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/
CenterStage: February is American Heart Month - Are Your Loved Ones Knowledgeable?
Heart disease is the leading cause of death for men and women in the United States. Every year, 1 in 4 deaths are caused by heart disease, according to the American Heart Association.
Talking with your loved ones about heart disease can be awkward, but it’s important. In fact, it could save a life. At the dinner table, in the car, or even via text, have a heart-to-heart with your loved ones about improving heart health as a family. Engaging those you care about in conversations about heart disease prevention can result in heart-healthy behavior changes.
Here are three reasons to talk to the people in your life about heart health and three ways to get the conversation started.
Three Reasons You Should Talk to Your Loved Ones About Heart Health
#1. More than physical health is at risk
Millions of people in the US don’t know that they have high blood pressure. High blood pressure raises the risk for heart attacks, stroke, heart disease, kidney disease and many other health issues. Researchers are learning that having high blood pressure in your late 40s or early 50s can lead to dementia later in life. Encourage family members to be aware of blood pressure levels and monitor them consistently.
#2. Feel Younger Longer
Just as bad living habits can age you prematurely and shorten your lifespan, practicing good heart healthy habits can help you feel younger longer. On average, U.S. adults have hearts that are 7 years older than they should be, according to the Center for Disease Control and Prevention. Just beginning the conversation with the people in your life that you care about can begin to make changes in their heart health.
#3. You Are What You Eat
Even small changes can make a big difference. Prepare healthier versions of your favorite family recipes by making simple ingredient swaps, simply searching the internet is all it usually takes to find an easy ingredient alternative. Find a new
recipe to cook for your family members, or get in the kitchen together and you’ll finish with something delicious and possibly making some new favorite memories as well. When grocery shopping, choose items low in sodium, added sugar, and trans fats, and be sure to stock up on fresh fruits and vegetables.
Three Ways to Start the Conversation
- Encourage family members to make small changes, like using spices to season food instead of salt.
- Motivate your loved ones to incorporate physical activity into every day. Consider a family fitness challenge and compete with each other to see who can achieve the best results.
- Avoid bad habits together. It has been found that smokers are twice as likely to quit if they have a support system. This applies to practicing healthier practices as well. Set goals and start by making small, positive changes, chances are they may have a big difference.
The key to heart health is a healthy lifestyle. It’s important to try to let go of bad habits that increase your risk of heart disease. By setting small, achievable goals and tracking those goals, you can possibly extend your life expectancy a little bit each day.
Heart disease can be prevented by making healthy choices and consciously monitoring health conditions. Making healthy choices a topic of conversation with your family and loved ones is a great way to open the door to healthier practices in all walks of life.
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5 things to know about this year’s flu
The nation is having a Terrible, Horrible, No Good, Very Bad flu season.
Flu is widespread in 46 states, according to reports to the U.S. Centers for Disease Control and Prevention (CDC).
Nationally, as of mid-December, at least 106 people had died from the infectious disease.
In addition, states across the country are reporting higher-than-average flu-related hospitalizations and emergency room visits. Hospitalization rates are highest among people older than 50 and children younger than 5.
In California, which is among the hardest-hit states, the virus struck surprisingly early this season. The state’s warmer temperatures typically mean people are less confined indoors during the winter months. As a result, flu season usually strikes later than in other regions.
Health experts aren’t sure why this season is different.
“We’re seeing the worst of it right now,” said Dr. Randy Bergen, a pediatrician who is leading Kaiser Permanente-Northern California’s anti-flu effort. “We’re really in historic territory, and I just don’t know when it’s going to stop.” (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)
Here are five things you should know about this flu season:
1. It’s shaping up to be one of the worst in recent years.
The H3N2 influenza A subtype that appears to be most prevalent this year is particularly nasty, with more severe symptoms including fever and body aches. Australia, which U.S. public health officials follow closely in their flu forecasting — in part because their winter is our summer — reported a record-high number of confirmed flu cases in 2017. Another influenza B virus subtype also is circulating, “and that’s no fun, either,” Bergen said.
Flu season in the U.S. typically starts in October and ends in May, peaking between December and February.
2. This season’s flu vaccine is likely to be less effective than in previous years.
U.S. flu experts say they won’t fully know how effective this season’s vaccine is until the it’s over. But Australia’s experience suggests effectiveness was only about 10 percent. In the U.S., it is 40 to 60 percent effective in an average season. Vaccines are less protective if strains are different than predicted and unexpected mutations occur.
3. You should get the flu shot anyway.
Even if it is not a good match to the virus now circulating, the vaccine helps to ease the severity and duration of symptoms if you come down with the flu.
Children are considered highly vulnerable to the disease. Studies show that for children a shot can significantly reduce the risk of dying.
High-dose vaccines are recommended for older people, who also are exceptionally vulnerable to illness, hospitalization and death related to the flu, according to the CDC.
