductions."

On the other hand, when pressed about whether they would vote for a bill without the restrictions on Title X or Planned Parenthood, the GOP women, like Boehner, demurred.

"We're going to wait and see what comes back," said Marsha Blackburn, R-Tenn.

The family planning amendments, however, aren't the only provisions in the spending bill related to abortion. (The family planning program, to be clear, has always banned abortion, but opponents say Planned Parenthood should not be allowed to be part of that program because its affiliates provide abortions using other funding sources).

Elsewhere in the bill is language that would restore two abortion restrictions that were in effect during previous GOP reigns. One would limit the ability of the District of Columbia to use locally raised tax funds to pay for abortions for poor women.

The other would reinstate the so-called "Mexico City Policy." It forbids U.S. foreign aid to international groups that "perform or promote" abortion. President Obama reversed the policy by executive order in January 2009.

(Note: Frank James has a related post on the It's All Politics Blog.)