Are You And Your Primary Care Doc Ready To Talk About Your DNA?

Knowing your genes could save your life, especially if a genetic mutation is hereditary. See why incorporating DNA testing is a crucial part of your primary care.


If you have a genetic mutation that increases your risk for a treatable medical condition, would you want to know? For many people the answer is yes. But such information is not commonly part of routine primary care.

For patients at Geisinger Health System, that could soon change. Starting in the next month or so, the Pennsylvania-based system will offer DNA sequencing to 1,000 patients, with the goal to eventually extend the offer to all 3 million Geisinger patients.

The test will look for mutations in at least 77 genes that are associated with dozens of medical conditions ranging from heart disease to cancer, as well as variability in how people respond to pharmaceuticals based on heredity.

“We’re giving more precision to the very important decisions that people need to make,” said Dr. David Feinberg, Geisinger’s president and CEO. In the same way that primary care providers currently suggest checking someone’s cholesterol, “we would have that discussion with patients,” he said. “‘It looks like we haven’t done your genome. Why don’t we do that?’”

Some physicians and health policy analysts question whether such genetic information is necessary to provide good primary care — or feasible for many primary care physicians.

The new clinical program builds on a research biobank and genome-sequencing initiative called MyCode that Geisinger started in 2007 to collect and analyze its patients’ DNA. That effort has enrolled more than 200,000 people.

Like MyCode, the new clinical program is based on whole “exome” sequencing, analyzing the roughly 1 percent of the genome that provides instructions for making proteins, where most known disease-causing mutations occur.

Using this analysis, clinicians might be able to tell Geisinger patients that they have a genetic variant associated with Lynch syndrome, for example, which leads to increased risk of colon and other cancers, or familial hypercholesterolemia, which can result in high cholesterol levels and heart disease at a young age. Some people might learn they have increased susceptibility to  malignant hyperthermia, a hereditary mutation that can be fatal since it causes a severe reaction to certain medications used during anesthesia.

Samples of a patient’s blood or spit are used to provide a DNA sample. After analysis, the results are sent to the patient’s primary care doctor.

Before speaking with the patient, the doctor takes a 30-minute online continuing education tutorial to review details about genetic testing and the disorder. Then the patient is informed and invited to meet with the primary care provider, along with a genetic counselor if desired. At that point, doctor and patient can discuss treatment and prevention options, including lifestyle changes like diet and exercise that can reduce the risk of disease.

About 3.5 percent of the people who’ve been tested through Geisinger’s research program had a genetic variant that could result in a medical problem for which clinicians can recommend steps to influence their health, Feinberg said. Only actionable mutations are communicated to patients. Geisinger won’t inform them if they have a variant of the APOE gene that increases their risk for Alzheimer’s disease, for example, because there’s no clinical treatment. (Geisinger is working toward developing a policy for how to handle these results if patients ask for them.)

Wendy Wilson, a Geisinger spokeswoman, said that what they’re doing is very different from direct-to-consumer services like 23andMe, which tests customers’ saliva to determine their genetic risk for several diseases and traits and makes the results available in an online report.

“Geisinger is prescribing DNA sequencing to patients and putting DNA results in electronic health records and actually creating an action plan to prevent that predisposition from occurring. We are preventing disease from happening,” she said.

Geisinger will absorb the estimated $300 to $500 cost of the sequencing test. Insurance companies typically don’t cover DNA sequencing and limit coverage for adult genetic tests for specific mutations, such as those related to the breast cancer susceptibility genes BRCA1 or BRCA2, unless the patient has a family history of the condition or other indications they’re at high risk.

“Most of the medical spending in America is done after people have gotten sick,” said Feinberg. “We think this will decrease spending on a lot of care.”

Some clinicians aren’t so sure. Dr. H. Gilbert Welch is a professor at the Dartmouth Institute for Health Policy and Clinical Practice who has authored books about overdiagnosis and overscreening, including “Less Medicine, More Health.”

He credited Geisinger with carefully targeting the genes in which it looks for actionable mutations instead of taking an all-encompassing approach. He acknowledged that for some conditions, like Lynch syndrome, people with genetic mutations would benefit from being followed closely. But he questioned the value of DNA sequencing to identify other conditions, such as some related to heart disease.

“What are we really going to do differently for those patients?” he asked. “We should all be concerned about heart disease. We should all exercise, we should eat real food.”

Welch said he was also concerned about the cascading effect of expensive and potentially harmful medical treatment when a genetic risk is identified.

“Doctors will feel the pressure to do something: start a medication, order a test, make a referral. You have to be careful. Bad things happen,” he said.

Other clinicians question primary care physicians’ comfort with and time for incorporating DNA sequencing into their practices.

A survey of nearly 500 primary care providers in the New York City area published in Health Affairs this month found that only a third of them had ordered a genetic test, given patients a genetic test result or referred one for genetic counseling in the past year.

Only a quarter of survey respondents said they felt prepared to work with patients who had genetic testing for common diseases or were at high risk for genetic conditions. Just 14 percent reported they were confident they could interpret genetic test results.