“Some protection is better than no protection,” Bergen said, “but it’s certainly disappointing to have a vaccine that’s just not as effective as we’d like it to be.
Shots may still be available from your doctor or local health clinic, as well as at some chain drugstores. Check the Vaccine Finder website for a location near you.
4. Basic precautions may spare you and your family from days in bed.
As much as possible, avoid people who are sick. Wash your hands frequently and avoid touching your mouth, nose and eyes.
Masks aren’t particularly effective in keeping you from catching the flu, although they may help keep sick people who wear them from spreading their germs further.
If you are sick, cover your cough and stay home from work if you can, Bergen said. Remaining hydrated, eating nutritious foods and exercising can also help strengthen your immune system.
Because elderly people are so vulnerable to the flu, some nursing homes and assisted living facilities may limit visitors and resident activities, depending on the level of illness.
5. Don’t mistake flu symptoms for those of a common cold.
The hallmarks of flu are fever and body aches that accompany cough and congestion, Bergen said.
If you feel as if you’re having trouble breathing, or if your fever can’t be controlled with medication like Tylenol, check with your doctor. It’s even more important for patients to see a doctor if they have a chronic medical condition like diabetes or heart disease, or if they are young or elderly.
Kaiser Permanente doctors now are being advised to prescribe antiviral drugs like Tamiflu — given as a pill or, for kids, an oral suspension — even without a lab test for influenza, Bergen said. According to a report in the Los Angeles Times, however, Tamiflu supplies are running low.
And Bergen cautioned that these medications are only partly effective, reducing the time of illness by just a day or two.
Read the original article.
Source: Kaiser Health News (22 January 2018). "5 things to know about this year’s flu" [Web blog post]. Retrieved from address https://workwell.unum.com/2018/01/5-things-know-years-flu/
Health Resolutions You Can Stick To In 2018
We ask the experts which resolutions we should be making this year, and how we can actually stick to them.
Whether it's giving up smoking, exercising more, or getting our 5-a-day, most of us have usually given up before January ends.
But with a little help from the pros, you can live a happier, healthier life in 2018...
1. Drink more water
Health and fitness mentor Sarah-Anne Lucas (birdonabike.co.uk) says starting a daily ritual is the answer to New Year resolutions. She suggests drinking more water: "Water intake is massive. Most people do not drink enough, but what we'd all like is more energy. That comes down to what you put in, so increase your water intake. It's the first thing you put in your body in the morning. Go and get yourself a minimum of 100ml water and get it into you. To progress that practice, add lemon, to make the body alkaline. Lemon water is amazing, it also adds a bit of flavour."
2. Learn to meditate
Life-coach and mindfulness practitioner Dr Caroline Hough (aspiring2wellness.com) says we can train our minds to reduce stress, making us more likely to achieve our goals: "It involves sitting and meditating for 20 minutes. Bring yourself into the moment and be aware. That's an awareness of your external environment, so just looking at the flowers and the trees and the sunshine and appreciating it instead of rushing through life. Be aware of your internal environment, by noticing if you're very stressed, for example if you're clenching your muscles. We tend to live our lives at a level of stress which is unhealthy."
3. Start self-watching
Professor Jim McKenna, head of the Active Lifestyles Research Centre at Leeds Beckett University, advises we record our successes to motivate ourselves: "Whatever you want to do, whenever you achieve, write it down. You're trying to achieve it every day, so it needs to be nice and small, and all your job is then is to keep the sequence running. It's really as simple as that. What you're capitalising on there is positive self-regard, but also the fundamental process of self-watching. There's a lot of success in seeing your own achievements. When you collect all that up, you can start saying, 'Actually I've got nearly 10 occasions there when I did well, I'm doing well, I'm someone who can change'."
4. Look after your skin
Louise Thomas-Minns (uandyourskin.co.uk), celebrity skin therapist, recommends we pay more attention to protecting and caring for our skin: "Wash your skin nightly. Not removing make-up, daily dirt, oil, grime and pollutants from the skin every night will result in infections and outbreaks. Your skin regenerates at night too, so give it a helping hand. And don't pick! Picking at your skin will result in scarring and create more spotty outbreaks. Wear SPF every day to slow ageing and protect from the harmful effects of UV rays. Find out your skin type from a skin health expert, so you stop wasting time and money on incorrect products."
Read the original article.
Source:
Go Active (6 December 2017). "Health Resolutions You Can Stick To In 2018" [Web blog post]. Retrieved from address https://www.goactiveincumbria.com/get-started/other/article/Health-Resolutions-You-Can-Stick-To-In-2018-e9f9d40d-ca39-48ed-be2e-b2f88f4061eb-ds
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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.
Read the original article.
Source:
Malek M. (4 December 2017). "Benefits to plants at your desk" [web blog post]. Retrieved from address https://workwell.unum.com/2017/12/3255/
It’s the most stressful time of the year: 5 tips to get your employees through the holidays
It’s that time of year again. Employees are preoccupied with thoughts of holiday shopping, party planning and visiting relatives, and the stress of it all can seriously impact their work. So what can you do to help?
