Monthly Archives: January 2017

Government-Run Health Care

It would be GREAT if our government could successfully manage American’s Health Care needs. I would be all in if the government guaranteed good health for everyone, and they were even remotely qualified to make such a guarantee. The truth is we all face different health issues at different ages. The recent health issues I faced were handled by doctors, hospitals, and nurses. I had made poor food and exercise choices and suffered a stroke because of those poor choices. Health professionals guided my recovery and no person from the government or from the health insurance company ever visited me while I was hospitalized or in recovery. The task of defining what a health care system looks should be determined by you and your doctor, not the health insurance companies, government, and lawyers that are currently the face of our health system.

The government, i.e. politicians, claim we all need health insurance, but who will pay for the premiums, co-pays, and not-covered illnesses and accidents? Will everyone enjoy good health because they a health insurance policy? Will everyone’s health insurance be free since the ACA has mandated everyone own a policy regardless of their individual health needs or financial position? Basically, at gun-point, ‘rhetorically speaking,’ the government is forcing everyone to purchase health insurance? If legal, where will the money come from to pay the health insurance premiums, or the health professionals who diagnose our illnesses? Where will the money come from to finance the equipment needed to diagnose and/or treat our health needs? Where will the money come from for the buildings needed to house the equipment and the facilities for the infirmed? These are just a few of the questions I have for those who profess the government should be responsible for our individual health needs. The last time I checked the government didn’t have any money to pay for anything unless they taxed you and me to get it.

What, you mean we already have a government-run health care system? Is that why my taxes are so high? Is that why I read in the newspaper recently that the government is paying millions of dollars every year for fraudulent health care claims? Is that why doctors are leaving the government-run health system for the more efficient private practices? Is that why the government is making criminals out of Americans who would rather not purchase health insurance policies? Golly, I hope the government does a better job of running Obamacare than they did managing health needs for our veterans through the Veterans Administration.

County Health Department

As clinical providers seek ways to improve the health of their patients at the population level, one great resource that they should tap is their county health department. There are many resources and skills that health departments will share with physicians and other providers that will improve their ability to improve the health of their patients.

In my work I have had numerous occasions to collaborate with the chief epidemiologist of the Kent County Health Department of Michigan-Mr. Brian Hartl. Through these contacts and through an introductory epidemiology course I have found that health departments are experts at providing population level health services. This is in contrast to most clinical providers who excel at working with their patients on a face-to-face level. Both staff of physician offices and staff of health departments are concerned with the health of individuals and groups of people.

Clinicians most often work with individuals during face-to-face encounters. They treat the disease or injury of an individual one at a time. For instance, if a physician is treating a patient with hypertension, she will plan a course of treatment with the individual in mind. If the physician considers the population level in her work, then she is looking at how the treatments and instructions that she provides affect a group of her patients. For instance, she may consider how effective she is in treating her patients with hypertension collectively.

The patients of a county health department are the population of the county. Only in a few instances do health departments treat individuals one at a time. Much of their work would not be considered clinical interventions. However, their work does affect the population as a whole. For instance, health departments are responsible for seeing that food at restaurants is handled and cooked correctly. Health departments track reports of communicable disease to identify potential clusters or outbreaks, such as measles, in order to mobilize the community and physician groups to respond and prevent further transmission.

Can these two health groups benefit each other in improving the health of their patients and, if so, how? I recently interviewed Brian Hartl about this and he shared some thoughts that I believe can help clinical providers do a better job. As an expert in population level health, Mr. Hartl sees much of his work as preventive in nature. In the emerging world of population level medicine it is important for physicians and other clinical staff to focus on prevention too-prevention of chronic diseases worsening for patients, such as prevention of patients diagnosed with prediabetes advancing to diabetes, and prevention of teen patients from misusing alcohol and other drugs, including tobacco. The Kent County Health Department has many resources that can help physicians achieve their goal and would be very willing to collaborate with clinical groups. In fact, KCHD currently has a grant whose funds can be used to improve patient opportunities for chronic disease prevention, risk reduction or management through clinical and community linkages.