“Even though they had training, they felt unprepared to incorporate genomics into their practice,” said Dr. Carol Horowitz, a professor at the Icahn School of Medicine at Mount Sinai in New York, who co-authored the study.

Speaking as a busy primary care practitioner, she questioned the feasibility of adding genomic medicine to regular visits.

“Geisinger is a very well-resourced health system and they’ve made a decision to incorporate that into their practices,” she said. In Harlem, where Horowitz works as an internist, it could be a daunting challenge. “Our plates are already overflowing, and now you’re going to dump a lot more on our plate.”

SOURCE:
Andrews, M (12 June 2018). "Are You And Your Primary Care Doc Ready To Talk About Your DNA?" [Web Blog Post]. Retrieved from https://khn.org/news/are-you-and-your-primary-care-doc-ready-to-talk-about-your-dna/


Employee benefit satisfaction has direct relation to job fulfillment

New reports say that employees would sacrifice pay increases for better benefits. Heres some tips on how to keep your employees satisfied.


A link between the satisfaction workers feel about their benefits — both employment based and voluntary — has a direct relation with retention opportunities for employers.

Eight in 10 employees who ranked their benefits satisfaction as extremely or very high also ranked job satisfaction as extremely or very high, according to Employee Benefit Research Institute’s recent 2017 Health and Workplace Benefits Survey. Additionally, nearly two-thirds of respondents who ranked benefits satisfaction as extremely or very high ranked their morel as excellent or very good.

“It is important for employers to understand that benefits continue to be valued by employees,” says Paul Fronstin, director of the health research and education program at EBRI. “Health insurance, retirement plans, dental, vision and life insurance continue to be highly important when making job change decisions.”

In fact, the survey finds that more than four in 10 respondents say they would forgo a wage increase to receive an increase in their work-life balance benefits, and nearly two in 10 state a preference for more health benefits and lower wages.

Employees continue to indicate benefits play a key role in whether to remain at a job or choose a new job. Since 2013, health insurance consistently remains one of the top benefits that employees consider in assessing a job change.

Last year, 83% say health insurance is very or extremely important in deciding whether to stay in or change jobs. A retirement savings plan is also one of the critical benefits, with 73% indicating it is extremely or very important in determining whether to stay in or switch jobs.

Although employees say they are generally satisfied with the employee benefits provide today, there is a growing concern benefit programs might start to dwindle. When asked, only 19% of respondents say they are extremely confident in what will be provided will be similar to what they have now in three years.

Other challenges remain

“The challenge is how employers can continue to provide the strong employee benefits package that employees want and need, while still controlling the costs of these benefits, particularly healthcare,” Fronstin notes.

Employee education on benefit offerings could use some beefing up. According to the study a little more than one-half (52%) of employees say they understand their health benefits and 43% indicate they understand their non-health benefits very/extremely well.

Some of this limited understanding of benefits may come from the lack — or perceived lack — of benefit educational opportunities that employees are receiving from their employer, according to the study.

Nearly one-third (31%) of employees indicate that their employer or benefits company provides no education or advice on benefits. Only 39% state that their employer provides education on how health insurance works, 24% say that their employer provides education on how a health savings account works, and 28% confirm that their employer offers education on how to invest money in their retirement plan.

In any case, Fronstin adds, “as employers weigh the future of benefits, they should consider that health insurance consistently remains one of the top benefits that employees consider in assessing a job change, with retirement savings plan also viewed as a critical benefit.”

SOURCE:
Otto N (4 June 2018) "Employee benefit satisfaction has direct relation to job fulfillment" [Web Blog Post]. Retrieved from https://www.benefitnews.com/news/employee-benefit-satisfaction-has-direct-relation-to-job-fulfillment


Five Practical Ways to Support Mental Well-being at Work

Mental well-being impacts engagement, absenteeism and productivity. Discover how help make the workplace atmosphere and environment more pleasant with these tricks.


The American Institute of Stress reports that stress is the nation’s top health problem. This makes sense, as mental capacity is highly valued in the workplace but can also be highly vulnerable. Today’s workplace, with technology, fast-paced growth and decreased resources, can contribute to increased stress.

Companies should value the mental health of their employees as a top asset and fiercely protect it. Mental well-being impacts engagement, presenteeism, absenteeism and productivity — all of which impact businesses bottom lines. More importantly, supporting and protecting the mental health of your employees is the right thing to do.

Here are five best practices to support mental health in the workplace.

  1. Normalize the conversation.

Top-down support of mental health is crucial in creating an open dialogue, as is an open-door policy. Senior leaders should participate in the conversation about mental wellbeing to show buy in. Normalizing the occurrence of a grief reaction or stress disorder can insure that your employees seek help when it happens to them.

Establishing mental health champions within your organization is another way to encourage a healthy dialogue. People with mental health conditions who want to help others are great candidates for this role.

Use awareness days that focus on stress and mental health as external nudges to educate staff about these important issues. Importantly, remind staff that a diversity of perspectives, including those with lived mental health experiences, are valued and encouraged in inclusive environments.

  1. Implement strong policies and procedures.

Disclosure can help an employee seek the appropriate resources and care before conditions worsen, so having proper policies and procedures in place are important in removing barriers to disclose.