While stress is a year-round issue, there are more obvious triggers for it around the holidays. Mark Malis, the head of global human resources at LifeWorks, assembled a list of five common causes of stressduring this time of year, and what you can do to tackle them.
1. Heavier workloads
Employees taking more days off means less time to get things done. It’s hard not to feel overwhelmed with work and holiday deadlines coming up fast.
The fix: Help your employees relax a little by making them feel valued. Let them know their hard work isn’t going unnoticed. You can even encourage employees to identify which colleagues are going the extra mile, and reward them with gifts.
2. Unhealthy eating
Plenty of sugary food options are always floating around during the holidays. All of the cookies and eggnog can really make your employees feel sluggish.
Encourage your employees to make better choices by hosting a healthy potluck. You can even turn this initiative into a weight loss competition to keep the good food choices going.
3. Finances
With the average American shopper expecting to spend almost $1,000 this holiday season, it’s no wonder money is on everyone’s mind.
Financial wellness workshops or budget planning seminars could really help your employees come up with a realistic budget and control their holiday spending. The less they’re worrying about money, the more employees will be able to focus on their work.
4. Depression
The holidays aren’t a joyful time for everyone. Some employees could be struggling with sad memories that resurface around this time of year.
When it comes to mental health, openness is always a good way to go. Encourage employees to discuss these feelings with each other in a supportive group setting. This can allow employees to help each other find solutions and make anxious workers feel less alone.
5. Illnesses
With the holiday season comes cold and flu season, too. Getting sick when you have a million things to get done can be disastrous.
It’s important to remind your employees about good hygiene practices. Make it clear that anyone who’s sick needs to stay home; the last thing you need is half the office out with the flu. Distributing handbooks or posters with tips to stay healthy can be a big help, too.
You can read the original article here.
Source:
Mucha R. (16 November 2017). "It’s the most stressful time of the year: 5 tips to get your employees through the holidays" [Web blog post]. Retrieved from address https://www.hrmorning.com/its-the-most-stressful-time-of-the-year-5-tips-to-get-your-employees-through-the-holidays/
Collaborative Innovation Is Necessary To Advance In Health Care
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As health needs grow, it is imperative that innovation is at the frontier of change, to keep the health needs and requirements of the 21st century scalable. For innovation in health care to be sustained at an economically and fiscally responsible pace, it has to be a collaborative effort, requiring input from diverse stakeholders and key players in the industry. A collaborative health care system that includes information sharing, cross-industry cooperation and open innovation can lead to beneficial industry practices like cost reduction and time efficiency. Together, these practices set a precedent for growth and development at a more rapid pace.
An Efficient Method Of Doing Things
Toeing the line of technology advancements, innovation within the health care system has pioneered the development of cost-efficient, highly-optimized pragmatic solutions to many industry and individual health challenges. Artificial retinas, robotic nurses and gene therapy are just a few examples of plentiful recent innovations. These innovative technologies pose solutions to medical feats that, in the past, have overwhelmed medical practitioners, and thereby are expected to permit better health care delivery to patients and the global population. However, for these new advancements to be successfully implemented and established within the health care system, they must be met with collaboration and cooperation.
Creating A Synergistic Environment
Open, collective innovation like Project Data Sphere, designed to collate big data and bridge the distant segments of the health care industry, markup the necessity of innovation in the sector. In the case of Project Data Sphere, the goal is to facilitate the creation of a connected health care network bereft of the many loopholes characteristic of the system. Interoperability between key segments of the industry has always been a rate limiting factor. A unified platform capable of linking these segments together can have a significant impact on the sector.
Multiple companies are undertaking projects to build "cloud-based, big data platform" solutions that manage data to give the health industry the necessary edge it needs to manage itself. This ranges from cloud-based platforms powered by libraries of clinical, social and behavioral analytics utilized for sharing information across multiple hospitals, to using big data and advanced analytics for clinical improvements, financial analysis and fraud and waste monitoring.
Collaborating To Go Digital
Concurrent with the world’s continued adoption of digital technologies is the rapid expansion of the digital health care market — an expansion fostered by collaboration among global leaders of digital innovation in the health care industry. The partnership between major players in both the private and public sectors has engineered a growing list of innovative digital health care solutions.
Just last year an Israeli-based pharmaceutical company joined forces with Santa Clara, California-based Intel to develop wearables that routinely record and analyze symptoms of Huntington’s disease. The data collected is processed to help grade motor symptom severity associated with the disease.
Most times, singular organizations lack the human and financial resources to orchestrate grand schemes of innovation alone — but collaboration presents a practical route to overcoming the limitations that hinder novelty, leading to quicker turnarounds and advancements.
