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Study: High clinician computer use lowers poor patients’ satisfaction


This  study published in JAMA Internal Medicine reports that “high computer use by clinicians in safety-net clinics {mostly serving the poor}  was associated with lower patient satisfaction and observable communication differences.”

The researchers found:

“Safety-net clinics serve populations with limited proficiency in English and limited health literacy who experience communication barriers that contribute to disparities in care and health. Implementation of electronic health records in safety-net clinics may affect communication between patients and health care professionals. We studied associations between clinician computer use and communication with patients with diverse chronic diseases in safety-net clinics.”

State, Ore. Medicaid provider duking it out


Seemingly tranquil Portland.

There’s a bitter contract dispute underway between the State of Oregon and FamilyCare Inc., a company providing medical care via Medicaid to 128,000 Oregon Health Plan members in the Portland area.

The (Portland) Oregonian reported that Oregon Health Authority Director Lynne Saxton wrote on Dec. 1 to other healthcare groups serving the Oregon Health Plan, which serves low-income people, “inviting them to apply for members served by FamilyCare, Inc. as a ‘precautionary’ move.” This suggests that the two organizations might soon part ways.

“The firm is one of 16 organizations and companies that serve the Oregon Health Plan, managing a slice of the state’s Medicaid budget to care for about one in four Oregonians.”

The Oregonian said that “The Oregon Health Authority and FamilyCare disagree over its 2015 reimbursement rates for services, and the state’s effort to retroactively lower them. The two sides are now in court and FamilyCare also has gone to lawmakers for help, according to the The Lund Report, a health care news Web site. The state’s proposed 2016 reimbursement rates are based on the rates currently in dispute.”

Highmark CEO discusses the great battle of Pittsburgh



In this video, David Holmberg, CEO of Pittsburgh-based health insurer and integrated delivery system Highmark Health, discusses its long and fierce battle with the University of Pittsburgh Medical Center for the region’s healthcare market. Among other things, the says the intense competition has helped build innovation at Highmark.

WellStar to expand into Atlanta


WellStar Health System  will acquire five Tenet Healthcare Corp. hospitals in a deal valued at $661 million.

The purchase will expand Marietta, Ga.-based WellStar’s  reach into Atlanta and add two trauma centers and 26 physician clinics to its  operations.

The shrinkage of out-of-network coverage


Leslie Small, in FierceHealthPayer,  writes about how more and more health insurers are questioning the concept of giving patients unlimited choices.

This f0llows  recent research showing  that insurance companies are offering fewer preferred provider organization (PPO) plans on the exchanges these days.

Kathy Hempstead, who directs coverage issues at the Robert Wood Johnson Foundation, told Ms. Small that, in Ms. Small’s words,  “Insurers are increasingly learning that the out-of-network component of PPO plans is problematic… adding those that made public announcements about dropping PPO plans have been frank about the fact that they’re losing a lot of money.”

An analysis by the foundation found that two-thirds of insurance companies that offered PPO plans last year on Affordable Care Act exchanges have either reduced or stopped offering them.

Ms. Small said that Ms. Hempstead says that, paraphrasing the latter, ”insurers are using network design to control costs because they have a limited ability to raise premiums, as consumers are highly cost-conscious, so instead they must try to lower utilization and limit pricey out-of-network care.”

Because of this trend in plan offerings, “consumers are going to seek less out-of-network care than they did before.”


BlueCross splits from Vanderbilt Medical Center


Part of Vanderbilt University Medical Center.

The Associated Press reports that BlueCross BlueShield of Tennessee has separated from Nashville, Tenn.-based Vanderbilt University Medical Center.

The AP reported that Vanderbilt spokesman John Howser  simply said that the two sides couldn’t reach an agreement. But reported  that BlueCross BlueShield of Tennessee said the companies were unable to successfully negotiate reimbursement rates.


ER physician burnout: Tense work, low control


A study in the Archives of Internal Medicine found, not surprisingly, that physician burnout is highest among emergency physicians. It usefully deconstructed the reasons.

Other high rates were among such other front-line physicians as family medicine, general internal medicine, neurology;  the lowest rates were found among pathology, dermatology, general pediatrics and preventive medicine.

The mean average of those reporting burnout was 45.8 percent,  with  emergency physicians having a 60 percent rate.

“Emergency physicians are a little more aware of burnout because of the intensity of their work,” Shay Bintliff, M.D., told MedPage Today.  He recently stopped working after 30 years as an ER doctor.

“Work environments that are high demand and low control are most likely to lead to burnout. ER docs work for somebody else. They work for a group, a hospital, or a corporation. They don’t have a single individual practice where they call the shots. They are pretty much at somebody else’s mercy.”

One co-op dying as another feels better

By JOHN DALEY, Colorado Public Radio and JEFF COHEN, WNPR

via Kaiser Health News

Thousands of Americans are again searching for health insurance after losing it for 2016. That’s because health cooperatives — large, low-cost insurers set up as part of  the Affordable Care Act — are folding in a dozen states.

The failure of Colorado’s co-op has hit Rick and Letha Heitman hard. They are customers of the Colorado HealthOP, which is closing up shop at the end of the year. The couple, who own a contracting business, say the co-op proved to be a life-saver when Rick was diagnosed with aggressive prostate cancer last spring.