Mr. Hartl believes there is potential to work together with physicians to establish a system for prescribing healthy living activities and lifestyles as non-clinical interventions for the prevention/management of chronic disease. For instance, the Kent County Health Department is actively engaged in helping communities develop walking paths in underserved areas in the City of Grand Rapids. He thinks that patients with chronic diseases can greatly benefit if they became more active by walking. He is willing to share maps and information about the location of such paths so that a physician can prescribe a walking agenda for a patient and then point them to nearby paths that they can easily access.

The Kent County Health Department is also engaged in working with community partners to bring fresh foods to locations in the county where access to fresh fruits and vegetables is difficult. These are known as ‘food deserts’ and often only have retail food stores that are ‘quick markets’ that have only boxed food, such as those found in many gasoline stations. His group is working with such retailers in the community to overcome the barriers to providing fresh foods. Mr. Hartl is willing to share with physician groups the locations of fresh food sources in the community so that clinicians can inform their patients of the locations and improve their food lifestyles.

These are just two examples of information that the health department is willing to share with clinical groups so that their patients can achieve healthy, active lifestyles. Besides information, health departments also have community contacts that could be useful. For instance, the Kent County Health Department works with the YMCA of Greater Grand Rapids, which has a nationally recognized program (the Diabetes Prevention Program) that helps prevent individuals diagnosed with prediabetes from becoming diabetic. The health department also has links with community educators, the Grand Rapids Urban League and prevention groups that focus on the prevention of the misuse of alcohol and other drugs.

As you can see there are many resources that are available from health departments. Will it be beneficial to clinical providers to access these resources? I believe that accessing these resources will help physicians and other clinical providers greatly improve the quality of life of their patients. Also, it will help in improving the outcomes of patients at the population level. This is very important for groups that have risk-based contracts with private payers and for those who serve patients who are covered by Medicare. According to an article in Modern Healthcare dated January 16, 2015, about 40% of all private payer contracts are incentive based now; those with such contracts need to focus on population level health.

There is a treasure of information at the health department for patient-centered medical homes that have patient care coordinators. One of the responsibilities of these coordinators is inform their patients of community resources that would be useful to them. The health department is an excellent source of such information.

The goals of healthcare providers remains to provide safe and high quality care to their patients while their management staff work to improve the bottom line. With the rise of risk based contracts that dictate managing care at the population level, I believe that county health departments can do a great deal to help providers meet their goals.

Population Level Health Management

There has been much discussion of population health management coupled with predictive analytics recently in the health care field. Why? Most who are discussing these topics see it as a means of improving the health of patients while reducing the costs of doing so. Providing better care at lower costs is becoming necessary as payers are beginning to pay for quality outcomes as they move away from fee-for-service.

What is population health and how does predictive analytics fit in? Let me begin by defining population health and illustrate predictive analytics. In statistics, population refers to the complete set of objects of interest to the investigation. For instance, it could be the temperature range of adolescents with measles. It could be the individuals in a rural town who are prediabetic. These two are of interest in healthcare. Population also applies to any other field of research. It could be the income level of adults in a county or the ethnic groups living in a village.

Typically, population health management refers to managing the health outcomes of individuals by looking at the collective group. For instance, at the clinical practice level, population health management would refer to effectively caring for all the patients of the practice. Most practices segregate the patients by diagnosis when using population health management tools, such as patients with hypertension. Practices typically focus on patients with high costs for care so that more effective case management can be provided to them. Better case management of a population typically leads to more satisfied patients and lower costs.

Population health from the perspective of a county health department (as illustrated in last month’s newsletter) refers to all the residents of a county. Most services of a health department are not provided to individuals. Rather, the health of residents of a county is improved by managing the environment in which they live. For instance, health departments track the incidence of flu in a county in order to alert providers and hospitals so that they are ready to provide the levels of care needed.

You should be able to see that the population whose health is being managed depends upon who is providing the service. Physician practices’ population is all the patients of the practice. For county health departments it is all residents of a county. For the CDC it is all residents of the United States.

Once the population is identified, the data to be collected is identified. In a clinical setting, a quality or data team is most likely the body that determines what data should be collected. Once data is collected, trends in care can be identified. For instance, a practice may find that the majority of the patients who are identified as being hypertensive are managing their condition well. The quality team decides that more can be done to improve the outcomes for those who do not have their blood pressure under control. Using the factors from the data that it has collected the team applies a statistical approach called predictive analytics to see if can find any factors that may be in common among those whose blood pressure is not well managed. For instance, they may find that these patients lack the money to buy their medication consistently and that they have trouble getting transportation to the clinic that provides their care service. Once these factors are identified, a case manager at the clinic can work to overcome these barriers.