Scaling The Barriers To Innovation
If the push for innovation in the health care system is to thrive, then the complexities and obstacles that have continually stifled progress must be confronted. Aside from collaboration, other notable barriers to innovation include:
• The immediate return mentality: By default, most leaders show a preference for innovative solutions that offer immediate financial rewards. Innovative solutions with brighter prospects but long term financial incentives are in most instances placed on a back burner.
• Bureaucracy in the distributive network:Innovators have to wade through multiple third parties if they are to stand any chance of getting their products to the end user, a process that is not only daunting but financially implicative.
• Stringent regulatory practices: In addition to scaling through the bureaucracy, innovative solutions looking to make a market appearance have to pass several screenings, some of which have been tagged redundant by experts.
Innovation is a necessary tool in the health care sector that gives an essential boost to scale insurmountable obstacles and limitations. For health care to evolve into a more sophisticated and efficient system, cross-industry collaboration and inter-professional cooperation must become the norm.
You can read the original article here.
Source:
Pando A. (19 September 2017). "Collaborative Innovation Is Necessary To Advance In Health Care" [Web blog post]. Retrieved from address https://www.forbes.com/sites/forbestechcouncil/2017/09/19/collaborative-innovation-is-necessary-to-advance-in-health-care/2/#6743d07669c9
Pagers, AI, And Google: 3 Tales Of Technology And Medicine
As a society, we owe technology applause for helping improve our medical abilities tenfold. Today, we thought it would be fun to take a look back on how technological advancements have succeeded in making our medicine better than ever, and how they continue to do so. Take a moment of your time to read this article from Forbes on Pagers, AI, and Google.
Medicine and technological advancement have been intimately intertwined, from the invention of the stethoscope to the latest innovations in MRI scanning. But the road isn’t always smooth. There can be interesting bumps and glitches along the way, as illustrated by these three recent stories.
1) Old tech can linger
The Guardian recently reported that the UK National Health Service uses more than 10% of the world’s pagers. The pagers cost £6.6 million ($8.9 million) per year. Furthermore, the UK will soon only have one provider of pagers nationwide after Vodafone exits the market.
One critic noted, “Taxpayers will wonder why the NHS is spending millions on outdated technology, especially at a time when savings need to be made.”
As a young doctor in the 1990s, I carried a pager. But nowadays, most physicians I know use cell phones to take emergency calls. However, The Guardian notes that there are still a few advantages to pagers, namely:
...[S]lightly more reliability. Where mobile phone networks can be patchy, or slow, or overloaded, the separate paging network offers a modest improvement in reception and reach, especially in rural areas. Compared with modern smartphones, pager batteries also last much longer.
I can see pagers lingering on for special niche applications. But for most people, their time has passed.
By Jakez (Own work), Creative Commons BY-SA 3.0, via Wikimedia Commons.An old pager/beeper.
2) New tech can be overhyped
I believe that artificial intelligence (AI) will some day have a major impact in the practice of medicine. But STAT News reporters Casey Ross and Ike Swetlitz have described how the IBM Watson AI system “isn’t living up to the lofty expectations IBM created for it.”
Specifically, the Watson for Oncology was intended to help improve cancer care by helping physician with treatment recommendations based on the best available worldwide data
Ross and Swetlitz reported:
While it has emphatically marketed Watson for cancer care, IBM hasn’t published any scientific papers demonstrating how the technology affects physicians and patients. As a result, its flaws are getting exposed on the front lines of care by doctors and researchers who say that the system, while promising in some respects, remains undeveloped...
Perhaps the most stunning overreach is in the company’s claim that Watson for Oncology, through artificial intelligence, can sift through reams of data to generate new insights and identify, as an IBM sales rep put it, “even new approaches” to cancer care. STAT found that the system doesn’t create new knowledge and is artificially intelligent only in the most rudimentary sense of the term.
Because of problems with Watson, the highly-regarded MD Anderson Cancer Center (part of the University of Texas) cancelled its partnership with Watson “amid internal allegations of overspending, delays, and mismanagement.”
I still believe that AI will revolutionize medical care, even if specific products might not (yet) be ready for prime time. I take heart in the fact that the Apple Newton was also a product not ready for prime time — but it did set the stage for the much more successful Apple iPhone and the current mobile technology revolution. Similarly, I think the long-term future of medical AI remains bright, even if specific products may struggle to meet expectations.
3) Current technology can alter the doctor-patient relationship in unexpected ways
Many patients routinely use search engines like Google to find good doctors or to learn more about their physician’s professional qualifications. But to what extent should doctors be searching for information on their patients?
Erene Stergiopoulos discusses this issue in a fascinating essay, “Getting Googled by Your Doctor”:
Searching for patients’ information online gives physicians a way to gather collateral data about a patient who either cannot or will not communicate important clinical information, says Paul Appelbaum, a psychiatrist, professor at Columbia University, and world expert in medical ethics and the law...
That online collateral information is especially useful [in the acute setting, Applebaum] says, where patients may be psychotic, intoxicated, or suicidal. In these acute settings, social media can provide clinicians with valuable context to make decisions — whether the patient uses drugs or alcohol, has self-harmed, or has family support...