This includes protection against discrimination, which is usually a top concern for employees, as well as providing appropriate workplace accommodations. Ensure managers are aware of key resources, like employee assistance programs, and maintain confidentiality when an employee discloses information.

Beyond this, educate employees on policies, procedures and proper protocols to increase employee awareness. Here’s a tip: Repeat key messages and tailor your communications to better reach your staff.

  1. Prevention is better than cure.

It’s essential to remember that anyone is susceptible to stress and a resulting decline in their mental health, whether a preexisting condition exists or not. Big life events like having a baby or losing a loved one and every day struggles like money worries, relationship issues or work-related stress can cause or aggravate mental health conditions to the point of interfering with work. 

Mental wellness sessions or work/life balance programs can help. Bring in an expert and talk to your staff about how to safeguard their own mental health, build resilience and recognize signs of distress in others.

  1. Tailor your benefits package to support mental wellbeing.

Choose a major medical plan that gives employees access to quality mental health specialists in network, as these costs can add up significantly. Helping employees have access to and triage the right specialist support is crucial in managing conditions.

EAPs can act as a first line of defense for a wide range of problems – from money and relationship worries to support for working caregivers. They provide both practical and emotional support for employees through confidential counseling and can help prevent issues from escalating and impacting productivity. These programs are often offered as part of a major medical or disability plan, so your company may already have access to them.

Money worries can also take an emotional toll on wellbeing. In fact, financial concerns were the leading cause of stress across all generations in a recent consumer study conducted by my company, Unum.

Help your employees establish a strong financial foundation by offering financially-focused benefits, like life and disability insurance, retirement savings options and supplemental health benefits that can close the rising financial gap in medical plans.

If your budget doesn’t cover these benefits, consider offering them on a voluntary basis. Access to financial protection benefits are more affordable when offered through the workplace, even if the employee picks up the cost.

Flexible hours or remote working options can also help employees schedule their work days when they’re feeling most productive. This can help reduce presenteeism for mental ill-health, and it also signals to employees that you’re supportive of a healthy work/life balance.

  1. Encourage self-care.

Self-care plays a critical role in overall wellbeing. Encourage employees to do small tasks that’ll help them build resilience over time.

The basics like getting plenty of sleep, eating healthy, drinking water, and exercising are foundational in overall wellbeing.

Beyond these staples, developing appropriate time management and work/life balance skills are also important. Delegating and collaborating are also key to ensure healthy work behaviors which also decrease stress.

While technology and our always-on culture make it hard to disconnect, encourage employees to set device off-times so they can fully recharge before the next day. And most important, model this behavior to your staff and limit after hours work and emails.

Having a holistic mental well-being strategy that includes prevention, intervention and protection is essential for unlocking a workforce’s true potential.

 

SOURCE:
Jackson M (4 June 2018) "Five Practical Ways to Support Mental Well-being at Work" [Web Blog Post]. Retrieved from http://www.workforce.com/2018/05/18/five-practical-ways-support-mental-well-work/


4 perks to make your employees' lives easier and less stressful

Recruit top talent with ease and confidence when considering these tips on attractive, creative and innovative employment perks.


A 2016 survey from Glassdoor found that 57 percent of people looking for jobs said benefits and perks are among their top considerations when weighing offers. So how can a company stack the deck in its favor when recruiting top talent? Although some companies limit their benefits packages to traditional offerings such as health insurance, 401Ks and paid time off, a today’s forward-thinking employers know they need to find more creative ways to offer benefits that make a genuine difference in employees’ day-to-day work and personal lives.

As competition for employees intensifies, the race to improve employer-based services is likely to result in better options for employees. Unconventional benefits options come in many shapes and forms, but they share one thing in common: the goal of saving time for employees, reducing their stress, and ultimately improving their health and satisfaction at work.

All other things being equal, companies that offer innovative perks that speak to the well-being of their employees are more likely to attract and retain the top talent in their field. Here are a few such perks to consider.

Expectant-parent counseling

You’ve thrown the baby shower, cut the cake, helped carry staff gifts to the car—and you’ve explained the company’s parental leave policy in detail. As you wave Julie from accounting off with best wishes, you’re confident she’ll come back to her desk in a few months’ time.

But the truth is that 43 percent of women who have babies leave the workforce permanently within a matter of months. Many say it’s because they don’t have adequate support at home to enable them to resume their careers. That is why companies like Reddit and Slack use a service called Lucy that provides expectant employees help before, during, and after parental leave, including 24/7 messaging and one-on-one sessions that can be done in the home or online.

As Reddit VP of People Katelin Holloway put it, “It’s not enough to simply offer parental leave; every child and family is different and has independent needs.” By helping expectant parents find resources that meet their specific needs, you’re making an investment in your workforce that pays enormous dividends in retention, productivity, and morale.

Caregiving support

A Gallup survey revealed more than 1 in 6 full-time or part-time American workers has difficulty balancing caring for elderly parents with their work commitments. This results in decreased productivity and frequent leaves of absence. Companies can help their employees cope and stay engaged with their work by providing concierge services that offer amenities such as taking elderly parents to doctor’s appointments and eldercare coaching when choosing between assisted living options.