I will finish this overview of population health management and predictive analytics with two examples of providers using the approach correctly. In August 2013 the Medical Group Management Association presented a webinar featuring the speakers Benjamin Cox, the director of Finance and Planning for Integrated Primary Care Organization at Oregon Health Sciences University, an organization with 10 primary care clinics and 61 physicians, and Dr. Scott Fields, the Vice Chair of Family Medicine at the same organization. The title of the webinar was “Improving Your Practice with Meaningful Clinical Data”. Two of the objectives of the webinar were to define the skill set of their Quality Data Team, including who the members were, and describing the process of building a set of quality indicators.

The clinics were already collecting a large variety of data to report to various groups. For instance, they were reporting data for “meaningful use” and to commercial payers as well as employee groups. They decided to take this data and more and organize it into scorecards that would be useful to individual physicians and to practice managers at each clinic. Some of the data collected was patient satisfaction data, hospital readmission data, and obesity data. Scorecards for physicians were designed to meet the needs and requests of the individual physicians as well as for the practice as a whole. For instance, a physician could ask to have a scorecard developed for him that identified individual patients whose diabetes indicators showed that the patient was outside of the control limits for his diabetes. Knowing this, a physician could devote more time to improving the quality of life of the patient.

Scorecards for the clinic indicated how well the physicians at the site were managing patients with chronic conditions as a whole. With predictive analytics the staff of the clinic could identify which processes and actions helped improve the health of the patients. Providing more active case management may have been demonstrated to be effective for those with multiple chronic conditions.

Mr. Cox and Dr. Fields also stated that the quality data team members were skilled at understanding access, structuring data in meaningful ways, at presenting data to clinicians effectively and in extracting data from a variety of sources. The core objectives of the data team were to balance the competing agendas of providing quality care, making sure that operations were efficient and that patient satisfaction was high.

A second example of population health management focuses on preventing cardiovascular disease in a rural county in Maine-Franklin County. Over a 40-year period, starting in the late 1960’s, a volunteer nonprofit group and a clinical group worked together to improve the cardiovascular health of the residents of the county. As the project advanced, a hospital joined in the efforts.

At the beginning of the prevention efforts, the cardiovascular health of this poor county was below the state average. As volunteers and clinical groups became more active in improving the health of its residents, various cardiovascular measures improved significantly and actually were better in some respects than more affluent counties in the state that had better access to quality health services. The improvements were driven by volunteers who went out into the community to get those identified as being at risk of developing cardiovascular problems involved in smoking cessation classes, in increasing their physical activity and in improving their diets. This led to lowering blood pressure, lowering cholesterol rates and improving endurance.

The results and details of this 40-year effort in Franklin County has been published in the Journal of the American Medical Association in January 2015. The article is “Community-wide CVD prevention programs linked with improved health outcomes”.

As you can see, a population level approach to healthcare provides effective results. A clinic can improve the outcomes of its patients with chronic diseases while balancing costs through improved efficiency by focusing on data at the population level. A community can improve the lives of its residents by taking a population level approach to preventive care. Population level approaches to healthcare are varied and can be very successful if population level theory is correctly implemented. Better results can be obtained pairing it with predictive analytics.

Is Mental Health Covered Under

For people who depend on any type of private or company insurance to cover the cost of their health needs, the question of whether or not the health insurance policy covers mental health problems is a crucial one for a number of reasons.

The idea of a split between physical health and mental health is an old one, and is a fairly arbitrary decision as to which is which some of the time. From a point of view of health insurance, classifying illnesses or diseases can determine whether or not the insurance company will pay for them, and for many people with mental health issues that can literally be a life or death process.

The term mental health can relate to a condition ranging from a fairly mild form of depression through to serious conditions of clinical depression, schizophrenia, alcoholism, full-blown psychotic episodes etc.

Any health insurance policy should specify exactly what types of illness or disease it is willing to provide cover for and those which it is not. This will also include what it specifies as a type of mental health problem or issue and whether or not the insurance policy provides any type of cover for it.

One of the reasons people are wary of health insurance plans with relation to mental health issues, is that often any type of treatment for a mental health issue relates either to what is known as a talking therapy, or some type of pharmaceutical drug based regime.