However, Stergiopoulos notes that patients can feel betrayed if content from their social media posts ends up in their medical record without their consent.
Furthermore, this can create medico-legal problems:
As more and more providers Google to guide their decisions, they may be shifting the clinical standards to which all practitioners are held... If practitioners neglect that standard, and something preventable goes wrong, they risk accusations of malpractice. In other words, if patient-targeted online searches become the new standard of care, then clinicians could become liable for information patients post online. If a patient leaves a suicidal message on Facebook, and the clinician misses it, there’s a future — seemingly more plausible by the day — in which that clinician could be sued for malpractice if the patient then attempts suicide.
In informal discussions with other health professionals, some colleagues have said they never Google their patients. Others do so selectively. Yet others consider it a legitimate part of conscientious medical practice. And some physicians feel strongly that if patients can Google their doctors, they as physicians should similarly be able to Google their patients.
Clearly, this is an area where medical and legal standards are still evolving. In the meantime, if patients are uncomfortable with their physicians Googling them, they might wish to make their preferences clear ahead of time, before they and their doctor suffer a misunderstanding.
New Regulations Broadening Employer Exemptions to Contraceptive Coverage: Impact on Women
You can read the original article here.
Source:
Sobel L., Salganicoff A., Rosenzweig C. (6 October 2017). "New Regulations Broadening Employer Exemptions to Contraceptive Coverage: Impact on Women" [Web Blog Post]. Retrieved from address https://www.kff.org/womens-health-policy/issue-brief/new-regulations-broadening-employer-exemptions-to-contraceptive-coverage-impact-on-women/
The Trump Administration has issued new regulations that significantly broaden employers’ ability to be exempt from the Affordable Care Act’s (ACA) contraceptive coverage requirement. The regulation opens the door for any employer or college/ university with a student health plan with objections to contraceptive coverage based on religious beliefs to qualify for an exemption. Any nonprofit or closely-held for-profit employer with moral objections to contraceptive coverage also qualifies for an exemption. Their female employees, dependents and students will no longer be entitled to coverage for the full range of FDA approved contraceptives at no cost.
On October 6, 2017, the Trump Administration issued two new regulations greatly expanding the types of employers that may be exempt from the Affordable Care Act’s (ACA) contraceptive coverage requirement. These regulations are a significant departure from the Obama-era regulations that only granted an exception to houses of worship. One of the regulations allows nonprofits or for-profit employer with an objection to contraceptive coverage based on religious beliefs to qualify for an exemption and drop contraceptive coverage from their plans. The other regulation also exempts all but publicly traded employers with moral objections to contraception from rule. These new policies, effective immediately, also apply to private institutions of higher education that issue student health plans. The immediate impact of these regulations on the number of women who are eligible for contraceptive coverage is unknown, but the new regulations open the door for many more employers to withhold contraceptive coverage from their plans.
Contraceptive coverage under the ACA has made access to the full range of contraceptive methods affordable to millions of women. This provision is part of a set of key preventive services that has been identified by the Health Resources and Services Administration (HRSA) for women that must be covered without cost-sharing. Since it was first issued in 2012, the contraceptive coverage provision has been controversial. While very popular with the public, with over 77% of women and 64% of men reporting support for no-cost contraceptive coverage, it has been the focus of litigation brought by religious employers, with two cases (Zubik v Burwell and Burwell v Hobby Lobby) reaching the Supreme Court. This brief explains the contraceptive coverage rule under the ACA, the impact it has had on coverage, and how the new regulations issued by the Trump Administration change the contraceptive coverage requirement for employers and affect women’s coverage.
How do the new regulations change contraceptive coverage requirements for employers?
Since they were announced in 2011, the contraceptive coverage rules have evolved through litigation and new regulations. Most employers were required to include the coverage in their plans. Houses of worship could choose to be exempt from the requirement if they had religious objections. This exception meant that women workers and female dependents of exempt employers did not have guaranteed coverage for either some or all FDA approved contraceptive methods if their employer had an objection. Religiously affiliated nonprofits and closely held for-profit corporations were not eligible for an exemption, but could choose an accommodation. This option was offered to religiously affiliated nonprofit employers and then extended to closely held for-profitsafter the Supreme Court ruling in Burwell v. Hobby Lobby. The accommodation allowed these employers to opt out of providing and paying for contraceptive coverage in their plans by either notifying their insurer, third party administrator, or the federal government of their objection. The insurers were then responsible for covering the costs of contraception, which assured that their workers and dependents had contraceptive coverage while relieving the employers of the requirement to pay for it.