To help reduce stress (and retain highly specialized employees), take a cue from companies like Microsoft and Facebook, which provide caregiver paid-leave programs to help employees care for ailing family members or sick relatives.

Dry cleaning at work

Sometimes it’s the little things that save time during the workday that can push the needle in your favor as a potential employer. It may sound trivial, but company-provided dry cleaning is a perk that’s proving to be a big draw in workplaces from Wall Street to Silicon Valley. Service providers pick up employees’ laundry or dry cleaning items from work and return them to a designated employer closet in their office building—one less errand, and no more lost tickets. “People have lives to live, so I try to make it easy for them to deal with any of those personal errands that could take up time for them,” said Experian CEO Craig Boundy, speaking about his company’s employee benefits programs in an interview with the The Orange County Register.

Car maintenance and service

According to the U.S. Bureau of Labor Statistics, the average American household owns 1.9 vehicles and spends around 1.5 percent of its annual income on auto maintenance and repairs. Cars are a significant investment for most of us, so the more you can help potential employees save time and money on maintaining their vehicles, the more tempting you’ll become as an employer. Growing numbers of innovative companies provide car repair services to help employees save money, find the best quality mechanics, and reduce stress associated with the entire process.

Some firms also offer on-site car wash services, giving employees peace of mind and a positive outlook as they drive home after work. Several big Silicon Valley corporations —including eBay, SanDisk, Cisco, and Oracle—use BoosterFuels to fill employees’ gas tanks while they’re at work. It saves employees time and protects them from potential accidents or robberies at gas stations.

SOURCE:
Weiss Y (31 May 2018) "4 perks to make your employees' lives easier and less stressful" Web Blog Post]. Retrieved from https://www.benefitspro.com/2018/05/11/4-perks-to-make-your-employees-lives-easier-and-le/


The Most Desirable Employee Benefits

When it comes to hiring new employees, benefits can make or break the process. Hire with confidence when considering these tips on attractive and affordable employment perks.


In today’s hiring market, a generous benefits package is essential for attracting and retaining top talent. According to Glassdoor’s 2015 Employment Confidence Survey, about 60% of people report that benefits and perks are a major factor in considering whether to accept a job offer. The survey also found that 80% of employees would choose additional benefits over a pay raise.

Google is famous for its over-the-top perks, which include lunches made by a professional chef, biweekly chair massages, yoga classes, and haircuts. Twitter employees enjoy three catered meals per day, on-site acupuncture, and improv classes. SAS has a college scholarship program for the children of employees. And plenty of smaller companies have received attention for their unusual benefits, such as vacation expense reimbursement and free books.

But what should a business do if it can’t afford Google-sized benefits? You don’t need to break the bank to offer attractive extras. A new survey conducted by my team at Fractl found that, after health insurance, employees place the highest value on benefits that are relatively low-cost to employers, such as flexible hours, more paid vacation time, and work-from-home options. Furthermore, we found that certain benefits can win over some job seekers faced with higher-paying offers that come with fewer additional advantages.

As part of our study, we gave 2,000 U.S. workers, ranging in age from 18 to 81, a list of 17 benefits and asked them how heavily they would weigh the options when deciding between a high-paying job and a lower-paying job with more perks.

Better health, dental, and vision insurance topped the list, with 88% of respondents saying that they would give this benefit “some consideration” (34%) or “heavy consideration” (54%) when choosing a job. Health insurance is the most expensive benefit to provide, with an average cost of $6,435 per employee for individual coverage, or $18,142 for family coverage.

The next most-valued benefits were ones that offer flexibility and improve work-life balance. A majority of respondents reported that flexible hours, more vacation time, more work-from-home options, and unlimited vacation time could help give a lower-paying job an edge over a high-paying job with fewer benefits. Furthermore, flexibility and work-life balance are of utmost importance to a large segment of the workforce: parents. They value flexible hours and work-life balance above salary and health insurance in a potential job, according to a recent survey by FlexJobs.

Eighty-eight percent of respondents said they’d give some or heavy consideration to a job offering flexible hours, while 80% would give consideration to a job that lets them work from home. Both flexible hours and work-from-home arrangements are affordable perks for companies that want to offer appealing benefits but can’t afford an expensive benefits package. Both of these benefits typically cost the employer nothing — and often save money by lowering overhead costs.

More vacation time was an appealing perk for 80% of respondents. Paid vacation time is a complicated expense, since it’s not simply the cost of an employee’s salary for the days they are out; liability also plays into the cost. American workers are notoriously bad at using up their vacation time. Every year Americans leave $224 billion dollars in unused vacation time on the table, which creates a huge liability for employers because they often have to pay out this unused vacation time when employees leave the company. Offering an unlimited time-off policy can be a win-win for employer and employee. (Over two-thirds of our respondents said they would consider a lower-paying job with unlimited vacation.) For example, HR consulting firm Mammoth considers its unlimited time-off policy a successnot just for what it does but also for the message it sends about company culture: Employees are treated as individuals who can be trusted to responsibly manage their workload regardless of how many days they take off.

