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preventative care Archives - ChangingMedia

Happy Birthday, Obamacare!

By | Health | No Comments

Happy Belated Birthday Obamacare! In just three little years the Affordable Care Act has made some big changes but has a whole lot more to do. All of the law’s provisions won’t be in full effect until around 2020 but that doesn’t mean the law hasn’t made a big impact already.

Most of us have heard that the law has put a tax on using tanning beds, provides free preventative services, lets young adults stay on their parent’s insurance until the age of 26, will require everyone to buy health insurance, and will create health insurance marketplaces called “exchanges.” Most people don’t know the bulk of what the law has done, so in celebration of the birth of Obamacare, here’s just some of what this ambitious law has accomplished. A full list of the ACA timeline can be found here.

Prevention is worth a pound of cure…

A lot of what Obamacare has focused on in the past three years is preventative services. In its first year the law created the National Prevention, Health Promotion and Public Health Council which passed the National Prevention Strategy and the law required any new health insurance plans to include minimum prevention services. It’s been a good few years for primary care doctors too, as their programs have received billions of dollars in funding and new residencies were added for primary care in an attempt to draw more pre-meds to a sorely under-staffed field. In the past few years the ACA has also focused on workplace wellness as it provided grants to small employers with a wellness program, and tax credits to large employers who invested in certain treatment projects.

While all this has been going on, the only thing that the average person might have noticed is new nutritional info on vending machines and at chain restaurants. But even more monumental changes have been made to the two heavyweights of America’s healthcare system – Medicare and Medicaid. A massive assessment of services is underway with the creation of the Medicaid and CHIP Payment Advisory Board. More immediately, the federal government has allowed states to begin to offer home and community-based services through Medicaid, which means more senior centers, transportation, home health aides, meal delivery or anything else that can help someone remain independent living at home.

Closing the doughnut hole…

As for Medicare, one of the biggest changes was tackling the prescription “doughnut hole.” In 2003, when the Bush administration added Medicare Part D to provide for certain types of drug coverage, the provision did not help pay for annual drug expenses between $2,250 and $5,100. Starting in 2010, Medicare patients started receiving $250 in rebates for brand name drugs, and then the following year they could get a 50 percent discount plus federal subsidies for generics. This year they can receive federal subsidies for brand-name drugs. Doughnut hole closed!

Figuring out how we pay for it all…

A lot of the ways in which the ACA is being funded (about 50 percent of it) is through Medicare and many of these funding changes occurred within the past three years. Some of this is funding received through trying out other models of payment instead of fee-for-service such as bundled payment programs and Accountable Care Organizations, which have recently been piloted. Other funding comes from an increase in Medicare Advantage premiums and a decrease in federal subsidies for this program, as well as a reduction in payment for Medicare patients who have been recently re-admitted to the hospital. This year too, wealthy elderly had a Medicare tax increase of 0.9 percent to help pay for the law.

And what it means for you…

For the future, a big obstacle will be getting the word out! The changes that affect everyone (the individual and employer mandate, exchanges, tax credits, Medicaid expansion) begin next year. Don’t delay! Now’s the time to educate yourself about how you’ll be affected and what your options will be. For all of Obamacare’s limitations, you’re sure to find it’s more than a party favor.

IMAGE CREDIT. Foxnews.com.

Disease Prevention is Sexy

By | Health, The Global Is Local | One Comment

Preventative health care is sexy. This is true in politics — as a means of addressing our long-term cost issues — but also to providers and patient advocates in terms of quality. We have heard a lot about preventative care in the last few years, especially with the discussion and passage of the PPACA (the Patient Protection and Affordable Care Act), a.k.a. “Obamacare.” But some argue that preventative care is just as expensive as the alternative.

So, does preventative care actually save money?

Regardless of whether or not it works, lowering costs by increasing preventative care is far from a new idea. A very brief search yielded this 1977 article touting the cost-effectiveness of preventative care. The theory is straightforward, and I will not belabor you with the details. In brief, however, it goes like this:

Some kinds of health care are expensive, and are often tied to chronic physical or psychological conditions. Treating those conditions early and often — improving habits and monitoring various indicators — rather than late and intensively should lower costs overall, since emergency or acute care in hospitals is very, VERY expensive. Oh, and health care expenditures are going up, in case you hadn’t heard.  (And although Medicare and Medicaid are part of the problem, they are far from the biggest part of the story…)

https://upload.wikimedia.org/wikipedia/commons/9/91/U.S._healthcare_GDP.gif

US Healthcare Spending as a Percent of GDP

That’s the short and sweet version. Feel free to look out there on that world wide web for far more in-depth discussion and articles, or look into one of the many excellent books on the subject. Also, I recommend the blog post by my colleague, , who provides analysis of one of the Affordable Care Act’s major provisions, State Insurance Exchanges.

In some form or another, earlier, preventative interventions are the basis for many of our health reform efforts, both current and past. Usually there is some lip service to quality of care, too, but savings sell. They’re sexy.

So what is the problem? Take care of people before they are sick, save money doing it, pat yourself on the back and call it a day!

The problem is simply that preventative care is ALSO expensive. In addition, if preventative care is successful, it may simply delay future costs. This argument is not new either, as Marcia Angell writes in the Journal of the American Medical Association in 1985: “Although preventive care may improve our health, it cannot be assumed to reduce medical costs, since a later death may be as expensive as an earlier one.” There’s also a fantastic study often cited by health economists by Manning et. al. proving that smokers and drinkers who die early based on their unhealthy behaviors actually are a net gain on the health economy.

Let’s circle back to the original question though: Does preventative care lower costs?

To help me answer this question, I had the pleasure of speaking with Doctor Jay Sanders yesterday. Among many other roles, he is a Professor of Medicine at Johns Hopkins University’s School of Medicine. He was quoted in Tuesday’s Kaiser Health News report on health kiosks in Walmart stores. These unmanned kiosks are self-service booths that allow customers to respond to questions about their health, diet, and family health history.

Dr. Sanders argued that the Preventative Care/Cost Reduction situation has been misrepresented. He pointed out that in the short-to-medium term (1-15 years), increased preventative care will almost certainly not decrease costs and instead probably drive them up. This does NOT mean that preventative care will cost more overall. Long term costs will likely come down, but the specifics are yet to be seen, and the time factor has been left out of the discussion.

To be successful, according to Dr. Sanders, health care needs to get smarter, more targeted, and more present for patients. He cites technological innovations, some of which are being developed and implemented here in our region, as potential game-changers. For instance, Under Armour and Zephyr are making items of clothing with embedded technology to monitor vital signs for athletes and gather other information for their coaches. Soon these items will be affordable consumer products that can be tied to our mobile devices, gathering data for us to share with our doctors about heart rhythms, activity levels, and asthma symptoms, among other metrics.

Finally, Dr. Sanders pointed out, the onus is on us as individual patients to generate better outcomes. Smart phones, apps, and wearable technology should make us more aware, at the least.

I agree with him, and I draw a tenuous parallel with democracy. We deserve the health, or government, that we get. If we want something different, we really ought to be more involved. If the Affordable Care Act is successful, we should not necessarily expect that success to be immediate. Instead, a long view is necessary, a chance to allow the experiment to take place.

As a parting thought, keep in mind that our spending as a country has not exactly yielded great results in the past. Quite frankly, a new approach could hardly make things worse:

Life expectancy vs health spending

 

IMAGE CREDITS,  University of California at Santa Cruz Health Atlas;
Organization for Economic Cooperation and Development