As of 2015, 10% of nonprofits with 5,000 or more employees had elected for an accommodation without challenging the requirement. This approach, however, has not been acceptable to all nonprofits with religious objections.1 In May 2016, the Supreme Court remanded Zubik v. Burwell, sending seven cases brought by religious nonprofits objecting to the contraceptive coverage accommodation back to the respective district Courts of Appeal. The Supreme Court instructed the parties to work together to “arrive at an approach going forward that accommodates petitioners’ religious exercise while at the same time ensuring that women covered by petitioners’ health plans receive full and equal health coverage, including contraceptive coverage.”2
On October 6, 2017, the Trump Administration issued new regulations greatly expanding eligibility for the exemption to all nonprofit and closely-held for-profit employers with objections to contraceptive coverage based on religious beliefs or moral convictions, including private institutions of higher education that issue student health plans (Figure 1). In addition, publicly traded for-profit companies with objections based on religious beliefs also qualify for an exemption. There is no guaranteed right of contraceptive coverage for their female employees and dependents or students. Table 1 presents the changes to the contraceptive coverage rule from the Obama Administration in the new Interim Final regulations issued by the Trump Administration.
Figure 1: Employers Objecting to Contraceptive Coverage: Exemptions and Accommodations Under the Trump Administration Regulations
The accommodation will be available to employers that previously qualified for the accommodation. They now will also have the choice of an exemption. The federal departments issuing the regulations posit that these new rules will have limited impact on the number of women losing contraceptive coverage. However, it is not clear how many employers previously utilizing the accommodation will now opt for an exemption, resulting in the loss of contraceptive coverage for their employees and dependents. In addition, there are also an unknown number of organizations that were not previously eligible for either the accommodation or exemption that may now opt for an exemption. These new regulations create two new categories of employers who can now qualify for an exemption or can voluntarily chooses an accommodation: 1) publicly traded for-profit companies with a religious objection and 2) nonprofit and closely held for-profit employers who have a moral objection to contraceptives, a considerably larger pool of employers than when the exemption was available only to those who were employees of a house of worship or who were eligible for an accommodation in the past.
| Table 1: Summary of Changes in the Contraceptive Coverage Regulations for Objecting Entities | ||
| Obama Administration August 2012 to October 5, 2017 |
Trump Administration Effective October 6, 2017 |
|
| What types of contraceptives must plans cover without cost-sharing? | At least one of each of the 18 FDA approved contraceptive methods for women, as prescribed, along with counseling and related services must be covered without cost-sharing. | No change |
| Are any employers “exempt” from the contraceptive mandate? |
|
|
| Who pays for contraceptive coverage for employees of organizations receiving an exemption? |
|
No change |
What type of employers may seek an “accommodation” to avoid paying for contraceptives in their plans? |
|
|
| Who pays for contraceptive coverage for employees of organizations receiving an accommodation? |
|
No change |
| When can entities change from an accommodation to an exemption? | N/A |
|
How has the contraceptive coverage rule affected women?
Contraceptive use among women is widespread, with over 99% of sexually-active women using at least one method at some point during their lifetime.3 Contraceptives make up an estimated 30-44% of out-of-pocket health care spending for women.4 Since the implementation of the ACA, out-of-pocket spending on prescription drugs has decreased dramatically (Figure 2). The majority of this decline (63%) can be attributed to the drop in out-of-pocket expenses on the oral contraceptive pill for women.5 One study estimates that roughly $1.4 billion dollars per year in out-of-pocket savings on the pill resulted from the ACA’s contraceptive mandate.6 By 2013, most women had no out-of-pocket costs for their contraception, as median expenses for most contraceptive methods, including the IUD and the pill, dropped to zero.7
Figure 2: The Contraceptive Coverage Policy Has Had a Large Impact on Out-Of-Pocket Spending in a Short Amount of Time
This provision has also influenced the decisions women make in their choice of method. After implementation of the ACA contraceptive coverage requirement, women were more likely to choose any method of prescription contraceptive, with a shift towards more effective long-term methods.8 High upfront costs of long-acting methods, such as the IUD and implant, had been a barrier to women who might otherwise prefer these more effective methods. When faced with no cost-sharing, women choose these methods more often9, with significant implications for the rate of unintended pregnancy and associated costs of childbirth.10
Finally, decreases in cost-sharing were associated with better adherence and more consistent use of the pill. This was especially true among users of generic pills. One study showed that even copayments as low as $6 were associated with higher levels of discontinuation and non-adherence,11 increasing the risk of unintended pregnancy.
Do states with no-cost contraceptive coverage laws allow exemptions to objecting entities?
The federal standards under Affordable Care Act created a minimum set of preventive benefits that applied to most health plans regulated by the federal government (self-funded plans, federal employee plans) and states (individual, small and large group plans), including contraceptive coverage for women with no cost-sharing. States have also historically regulated insurance, and many have had mandated minimum benefits for decades. State laws, however, have more limited reach in that they only apply to state regulated fully insured plans, do not have jurisdiction over self-funded plans, where 61% of covered workers are insured.12 In self-funded plans, the employer assumes the risk of providing covered services and usually contracts with a third party administrator (TPA) to manage the claims payment process. These plans are overseen by the Federal Department of Labor under the Employer Retirement Income Security Act (ERISA) and are only subject to federally established regulations.13 The ACA sets a minimum standard of coverage for preventive services for all plans. However, state laws regulating insurance, including contraceptive coverage, can require fully insured plans to provide coverage beyond the federal standards.