Switching to an unlimited time-off policy can solve the liability issue; wiping away the average vacation liability saves companies $1,898 per employee, according to research from Project: Time Off. And with only 1%–2% of companies currently using an unlimited time-off policy, according to the Society for Human Resource Management (SHRM), it’s clearly a benefit that can make companies more attractive.

Contrary to what employers might expect, unlimited time off doesn’t necessarily equal less productive employees and more time out of the office. A survey from The Creative Group found that only 9% of executives think productivity would decrease significantly if employees used more vacation time. In some cases, under an unlimited time-off policy, employees take the same amount of vacation time. We adopted an unlimited time-off policy at Fractl about a year ago and haven’t seen a negative impact on productivity. Our director of operations, Ryan McGonagill, says there hasn’t been a large spike in the amount of time employees spend out of the office, but the quality of work continues to improve.

Student loan and tuition assistance also ranked highly on the list of coveted benefits, with just under half of respondents reporting that these bonuses could nudge them toward a lower-paying job. A benefits survey from SHRM found that only 3% of companiescurrently offer student loan assistance, and 52% of companies provide graduate educational assistance. Although education assistance sounds costly, companies can take advantage of a tax break; employers can provide up to $5,250 per employee per year for tuition tax free.

Job benefits that don’t directly impact an individual’s lifestyle and finances were the least coveted by survey respondents, such as in-office freebies like food and coffee. Company-sponsored gatherings like team-bonding activities and retreats were low on the list as well. This isn’t to say these benefits aren’t valued by employees, but rather that these perks probably aren’t important enough on their own to convince a job candidate to choose a company.

We noticed gender differences regarding certain benefits. Most notable, women were more likely to prefer family benefits like paid parental leave and free day care services. Parental leave is of high value to female employees: 25% of women said they’d give parental leave heavy consideration when choosing a job (only 14% of men said the same). Men were more likely than women to value team-bonding events, retreats, and free food. Both genders value fitness-related perks, albeit different types. Women are more likely to prefer free fitness and yoga classes, while men are more likely to prefer an on-site gym and free gym memberships.

Our survey findings suggest that providing the right mix of benefits that are both inexpensive and highly sought after among job seekers can give a competitive edge to businesses that can’t afford high salaries and pricier job perks.

SOURCE:
Jones K (30 May 2018). [Web Blog Post]. Retrieved from address https://hbr.org/2017/02/the-most-desirable-employee-benefits


Is Ergonomics A "Must-Have" For Your Workplace Wellness Plan?

 

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Workplace wellness in most organizations centres around health promotion activity or policy development to support healthy behaviour and improve health outcomes in the workplace. A "workplace wellness" Google search reveals a range of programs focused on fitness, weight management, smoking cessation, stress management, work-life balance and occasionally flexible work scheduling. These are legitimately important aspects targeted at improving specific health outcomes.

It is important to realize that the average office worker spends over 65 per cent of their time at work in a sedentary seated position. No doubt you have seen the media campaigns touting the health concerns related to sedentary behaviour, some going as far as labelling sitting as the new smoking. Prolonged sitting has been associated with cardiovascular problems, increases in musculoskeletal discomfort, and decreases in concentration and productivity. Improper sitting and work station setup has been associated with an increase in musculoskeletal pain and injury (MSI) in the neck, shoulders, arms, wrists, legs and lower back. MSI are associated with the wear and tear on the muscles, tissues, ligaments and joints of the body.

It is for these reasons that office ergonomics should be on the workplace wellness program menu. Ergonomics is the science of matching the work to the worker. In an office environment, a major focus would be insuring that employee workstations fit the worker – not the employee made to fit the workstation. To design a healthy employee work station properly requires an understanding of the limitations of the human body, especially in terms of muscle and soft tissue fatigue. Again, a Google search on "office ergonomics" leads you to resources on the proper configuration of computer workstations to promote a neutral sitting posture aimed at reducing muscle and soft tissue pain.

This is a great place to start, but does not replace the knowledge of an experienced ergonomist to ensure that individual limitations and pre-existing health conditions are accommodated for properly. Here are some examples of the most common office ergonomic challenges I encounter when consulting with organizations. The first is the desk. The working height of a standard desk is 30 inches, for which we expect it be comfortable for both the 5-foot-2-inch and a 6-foot-2-inch employee. But the reality is that this standard desk height is appropriate for the 6-foot-2-inch employee. The average female is 5-foot-4-inches, which would suggest that the standard 30-inch working height is too high for the majority of female workers in the office. When the working height is too high, the employee will adopt a posture where the wrists are extended when keyboarding, the neck is extended, shoulders are hunched and back is flexed forward off the chair.

—theglobeandmail.com


While Talk About Opioids Continues In D.C., Addiction Treatment Is In Peril In States

How is Washington handling the opioid crisis? Let's find out in this article from Kaiser Health News.


Opioids were on the White House agenda Thursday — President Trump convened a summit with members of his administration about the crisis. And Congress authorized funds for the opioid crisis in its recent budget deal — but those dollars aren’t flowing yet, and states say they are struggling to meet the need for treatment.

