A Presidential Politics-Free Health Wonk Review

Welcome to the Health Wonk Review, a compendium of the latest insights from more than two dozen health policy blogs. Each HWR issue is hosted at a different participant's blog, with topics that include health policy, delivery infrastructure, pharma, insurance and information technology.

Your HWR host, the Population Health Blog, uses a skeptical physician's perspective to write about "systems" of care.  Lately, it has focused on mHealth interventions that influence clinical and economic outcomes at a "population" level, as well as the effective governance of health enterprises.

 

It's also been a proud HWR participant for more than eight years.

The PHB is pleased that NONE of this issue's participants chose to mention any of the appalling lead candidates for U.S. President. Readers could use a break from the campaign cacophony, so the PHB welcomes you to the  Presidential Politics-Free Health Wonk Review.

The Affordable Care Act - What are the numbers?

Charles Gaba of ACASignups has been tracking the progress of the Affordable Care Act. This ongoing labor of love led him to comb through too-numerous-to-count public domain sources to provide an original-sourced summary (with links galore) of the health insurance status for the entire U.S. population in one chart.  He calls it "ambitious."  The PHB calls it gloriously detailed, credible and superb. KHN, you've met your match.

Medicaid

Hank Stern of the InsureBlog reminds us that Medicaid fails to meet the true definition of "health insurance." While beneficiaries get their health bills covered, this payment system is a government program that is ultimately paid for by taxpayers. As this form of income redistribution program expands, the opportunity for the "real" commercial insurance market dims. Ʀєfùsєηíκ indeed!

#mHealth - or the PHB is going to need an app to manage all its patients' apps.....

Peggy Salvatore of the Health System Ed Blog provides a summary of the ePharma Summit 2016 and regales readers with descriptions of how eHealth is helping persons who have gastrointestinal disorders, cancer or complex medication regimens be placed at the center of care.  "eHealth" is reaching critical mass without the help of any government mandates or meaningful use requirements. Imagine that.

David Harlow of the HealthBlawg takes a bite of Apple's CareKit Platform by unpacking the first app entrant from Iodine dubbed "Start."  Start promises to help users to individually manage both the benefits and side effects of anti-depressant medications. The app relies on a validated depression survey to assess progress, promising to take the guesswork out of treatment.

Outcomes

Brad Flansbaum of The Hospital Leader not only summarizes "the best (peer-reviewed) study on (hospital) readmissions to date," but interviews the lead author. As many have suspected, a significant proportion of preventable readmissions are outside the control of the institution and practically all of the current public-reporting measures fail to take that into account. Two insights are that 1) readmission rates will never go to zero, nor should they and 2) innovative interventions to minimize the risk of readmission are just now being developed. The PHB predicts that soon, no at-risk patient will leave the hospital without a dedicated app and telehealth-linked handheld device.  Given the dollars at stake, perhaps those patients without handhelds should be given one.....  

Pharma Misbehavior

Roy Poses from Health Care Renewal pulls aside the curtain and exposes the persons ultimately responsible for the OxyContin fiasco. Members of Purdue Pharmaceutical's C-suite had to pay hefty fines for the company's allegedly misleading advertising, but the upstream owners seem to have escaped scrutiny with their gazillions intact. If any of this is true, we've learned nothing about combatting corporate misdeeds.

Health Savings Accounts

Jay and Louise Norris of the Colorado Health Insurance Insider Blog take a look at some of the arcana and paranoia emerging around health savings accounts (HSAs).  First the arcana: HHS has a BPP about the HSA designation from QHPs that have otherwise been contrived to get around other regulations, likely promulgated in other BPPs. The paranoia is from wary conservatives, who are wondering if the liberals are unable to limit themselves to just "the nine words" by using BPPs to ultimately undermine HSAs.  What could possibly go wrong?  

Dual Eligibles

Tom Lynch of Worker's Comp Blog reviews the history of the successful Commonwealth Care Alliance.  This non-profit HMO currently serves over 17,000 "dual eligibles" in Massachusetts; these persons have significant disabilities and therefore qualify for both Medicare and Medicaid.  Despite huge claims costs, this HMO has been ably served by leadership who understands how money and mission underlie successful health insurance.

A Minimum Wage A Day Keeps the Doctor Away

California's Anthony Wright of the Health Access Blog is not only unapologetic about his home state gradually increasing the minimum wage to $15, he argues that that level of income correlates with better insurability, out-of-pocket affordability, higher health status, improved social determinants and less need for Medicaid.  What's there not to like, especially since the 48 other states can see how this ultimately works out.

Drugs: You Don't Get What You Don't Pay For

David Williams of the Health Business Blog has some thoughts for the pharmaceutical industry's efforts to justify its drug pricing policies. He recommends that pharma not only embrace cost-effectiveness, but lead the fight to include that methodology in all things healthcare.  They also need to help the public understand that you don't get good stuff for free: someone has to pay.

Speaking of Drugs....

Joe Paduda of the Managed Care Matters blog attended the Rx Drug Abuse Summit and has posted some of the more scary data that was presented there. The vast majority of heroin users started with prescription opioid drug abuse and a lot of smart concerned people are mobilizing to address the problem.  Awareness is the first step in addressing this unmitigated disaster.

Food, er Flu Fight

And saving the best for last, in the Health Affairs Blog, Peter Doshi, Kenneth Mandle and Forence Bourgeois scrutinize the CDC's recent recommendations on the treatment of influenza with antiviral drugs. After contrasting the recommendations with the FDA's and others' more detailed analyses on the subject, the authors find the CDC's promotion of a drug of questionable effectiveness to be "problematic."  In academic speak, them's fighting words. This ain't over, so sit back and enjoy while the flu fur flies.  

Your next Health Wonk Review will be hosted by the Health System Ed blog on April 21.