Eight states have strengthened and expanded the federal contraceptive coverage requirement (CA, IL, MD, ME, NV, NY, OR, VT). Another 20 states have contraceptive equity laws that require plans to cover contraceptives if they also provide coverage for prescription drugs but they do not necessarily require coverage of all FDA-approved contraceptives or ban cost-sharing (Figure 3).
Figure 3: Many States Have Contraceptive Coverage Requirements
Many of the 28 states that have passed contraceptive coverage laws (both equity and no-cost coverage) have a provision for exemptions, but the laws vary from state to state and only apply to fully insured plans. This means that there may be a conflict between the state and federal requirements when it comes to religious exemptions. In some states with a contraceptive coverage requirement, some employers who are eligible for an exemption under federal law will not qualify for an exemption under state law (Table 2). Employers in those states will have to have to meet the standards established by their state even though they may qualify for an exemption based on the new federal regulations. This conflict may set the stage for future litigation.
| Table 2: State Requirements for No-Cost Contraceptive Coverage | |||||||
| StateDate Effective | Applies to | Coverage required without cost sharing | Exemptions allowed | ||||
| Private plans | Medicaid | With RX all FDA approved | OTC | Vasectomy | Religious | Moral | |
| CaliforniaJanuary 2015 | X | MCOs | X | Narrowly defined nonprofit religious employers | None | ||
| IllinoisJanuary 2017 | X | X | X except male condoms |
Any employer, or insurer with a religious objection | Any employer, or insurer with a moral objection | ||
| MarylandJanuary 2018 | X | X | X | X | X | Religious organizations if the coverage conflicts with the organization’s bona fide religious beliefs and practices | None |
| MaineJanuary 2019 | X | X | Narrowly defined nonprofit religious employers | None | |||
| NevadaJanuary 2018 | X | X | X | Insurers affiliated with a religious organization | None | ||
| New YorkAugust 2017 | X | X | Narrowly defined nonprofit religious employers* | None | |||
| OregonAugust 2017 | X | X | X | Narrowly defined nonprofit religious employers | None | ||
| VermontOctober 2016 | X | X – and all other public health assistance programs | X | X | None | None | |
| NOTES: *Requires the insurer to offer a rider to policyholders so that women will have contraceptive coverage. SOURCE: Kaiser Family Foundation analysis of state laws and regulations. |
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Conclusion
The Trump Administration’s new regulations substantially expand the exemption to nonprofit and for-profit employers, as well as to private colleges or universities with religious or moral objections to contraceptive coverage. It is unknown how many of these employers and colleges will maintain coverage through the accommodation as before and how many will now opt for the exemption leaving their students, employees and dependents without no-cost coverage for the full range of contraceptive methods. As a result of the new regulation, choices about coverage and cost-sharing will be made by employers and private colleges and universities that issue student plans. For many women, their employers will determine whether they have no-cost coverage to the full range of FDA approved methods. Their choice of contraceptive methods may again be limited by cost, placing some of the most effective yet costly methods out of financial reach.
You can read the original article here.
Source:
Sobel L., Salganicoff A., Rosenzweig C. (6 October 2017). "New Regulations Broadening Employer Exemptions to Contraceptive Coverage: Impact on Women" [Web Blog Post]. Retrieved from address https://www.kff.org/womens-health-policy/issue-brief/new-regulations-broadening-employer-exemptions-to-contraceptive-coverage-impact-on-women/
Self funded health care – a big business advantage
Check out this article from Business Insurance by one of their staff writers. In this article, Business Insurance dives into the awesome advantages of self-funding for big businesses.
You can read the original article here.
Health insurance benefits are expensive. The rising costs of health care has driven up insurance premiums to levels where many businesses have been forced to reduce these benefits or drop them altogether. There is, however another option that is less regulated, taxed less and typically results in cost savings: self funded health insurance. The problem is, it's not always the best option for all employers, particularly the smaller ones. And there's a number of reasons for this:
What is self funded health care a.k.a. self-insurance?
Self-insurance is a method of providing health care to employees by taking on the financial liabilities of the care instead of paying premiums to an insurance agency to do the same. In other words: when a person covered under a self-funded plan needs medical care, the company is financially responsible for paying the medical bill (minus deductibles). It's an alternative risk transfer strategy that assumes the risk and liability of medical bills for those covered instead of outsourcing it to a third party. It's a surprisingly common practice:
In 2008, 55% of workers with health benefits were covered by a self-insured plan….and 89% of workers in firms of 5,000 or more employees.
