Liverpool Care Pathway

End of life care, while one of the most important questions for anyone facing a terminal illness has turned into a dirty political issue in US. This article talks about an approach taken in the UK known as the Liverpool Pathway. While this type of end of life care may or may not be feasible in the US, I think the Liverpool Pathway can frame the discussion we currently have about end of life in a different manner. Instead of focusing on cost-benefit analysis that drive a majority of policies in U.S. perhaps end of life care should be driven by a different philosophy. The philosophy that patients deserve a kinder death than is currently afforded to them by our medical system, cost shouldn’t matter and we should resist the temptation of pushing palliative care based on a cost benefit analysis. http://www.guardian.co.uk/society/2012/nov/13/importance-open-end-to-life

Dr. Berwick's Pink Slip

This is an old NYTimes op-ed, but it does a good job of summing up what Republican's lost when they refused to confirm Don Berwick as head of the Centers for Medicare and Medicaid Services last year.

Namely: the country lost someone who dared to think of the agency as an improvement organization, and a powerful force for healthcare improvement. In 17 months, he trained executive agency staffers as "improvement coaches" and made strides toward helping health insurers and hospitals find simple ways to improve things like preventing hospital readmissions for chronic conditions.

Imagine what he could do with four more years... Is anyone pushing for this? (Shouldn't we be?)

Dr. Berwick's Pink Slip

Parkinson's Voice Initiative

In the context of our "value" discussions, thought I'd post something about an interesting project I recently heard about, called the Parkinson's Voice Initiative.

Researchers are trying to fine-tune their ability to diagnose Parkinson's over the phone through a 30-second voice test. This method would be much faster, easier and cost-effective than how people are currently screened for Parkinson's, a neurological test performed at a clinic or doctor's office. They're hoping that this will lead to more screenings, earlier diagnosis, and better monitoring for those who already have the disorder.

The initiative aims to collect 10,000 voices (with or without Parkinson's) from around the globe, so if anyone wants to participate, the number's on their website. You'll hear a lovely British lady asking you questions and prompting you to sit up straight and say your vowels.

Here's a Ted Talk about the effort for more details.

Republican concerns about health exchanges

Since the beginning of this course, I have been trying to learn how the Republicans can be so against the insurance exchanges mandated by the PPACA when the original idea was, in fact, a Republican idea.  This week, Forbes magazine has a column written by Avik Roy, who was also a healthcare policy advisor for the Romney campaign, outlining his (Roy's) primary concerns with the exchanges.  As it turns out, his complaint is not with the exchanges themselves but with the mandated minimum requirements for the plans included on the exchanges, and to some extent the requirement for community rating.

I don't necessarily agree with his ideas, but it's refreshing to actually know which ideas I'm not agreeing with!!  I wish he had put forward this coherent of an argument during election season; I would have understood Romney's position better.

Here's the link:
http://www.forbes.com/sites/aroy/2012/11/19/what-states-should-build-instead-of-obamacares-health-insurance-exchanges/

The Impact of Provider Consolidation on Rising Costs

Interesting article on Health Affairs Blog. We have focused on several reasons why health care costs are rising, including technology and changing standards of care, an older and relatively healthier population, and inefficiencies/waste. One thing we almost never talk about is the impact that provider consolidation has on unit price of doctors and hospitals. As insurers and hospitals are continually merging in light of health reform and the impending health exchanges, it will be important to keep an eye on how these consolidations impact rates--particularly for the private insurance market.

Basic Health Plans?

As some of us know, the ACA includes a provision for states to set up a Basic Health Plan (BHP) that would essentially prevent families from churning (the process of losing and gaining coverage) between Medicaid and the exchange, and reduce coverage disruptions. I thought this was an interesting new article that discuss the pros and cons for states thinking about establishing a BHP. The article also notes that California will be considering a bill to establish a BHP in the upcoming special session. It will be interesting to see how the BHP debate in CA will play out, especially since this only now being seriously considered by states on the brink of 2014.

Throughout the ACA conversation, it has been said that little was included to expand the supply of doctors that would meet the needs of the newly insured. This article suggests that the demand for additional doctors is not mainly driven by the ACA, but instead by an aging population:

http://www.washingtonpost.com/blogs/wonkblog/wp/2012/11/16/maybe-obamacare-isnt-driving-the-doctor-shortage/