The Oklahoma agency in charge of substance abuse has been told by the state’s legislature to cut more than $2 million from this fiscal year’s budget.

“Treatment dollars are scarce,” said Randy Tate, president of the Oklahoma Behavioral Health Association, which represents addiction treatment providers.

It’s like dominoes, Tate said. When you cut funding for treatment, other safety-net programs feel the strain.

“Any cuts to our overall contract,” he said, “really diminish our ability to provide the case management necessary to advocate for homes, food, shelter, clothing, primary health care and all the other things that someone needs to really be successful at tackling their addiction.”

In just three years, Oklahoma’s agency in charge of funding opioid treatment has seen more than $27 million dollars chipped away from its budget — thanks to legislative gridlock, slashed state taxes and a drop in oil prices (with the additional loss in state tax revenue that resulted).

Jeff Dismukes, a spokesman for Oklahoma’s Department of Mental Health and Substance Abuse Services, says the already lean agency has few cost-cutting options left.

“We always cut first to administration,” he said, “but there’s a point where you just can’t cut anymore.”

The agency may end up putting off payments to treatment providers until July — the next fiscal year. Tate says that could be devastating.

“Very thinly financed, small rural providers are probably at risk of going out of business entirely — up to and including rural hospitals,” he said.

Getting treatment providers to open up shop in rural areas is really hard, even in good times, and more financial uncertainty could make that problem worse. In the meantime, according to an Oklahoma state commission’s opioid report, just 10 percent of Oklahomans who need addiction treatment are getting it.

That statistic is similar in Colorado. And as 2018 began, Colorado’s escalating opioid crisis got worse, when the state’s largest drug and alcohol treatment provider, Arapahoe House, shut its doors.

The facility provided recovery treatment to 5,000 people a year. Denise Vincioni, who directs another treatment center, the Denver Recovery Group, says other facilities have scrambled to pick up the patients.

Most of Arapahoe’s clients were on Medicaid. Autumn Haggard-Wolfe, a two-time Arapahoe House client who is now in recovery, worries the facility’s closing will have dire consequences, especially for people who need inpatient care, as she did.

“I feel like the only other option right now in therapy would be jail for people,” she said, “and people die in there from withdrawing.”

Arapahoe House’s CEO blamed its closure on the high cost of care and poor government reimbursement for services.

The mother of Colorado state lawmaker Brittany Pettersen struggled with addiction, and was treated at Arapahoe House. Pettersen says treatment centers rely on a crazy quilt of funding sources and are chronically underfunded — often leaving people with no treatment options.

“We have a huge gap in Colorado,” Pettersen said, “and that was before Arapahoe House closed.”

She is pushing legislation in the state to increase funding for treatment. But to get tens of millions of dollars in federal matching funds, Colorado lawmakers need to approve at least $34 million a year in new state spending.

That price tag may simply be too high for some lawmakers. But either way, she added, “It’s going to take a lot to climb out of where we are.”

Colorado did get new federal funds to fight the opioid crisis through the 21st Century Cures Act, passed in December of 2016, but it was just $7.8 million a year for two years — divvied up among a long list of programs.

Read the article.

Source:
 Daley J.,Fortier J. (5 March 2018). "While Talk About Opioids Continues In D.C., Addiction Treatment Is In Peril In States" [Web Blog Post]. Retrieved from address https://khn.org/news/while-talk-about-opioids-continues-in-dc-addiction-treatment-is-in-peril-in-states/

Benefits to plants at your desk

Leaves on trees have turned, and a walk to the office often feels like a walk through an icebox. Open windows are a thing of months past. Cooped up, breathing dry indoor air, no one could blame you for feeling down.

But you can brighten your mood and boost your health by adding a plant or two to your workspace. You don’t even need much natural light or a green thumb.

Plants bring a bit of nature inside, along with other good stuff.

They make people happy, and taking care of them can make people even happier. That’s especially true if you’re digging in a garden – horticultural therapy helps sharpen memory and cognitive skills – but desk-side pruning can do wonders for your mental state too.

Plants are also terrific air purifiers.

The air in your office (and home) might be more polluted than air outside – especially if you’re in a big city. Furniture, carpet, plastic items and other synthetic materials are to blame, according to the Environmental Protection Agency.

Plants help by wicking away airborne chemicals and the carbon dioxide we puff out, and then give us oxygen, research from NASA shows.

Four decades ago, NASA scientists found more than 100 volatile organic compounds floating through the air of the Skylab space station. The bad stuff came from synthetic materials off-gassing low levels of chemicals such as formaldehyde, benzene and trichloroethylene – known irritants and potential carcinogens that are in earthly buildings too.

When the chemicals are trapped in an area, people breathing within that same area can get sick because the air isn’t getting “the natural scrubbing by Earth’s complex ecosystem,” as NASA puts it.

Hail plants.

Here are two that demand next to nothing and tolerate very low light (but are just as happy with lots of it). Expect them to live for years and years, without repotting. I speak from experience, but you’ll also find them on plenty of lists and in lots of books about easy-care plants that are good for your health.