Most (but not all) self-insurance plans are administered by a third party, usually a health insurance company, in order to process claims. The bills are simply paid for by the employer. Health insurance companies act as a third party administrators in what are called ASO contracts (Administrative Services Only)
Another common component of self insurance plans is stop-loss insurance. This is a separate insurance plan that the employer can purchase to reduce the overall liability of claims. With this type of insurance, if claims exceed a certain dollar amount, stop-loss kicks in paying the rest. There are two kinds of stop-loss insurance:
Specific – covers the excess costs from larger claims made by individuals in the group
Aggregate – kicks in when total claims by the group exceed a set amount
For example, a company who self-insures their $1000 employees projects $100,000 in medical care claims for the year. If they purchase aggregate stop-loss insurance for claims that exceed 120% of the expected amount or $120,000, the insurance will pick up the bill for the remaining claims. If the company purchases specific stop-loss insurance at 200%, if any single claim exceeds $2,000, the stop-loss pays the remainder.
Typically, self-funded insurance providers will purchase both specific and aggregate stop-loss insurance unless the conditions are such that specific stop-loss provides enough financial protection.
Benefits of self-insurance
There are a number of financial and administrative advantages to using self-funded health insurance plans for employers. According to the Self-Insurance Institute of America (SIIA) these include:
- The employer can customize the plan to meet the specific health care needs of its workforce, as opposed to purchasing a 'one-size-fits-all' insurance policy.
- The employer maintains control over the health plan reserves, enabling maximization of interest income – income that would be otherwise generated by an insurance carrier through the investment of premium dollars.
- The employer does not have to pre-pay for coverage, thereby providing for improved cash flow.
- The employer is not subject to conflicting state health insurance regulations/benefit mandates, as self-insured health plans are regulated under federal law (ERISA).
- The employer is not subject to state health insurance premium taxes, which are generally 2-3 percent of the premium's dollar value.
- The employer is free to contract with the providers or provider network best suited to meet the health care needs of its employees.
There are, however, some drawbacks to self-insurance policies:
Health care can be costly, so heavy claims years can be extremely expensive
Self insurance isn't tax deductible the same way the costs of providing health insurance is.
Financial benefits are long-term, particularly with an investment component.
Small businesses at a disadvantage
Self insurance is much more prevalent for larger companies mostly because it is easier to predict health care costs from a larger group. The more people in the group, the less potentially damaging a single expensive claim will be to the plan overall. That's why less than 10% of companies with less than 50 employees use self-insurance.
Because risk is more difficult to predict with smaller groups, stop-loss insurance is also more expensive for smaller businesses. The practice of “lasering”, or increasing deductibles for specific higher risk employees can also be much tougher on small firms. As a result, self-insurance tends to be a less cost effective option than it is for larger companies.
Another roadblock for small businesses is a lack of cash-flow that is necessary to finance self-insurance. This doesn't mean, however, that small businesses can't benefit from a self-insurance plan. In fact, an increasing number of small businesses still are. But fully understanding the risks and rewards for doing so can sometimes be difficult.
Regulations
Because the only 3rd party administration of insurance (stop-loss) is between the employer and the insurance company directly, it is not subject to state level regulation the way traditional insurance policies are. Instead, they're regulated by the department of labor under the Employee Retirement Income Security Act – ERISA. Benefit administrators must still comply with federal standards despite the lack of state regulation.
California SB 1431
California is considering a proposed legislation to regulate the sale of stop-loss policies to smaller businesses. On the surface, the regulation looks as though it is an attempt to prevent small businesses from taking on too much risk. But the true intentions of the legislation may be to prevent cherry-picking of generally healthier small businesses (effectively removing them from the health insurance pool). This cherry-picking would theoretically cause traditional insurance premiums to become more expensive.
According to the SIIA, SB 1431 would prohibit the sale of stop-loss policies to employers with fewer than 50 employees that does any of the following:
- Contains a specific attachment point that is lower than $95,000;
- Contains an aggregate attachment point that is lower than the greater of one of the following:
- $19,000 times the total number of covered employees and dependents;
- 120% of expected claims;
- $95,000
This legislation would effectively limit the options of small businesses as it would force them to purchase a more expensive low deductible stop-loss policies. And according to the SIIA, with this legislation, almost no small business under 50 employees would (nor should they) consider self-insurance as an option.
If the legislation is passed in California, it has been suggested that it is only time before other states follow suit and/or enact even stricter regulations on small businesses. The SIIA even has a facebook page dedicated to defeating the bill they say is:
“…unnecessary and will only exasperate the problem that small employers in California face in being able to afford the rising cost of providing quality health benefits to their employees.”
So while self insurance can be a relatively risky option for small businesses, with legislation like this, it could no longer be a realistic option at all… And, in effect: another competitive advantage big businesses will have over their smaller counterparts.
You can read the original article here.
Source:
Staff Writer. (Date Unlisted). "Self funded health care – a big business advantage" [Web Blog Post]. Retrieved from address https://www.businessinsurance.org/self-funded-health-care-a-big-business-advantage/