The posts for this week’s Health Wonk Review are an interesting and varied lot. Accordingly, despite the absence of a post on medical marijuana, we’ll call this a “Pot Luck” edition of the Health Wonk Review.
We start with Peggy Salvatore’s post at Health System Ed. Peggy describes a Google Hangout featuring Peter Diamandis, cofounder of the Human Longevity Institute, which seeks to extend and expand the “healthy, high-performance lifespan.” Diamandis described “Human Nucleus,” a project that could allow you, for a $25,000 payment, to have your genome completely sequenced and analyzed.
“The idea of medicine being this personalized almost runs counter to the notion of population health, but actually it is population health in extremis,” Salvatore writes. “Your highly secure information is first analyzed for your personalized health risk assessment and individual care plan around the assessment. Then your data is aggregated and analyzed along with all the other de-identified data resulting in ongoing machine learning insights.”
Clinton’s Health Care Proposals
From here we move to a post about something that many believe long ago surpassed its “healthy, high-performance lifespan:” the 2016 presidential election. Specifically, Joe Paduda at Managed Care Matters takes a quick walk through the major planks of presumptive Democratic nominee Hillary Clinton’s health plan; he notes that her adoption of more populist planks might be seen as a recognition of Senator Sanders’ influence on her potential voter base. Joe observes that “most striking” among Clinton’s prescription drug pricing proposals:
is the mostly-unformed concept of forcing drug developers to spend a set amount on R&D, with any additional revenues handed back to the Feds for government research on new therapies. This is intended to address the industry’s argument that research costs demand high prices (an oft-criticized and rather doubtful argument). Sounds good, but I doubt—very much—if it could be implemented without causing a lot of problems as drug companies quickly figure out ways to game the system.
Theranos: A Contrarian View
And speaking of prescription drugs, next up is a post about an entity for which longevity projections have been decidedly pessimistic: Theranos. Jaan Sidorov describes his Population Health Blog as “contrarian,” and true to form he offers a more optimistic prognosis for the troubled company, or at least its low-cost, direct-to-consumer blood testing model.
“If not Theranos, then some other company will profit from putting patients in at the center of lab testing. The genie is out of the bottle,” Jaan writes.
Premiums In Colorado Headed For Rocky Mountain Highs?
One of the big health policy discussions this year has been potential changes in premiums and other coverage parameters in the Affordable Care Act’s marketplaces. Louise Norris at Colorado Health Insurance Insider looks at what’s in store for her state’s individual market in 2017.
The short version: Three carriers are leaving the individual market in Colorado and one new carrier is entering, meaning a total of seven carriers will offer individual coverage in Colorado next year. As in other parts of the country, Colorado carriers have requested sharp rate increases, especially in the rural areas, which has sparked the Division of Insurance to study making the entire state one big rating area. Importantly, Norris notes that the Colorado Department of Insurance may not approve requested rate hikes, so final premiums won’t be known for a few months.
What To Expect From ‘Simple Choice’ Plans
Our list features a second post by Louise Norris on the ACA marketplaces, this time at healthinsurnace.org. Louise examines whether the Centers for Medicare and Medicaid Services’ recently announced “Simple Choice” standardized plans will live up to their name and make shopping for appropriate and affordable plans easier for consumers when 2017 open enrollment begins in November.
She observes: “Health Affairs’ Douglas Jacobs has laid out a good case for how standardized plans reduce discrimination against people with significant health conditions, although it’s worth noting that the standardized plan states in the study—California, New York, and Massachusetts—all had strict regulations in terms of cost-sharing for specialty medications” that will not be present in the 2017 Simple Choice plans offered through Healthcare.gov. Stay tuned.
California Moves Toward Truly Universal Health Coverage
At Health Access California, Anthony Wright discusses a new law authorizing California to seek a 1332 waiver to allow all Californians to buy unsubsidized coverage in Covered California, the state’s ACA marketplace, regardless of immigration status. Anthony acknowledges that affordability will still be a barrier for some, but he says the legislation is nevertheless an important symbol of inclusion, as well as a practical benefit for the more than 70 percent of undocumented Californians in mixed-status households, who want to enroll as a family.