“I owe them for taking care of me. They helped me at a time when I needed it a lot,” he says.

About 80,000 people are in the same boat as the Heitmans, on the hunt for new insurance plans on Colorado’s exchange. HealthOP’s CEO Julia Hutchins says the co-op got walloped by the equivalent of a fast-moving tornado after the federal government said it wouldn’t be paying co-ops millions in subsidies they had expected.

“We were really blindsided by that,” she says. “We felt like we’d done our part in helping serve individuals who really need insurance and now we’re the one left holding the bag.”

And, she insists the co-op was on track to be profitable. Colorado HealthOp is one of 23 nationally in 22 states that opened after the ACA was enacted. The startups were supposed to shake up the traditional marketplace by being member-owned and nonprofit, but it was tough to figure out how much to charge. They needed to estimate how much medical care their customers would use, and they had to do that without data from previous years and without the cushion of a reserve fund. Established insurers can use reserves and experience to recover if they underestimate premium prices in a given year.


Many co-op plans were priced low, and customers poured in. But these new customers had high health costs, so the co-ops had to start paying a lot of bills. The math didn’t add up. On top of that, they were counting on a variety of funding streams from the federal government, and not all of them materialized.

Linda Gorman, with the Independence Institute, a conservative-leaning Colorado think tank, says the new co-ops were in over their heads.

“You shouldn’t go into business counting on federal subsidies,” she says. “The notion that you should beat up on for-profit entities and then form these nonprofits and everything will be magically OK is unfortunate to begin with. We’ve wasted a lot of taxpayer money on that.”

But the HealthOP’s senior IT manager Helen Hadji, a Republican, blames conservatives in Congress for not authorizing the money needed to keep the cooperatives afloat.

“This is a federal failure,” she says. “This is all a political battle to dismantle Obamacare.”

Colorado’s co-op captured 40 percent of the individual market on the state’s exchange. Now as customers, like the Heitmans, hunt for new insurance, they are finding higher prices: They paid about $500 a month last year. Next year, it could be double or triple that.

“You know, that’s a big ‘owee!’” says Letha Heitman.

But it’s the price they’ll pay to keep Rick with the physicians who are treating his cancer.

In Connecticut, the opposite story is playing out. If Colorado saw an early surge in membership because of low prices, Connecticut’s co-op nearly priced itself out of the market in its first year. With rates much higher than its competitors, HealthyCT only got 3 percent of the state’s business under the Affordable Care Act.

“In that first year, the reason we had such low market share was that consumers — new to the industry, new to insurance — most of those individuals bought on price,” says Ken Lalime, who runs the co-op.

And, he says, starting it was hard.

“Nobody’s built a new insurance company in the state of Connecticut in 30 years,” he says. “There’s no book that you pull off the shelf and say, ‘Let’s go do this.’”

Lalime faced the same problem as insurers across the country: He didn’t know who his customers would be, he didn’t know whether they’d be sick or healthy, and he didn’t know how much to charge. It turns out he ended up charging too much.

But even though that meant relatively few signups in year one, the slow ramp-up actually helped. He didn’t have a huge number of claims to pay right out of the gate, and the ones he did pay didn’t break the bank.

“Hindsight, yes, that didn’t hurt us. To be able to take it slowly,” he says.

In year two, he had more competitive average premiums — and his company went from 3 percent market share to 18 percent. For 2016, HealthyCT and the state — after some back and forth — settled on a 7 percent premium hike for customers.

Paul Lombardo is an actuary for the state. He says that bouncing around is an indicator that setting premiums under the Affordable Care Act is still a bit of a gamble. That’s in part because there’s still no good data. So few people signed up with HealthyCT in the beginning that they didn’t have enough information to help set 2016 premiums.

“There wasn’t a lot of data to say, OK, we can use 2014 experience to project forward,” Lombardo says.

For now, at least, Lombardo says HealthyCT is holding its own.

“They’re in good standing,” he says. “The premium we think that we’re setting for 2016 — albeit a little bit higher than they wanted it to be on the revision — is appropriate.”

Enrollment for health insurance in the co-ops runs through Jan. 31 with just 11 of the original 23 co-ops still in business.

This story is part of a reporting partnership with NPR, Colorado Public Radio, WNPR and Kaiser Health News.

On-screen mental-health care at PCP office


There’s a growing movement to integrate mental-health care with primary-care practices in part by using  “virtual therapists” via telehealth technology in the primary-care offices. The Affordable Care Act encourages at least some of this.

As The Washington Post noted ”Integration has become the mantra of many systems nationwide,” and in some places primary-care practices  collaborate with “virtual teams of specialists {usually psychiatric social workers} collaborating with … primary care practices.”

This makes it easier to deal with the national shortage of psychiatrists.

As it is, primary-care doctors are often the only clinicians seeing, and trying to treat,  most patients’ serious mental- and behavioral-health problems — especially in rural areas and in the South generally. They need the help of psychiatric social workers, often communicating with patients on screens, to lessen their loads.


Video: On precision and imprecision medicine


An example of a protein structure determined by the Midwest Center for Structural Genomics.

Text and video panel discussion on “precision medicine” and “imprecision medicine” and why precision medicine isn’t just genomics.

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