Any type of talking therapy that is likely to be effective is likely to be a relatively long-term process, depending upon the nature and seriousness of the illness. Any insurance policy that does cover specified mental health conditions will also provide very strict criteria as to what type of talking therapy is covered, for how long and by whom the talking therapy can be carried out by.

The other issue to be really aware of when looking at any type of mental health coverage under a health insurance plan is the nature of deductibles, co-pay and co-insurance. These terms are essentially ways of getting the person who is insured under the policy to bear some of the cost of the treatment on an ongoing basis in relation to the insurance company.

Most people are familiar with the idea of a deductible, sometimes called an excess, in a policy, but any health insurance policy needs to be looked at carefully in terms of what it’s deductibles are. This is because there are often several different deductibles applicable to the same policy, each for differing amounts and applying to different sections of the policy.

This means that a health insurance policy could have both an individual and a family deductible. This deductible could be separate from another deductible that would apply to specific types of drugs, normally where a distinction is made between a generic and a brand-name drug. The amounts involved in terms of these deductibles can be significant, and when taken in addition to any co-pay or co-insurance amounts can stack up into a sizeable burden that the individual will have to carry for themselves.

The Impact Of Shift Work On Health

The health and motivation for shift work has been known to have its own peculiar demands. This has set it apart from jobs that have traditional hours of work. Shift work has its own health merits. The shift work has been created to aid workflow processes between employer, employee and tasks at hand. Over the years, it has been noticed that workers identified in shift work often receive better health plans, health products and remuneration and by this, give shift workers time to do other tasks or personal chores while being watchful of individual mental health.

However, the scientific and medical communities report continually that shift workers concerned stand an increased risk of certain health disorders and mental health challenges that have severe negative impact on the general well-being of work shift staff which may not be achieved until the right health products are used.

There is a concern for the 9 to 5ers, as one sees a case of the health of those who barely get by with the hard life of routine which most times is viewed to compensate only the boss at the top. Furthermore, we sought to consider those who work less conventional hours that include working shifts at night. Any way it is looked at, an adequate welfare plan should be in place for them while introducing supplements of health products.

Researchers have discovered that those more at risk of suffering certain mental health challenges and chronic ailments or diseases, are shift workers, such as flight attendants, police officers, doctors, bartenders, nurses, and the like. Shift work can be classified as any type of work schedule that involves hours that are uncommon, or unusual when comparing this type of work schedule with the traditional work schedule that occurs within the day between 6 am and 6 pm.

For clarity, the term shift work can refer to rotating shifts, working overnight, evening shifts and other flexible shift patterns desired or arranged by the employer that also addresses the challenge of mental health in shift work platforms. In other to assist shift workers, first aid boxes can be kept handy and filled with health products for shift workers.

It’s been recorded by the Bureau of Labor Statistics (BLS), that over 16.8% salary workers and full-time wage workers are employed to work alternative shifts. Another interesting discovery made is that evening shifts are the most common alternative shifts, which have their working hours starting at between 2 pm and midnight. Work schedules may also constantly change as a result of irregular work shifts that also result in mental health and hormonal imbalances.

In this article, we take a look at what the resultant effects of what shift work are, what shift workers can potentially do in other to lower their risks of diverse health problems and what salient reasons could possibly be behind these findings. The mental health and prescribed health products of shift workers should not be left unaddressed as this plays an important role in the health and total well-being of the workers.

At first glance, it appears as though shift workers have and work different hours compared to the regular workers’ typical 9-to-5 routine. Reports also show that this is not the only underlying factor, as one key factor also is an increased risk of some diseases.

Some medical associations such as the Medical News Today have reported on studies that relate lack of usage of health products and increased risk of certain health problems with shift work. These relationships have seen discoveries ranging from the predictable to the most amazing jaw-dropping situations.

A reputable medical journal published a meta-analysis in 2014 which suggested that shift workers face an increased risk of type 2 diabetes. This is a red flag. Taking into consideration, shift workers rotating shifts also face an increased risk of 42%. So we see a need for the inclusion of health products as ready supplements for shift workers.

Interestingly, shift workers who rotate night shifts for 15 years and above were found to potentially increase the health risk of lung cancer mortality and poor mental health. The use of health products will aid these situations enhance longevity and maintenance.