Snake Plant or Mother-In-Law’s Tongue (Sansevieria trifasciata)

A sturdy plant with upright and stiff leaves. Ideally, its soil should dry out between waterings. It will grow bigger and look better if you water it as soon as the soil dries (not wait forever) and if it’s in medium light. But it still will live for months if you ignore it, and spring back to robust happiness when you give it a little love.

Pothos (Epipremnum aureum)
A flowing plant with vine-like stems that can easily take over your desk. Ideally, its soil should stay a little moist. But if you let the soil dry out completely, you can jolt the plant back to life with watering. It’s perfectly happy with all kinds of lighting, including florescent, but it will be fuller with better color when it gets decent natural light.

 

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Source:
Malek M. (4 December 2017). "Benefits to plants at your desk" [web blog post]. Retrieved from address http://workwell.unum.com/2017/12/3255/


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Apple, Fitbit to join FDA program to speed health tech

Wondering how technology can speed the process of developing health tech? In this article from BenefitsPro written by Anna Edney, gain a close insight on how Apple and Fitbit are working together with the FDA to make your health of vital importance.

You can read the original article here.


A federal agency that regulates apples wants to make regulations on Apple Inc. a little easier.

The Food and Drug Administration, which oversees new drugs, medical devices and much of the U.S. food supply, said Tuesday that it had selected nine major tech companies for a pilot program that may let them avoid some regulations that have tied up developers working on health software and products.

“We need to modernize our regulatory framework so that it matches the kind of innovation we’re being asked to evaluate,” FDA Commissioner Scott Gottlieb said in a statement.

The program is meant to let the companies get products pre-cleared rather than going through the agency’s standard application and approval process that can take months. Along with Apple, Fitbit Inc., Samsung Electronics Co., Verily Life Sciences, Johnson & Johnson and Roche Holding AG will participate.

 

A new report and video from the Health Enhancement Research Organization (HERO) identifies six promising practices for effectively integrating wearables...
The FDA program is meant to help the companies more rapidly develop new products while maintaining some government oversight of technology that may be used by patients or their doctors to prevent, diagnose and treat conditions.

Apple is studying whether its watch can detect heart abnormalities. The process it will go through to make sure it’s using sound quality metrics and other measures won’t be as costly and time-consuming as when the government clears a new pacemaker, for example. Verily, the life sciences arm of Google parent Alphabet Inc., is working with Novartis AG to develop a contact lens that could continuously monitor the body’s blood sugar.

Faster Pace

“Historically, health care has been slow to implement disruptive technology tools that have transformed other areas of commerce and daily life,” Gottlieb said in July when he announced that digital health manufacturers could apply for the pilot program.

Officially dubbed the Pre-Cert for Software Pilot, Gottlieb at the time called it “a new and pragmatic approach to digital health technology.”

The other companies included in the pilot are Pear Therapeutics Inc., Phosphorus Inc. and Tidepool.

The program is part of a broader move at the FDA, particularly since Gottlieb took over in May, to streamline regulation and get medical products to patients faster. The commissioner said last week the agency will clarify how drugmakers might use data from treatments already approved in some disease to gain approvals for more conditions. In July, he delayed oversight of electronic cigarettes while the agency decides what information it will need from makers of the products.

Rules Uncertainty

As Silicon Valley developers have pushed into health care, the industry has been at times uncertain about when it needed the FDA’s approval. In 2013, the consumer gene-testing company 23andMe Inc. was ordered by the agency to temporarily stop selling its health analysis product until it was cleared by regulators, for example.

Under the pilot, the FDA will scrutinize digital health companies’ software and will inspect their facilities to ensure they meet quality standards and can adequately track their products once they’re on the market. If they pass the agency’s audits, the companies would be pre-certified and may face a less stringent approval process or not have to go through FDA approval at all.

More than 100 companies were interested in the pilot, according to the FDA. The agency plans to hold a public workshop on the program in January to help developers not in the pilot understand the process and four months of initial findings.

You can read the original article here.

Source:

Edeny A. (27 September 2017). "Apple, Fitbit to join FDA program to speed health tech" [Web Blog Post]. Retrieved from address http://www.benefitspro.com/2017/09/27/apple-fitbit-to-join-fda-program-to-speed-health-t

 


Absent federal action, states take the lead on curbing drug costs

What's your state's stance on the cost of prescription drugs? See how Maryland has moved forward in their decision making for drug prices, giving themselves the ability to say "no" in this article from Benefits Pro written by Shefali Luthra.

You can read the original article here.


Lawmakers in Maryland are daring to legislate where their federal counterparts have not: As of Oct. 1, the state will be able to say “no” to some pharmaceutical price spikes.

A new law, which focuses on generic and off-patent drugs, empowers the state’s attorney general to step in if a drug’s price climbs 50 percent or more in a single year. The company must justify the hike. If the attorney general still finds the increase unwarranted, he or she can file suit in state court. Manufacturers face a fine of up to $10,000 for price gouging.