Detecting Drug Shortages Early
Here at Health Affairs Blog, Mirielle Jacobson and Hanna Liu offer another post on prescription drugs. Commenting on a May Health Affairs article by Serene Chen and coauthors, Mirielle and Hanna offer some thoughts on ways to better detect and address impending drug shortages:
In an era of electronic ordering systems, social media, big data, and predictive analytics, can we build on existing data sources to create a richer, more complete understanding of current drug shortages? What if those with a Drug Enforcement Administration number, a National Provider Identifier, or some other prescription-related credential could text or upload to a website a report on the difficulty of obtaining a specific drug. While such reporting would be voluntary, it could—assuming enough providers participate—serve as an early warning system, alerting regulators and the public not only to what drugs may be in short supply but where those bottlenecks may be occurring, i.e., in what locations and settings.
Physicians Love Alexa, Too.
David Williams at the Health Business Blog tells us that the Amazon Echo can do more than play Beetles music or tell you what time it is in Germany. The Echo also has many health care uses. Williams notes:
Echo represents the latest example of physicians bringing cutting edge consumer technology into the hospital and running circles around the standard tools offered by the IT department. In the real world, physicians are early and enthusiastic adopters of tools like the iPad and iPhone, and through the ‘bring your own device’ (BYOD) movement they have upended the traditional, clunky hospital IT environment.
A Wearables Privacy Manifesto?
Focusing on a different sort of health technology, David Harlow at HealthBlawg offers a conversation with Michelle De Mooy at the Center for Democracy and Technology; they speak about De Mooy’s year-long collaboration with Fitbit building a culture of privacy, security, and ethics around research involving employee data (and anonymized customer data) recorded by wearable activity trackers. The post and accompanying 20-minute audio offers a look at the development of a framework for data stewardship where none is mandated by government.
Clinical Practice Guidelines: Still Conflicted After All These Years
Five years ago, the Institute of Medicine (IOM) released a report noting that clinical practice guidelines (CPGs) may be influenced by companies that sell health care goods or services, particularly drugs and devices, through their financial arrangements with the organizations that sponsor guidelines and the individuals that produce them. Therefore, the IOM recommended restricting such relationships. At Health Care Renewal, Roy Poses asks how we are doing in implementing the IOM’s recommendations. The short answer, based on a new article: not so well.
So should physicians trust clinical practice guidelines? At least this article suggests they ought to be very, very skeptical of them. The IOM report meant to improve the trustworthiness of practice guidelines seems to be honored mainly in the breach. The likelihood that any given guideline was produced so as to reduce the influence of conflicts of interest on it is low.
Risk Adjustment Games
At InsureBlog, Henry Stern unpacks the numbers behind the Affordable Care Act’s risk adjustment program. Some have argued that insurers are gaming the system by maximizing their risk scores, even if this does not result in an accurate description of their insured populations. Hank offers us some (cold) comfort: “Frankly, I fail to see the problem: carriers are simply following (willfully stupid) rules as intended, with entirely predictable results. When you incentivize a behavior, you tend to get more of it, no?”
Differing Priorities On Cancer Care Funding
What factors matter to cancer patients when funding cancer care, and how do patient preferences differ from those of payers and the general public? Jason Shafrin consults the literature to provide the answer at the Healthcare Economist.
“All three stakeholders were aligned on only eight funding criteria—which primarily encompassed the notions of funding effective, life-saving treatments that can provide patient-relevant health benefits to individuals in need…However, patients (and the general public) also consider ‘access to information,’ ‘autonomy in decision making,’ and the ‘value of hope’, but we found no evidence that payers also share these considerations,” Jason writes.
The Travails Of Workers’ Comp
Finally, the workers’ compensation system is often overlooked in public health policy discussions, yet it’s the backbone of the occupational health system for the nation’s workers. Despite this, Tom Lynch at Workers’ Comp Insider informs us, there is little consistency of benefits or programs in the 50 states and as the years go on, the differences become greater not fewer. Lynch looks at the progress—or lack of progress—in his post.