As Congress stalls on what voters say is a top health concern — high pharmaceutical costs — states increasingly are tackling the issue. Despite often-fierce industry opposition, a variety of bills are working their way through state governments. California, Nevada and New York are among those joining Maryland in passing legislation meant to undercut skyrocketing drug prices.

Maryland, though, is the first to penalize drugmakers for price hikes. Its law passed May 26 without the governor’s signature.

The state-level momentum raises the possibility that — as happened with hot-button issues such as gay marriage and smoke-free buildings — a patchwork of bills across the country could pave the way for more comprehensive national action. States feel the squeeze of these steep price tags in Medicaid and state employee benefit programs, and that applies pressure to find solutions.

“There is a noticeable uptick among state legislatures and state governments in terms of what kind of role states can play in addressing the cost of prescription drugs and access,” said Richard Cauchi, health program director at the National Conference of State Legislatures.

Many experts frame Maryland’s law as a test case that could help define what powers states have and what limits they face in doing battle with the pharmaceutical industry.

The generic-drug industry has already filed a lawsuit to block the law, arguing it’s unconstitutionally vague and an overreach of state powers. A district court is expected to rule soon.

The state-level actions focus on a variety of tactics:

“Transparency bills” would require pharmaceutical companies to detail a drug’s production and advertising costs when they raise prices over certain thresholds. Cost-limit measures would cap drug prices charged by drugmakers to Medicaid or other state-run programs, or limit what the state will pay for drugs. Supply-chain restrictions include regulating the roles of pharmacy benefit managers or limiting a consumer’s out-of-pocket costs.

A New York law on the books since spring allows officials to cap what its Medicaid program will pay for medications. If companies don’t sufficiently discount a drug, a state review will assess whether the price is out of step with medical value.

Maryland’s measure goes further — treating price gouging as a civil offense and taking alleged violators to court.

“It’s a really innovative approach. States are looking at how to replicate it, and how to expand on it,” said Ellen Albritton, a senior policy analyst at the left-leaning Families USA, which has consulted with states including Maryland on such policies.

Lawmakers have introduced similar legislation in states such as Massachusetts, Rhode Island, Tennessee and Montana. And in Ohio voters are weighing a ballot initiative in November that would limit what the state pays for prescription drugs in its Medicaid program and other state health plans.

Meanwhile, the California legislature passed a bill earlier in September that would require drugmakers to disclose when they are about to raise a price more than 16 percent over two years and justify the hike. It awaits Democratic Gov. Jerry Brown’s signature.

In June, Nevada lawmakers approved a law similar to California’s but limited to insulin prices. Vermont passed a transparency law in 2016 that would scrutinize up to 15 drugs for which the state spends “significant health care dollars” and prices had climbed by set amounts in recent years.

But states face a steep uphill climb in passing pricing legislation given the deep-pocketed pharmaceutical industry, which can finance strong opposition, whether through lobbying, legal action or advertising campaigns.

Last fall, voters rejected a California initiative that would have capped what the state pays for drugs — much like the Ohio measure under consideration. Industry groups spent more than $100 million to defeat it, putting it among California’s all-time most expensive ballot fights. Ohio’s measure is attracting similar heat, with drug companies outspending opponents about 5-to-1.

States also face policy challenges and limits to their statutory authority, which is why several have focused their efforts on specific parts of the drug-pricing pipeline.

Critics see these tailored initiatives as falling short or opening other loopholes. Requiring companies to report prices past a certain threshold, for example, might encourage them to consistently set prices just below that level.

Maryland’s law is noteworthy because it includes a fine for drugmakers if price increases are deemed excessive — though in the industry that $10,000 fine is likely nominal, suggested Rachel Sachs, an associate law professor at Washington University in St. Louis who researches drug regulations.

This law also doesn’t address the trickier policy question: a drug’s initial price tag, noted Rena Conti, an assistant professor in the University of Chicago who studies pharmaceutical economics.

And its focus on generics means that branded drugs, such as Mylan’s Epi-Pen or Kaleo’s overdose-reversing Evzio, wouldn’t be affected.

Yet there’s a good reason for this, noted Jeremy Greene, a professor of medicine and the history of medicine at Johns Hopkins University who is in favor of Maryland’s law.

Current interpretation of federal patent law suggests that the issues related to the development and affordability of on-patent drugs are under federal jurisdiction, outside the purview of states, he explained.

In Maryland, “the law was drafted narrowly to address specifically a problem we’ve only become aware of in recent years,” he said. That’s the high cost of older, off-patent drugs that face little market competition. “Here’s where the state of Maryland is trying to do something,” he said.

Still, a ruling against the state in the pending court case could have a chilling effect for other states, Sachs said, although it would be unlikely to quash their efforts.

“This is continuing to be a topic of discussion, and a problem for consumers,” said Sachs.

“At some point, some of these laws are going to go into effect — or the federal government is going to do something,” she added.

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation. KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Source:

Luther S. (29 September 2017). "Absent federal action, states take the lead on curbing drug costs" [Web Blog Post]. Retrieved from address http://www.benefitspro.com/2017/09/29/absent-federal-action-states-take-the-lead-on-curb?page=2