Friday, August 29, 2014

This Ability

Steve Gladstone

Posted August 25, 2014 on Insights for the Blind

Note from Brian: Steve Gladstone is a close friend since childhood and a fixture in South Florida's arts community. In addition to his blindness, which came on in his early 20's from retinitis pigmentos just as he was brought onto (and then released from) the American Shakespeare Company, over the last few years he's also been afflicted with hearing and balance problems. He turned to writing, which I would argue is his best virtue.

A little different something for a Friday post. Enjoy.

You read it right: this ability.

What I can’t do is see.

What I can do is act, write, sing, dance, tell jokes (my best virtue), run a business, listen, observe human behavior, give guidance to my adult children, love, shop for groceries, and water my plants. I can also clean my house (but avoid doing that as much as possible).

I’ve found that most of the world sees my disability first – blindness trumps all my other abilities until people get familiar with me. And then something curious happens – they forget I’m blind.

Often a pal will walk away from me when we’re out and about. We stop to put our plastic bags in the recycling bin in front of the supermarket and my pal takes off without me. Funny stuff. I simply call out, “Hey, did you forget something?”

I’ve always found it curious that folks in our society create an instant opinion of others based on skin color, gender, disability…hey, even clothing, before the first words are uttered between the two parties.

Years ago, when I was selling consumer electronics, an unshaven customer walked into my shop wearing cut-off jeans, flip-flops and a torn sweatshirt. All my salespeople ignored him until he asked for some help. I immediately gave him my full attention. An hour later he was out the door with a $4500 stereo system. Turns out he was an attorney, satisfying his inner slacker on his day off. My sales guys were miffed.

I suppose it’s our nature to judge folks before we get to know them. Must be in our DNA. Where disability is concerned, the ruling seems to be if one part of you is broken, the rest of you must be broken too.

It has occurred to me that Franklin D. Roosevelt might not ever have been elected President if TV sets were abundant in the 1930s. People seeing a man in a wheelchair might have had serious doubts that he could lead this country out of the Great Depression or be a strong Commander-in-Chief as we entered World War II.

Imagine seeing a woman in a wheelchair and instantly becoming interested in her skills rather than her method of ambulating. And then maybe also finding out that she plays basketball and is a med student too. It’s about what we can do, not what we can’t do. It’s about this ability.

By the way, I now only give guidance to my grown children when they ask for it. Unsolicited advice from anyone is unwanted, especially from blind fathers with this ability.

Wednesday, August 27, 2014

IRS to Host Webcast for Employers on Reporting of Minimum Essential Coverage under Tax Code Section 6055

NBCH thanks the American Benefits Council for the information provided in this post.
The Internal Revenue Service (IRS) will host a webcast for employers on September 9 at 2:00 p.m. Eastern Time to describe how applicable large employers should report minimum essential coverage under Internal Revenue Code Section 6055, as required by the Patient Protection and Affordable Care Act (PPACA).

(This follows the agency's recent webcast on employer reporting of health care coverage under Section 6056. A digital playback is available here.)

Code Section 6055 requires every health insurance issuer, including sponsors of self-insured health plans, to file annual returns reporting certain information for each individual for whom minimum essential coverage is provided and to provide a copy of the return to the individual.

On March 5, the Internal Revenue Service (IRS) issued final regulations on Section 6055 reporting, followed by the release of draft forms on July 24. IRS instructions for completing the forms have not yet been released. These reporting requirements will not be effective until 2015 (first reporting is due in early 2016).

The September 9 IRS webinar will cover:
  • Internal Revenue Code Section 6055
  • Who is required to report
  • What elements are required to be reported
  • How do government entities designate reporting
Speakers for the webcast will include Tennille Francis, Tax Law Specialist, IRS office of Federal State & Local Governments; Stephen Tackney, Deputy Division Counsel/Deputy Associate Chief Counsel, IRS office of Chief Counsel; and Jeffrey T. Rodrick, Senior Technician Reviewer, IRS office of Chief Counsel.

Interested individuals can register for the IRS webcast here.

Tuesday, August 26, 2014

Now Politico Tries RUC Raking

Note From Brian: In 2007 I was a Fellow at the first week-long Aspen Health Forum, and found myself in a shuttle to the Aspen Institute campus with Roy Poses, MD, Associate Professor of Medicine at Brown University, and relentless investigative journalist on the blog Health Care Renewal. 

Dr. Poses asked me whether I'd ever heard of the RUC, and I told him that I hadn't. He told me that it was a hugely important but vastly underappreciated issue, and urged me to check it out when I returned home, which I did. Soon afterward, I published an article on The Health Care Blog called Bad Medicine: How the AMA Undermined Primary Care in America. Three years later, with David Kibbe MD, I revisited the subject, first with an article calling for primary care societies to Quit the RUC, and then with a larger campaign that culminated in a lawsuit against Medicare and HHS.

In this article published today, Roy responds to the Politico article by Katie Jennings published late last week, and distills the RUCs problems down to a few key salient points. As usual, he gets to the nub of the problem.

Some readers may dismiss this issue as overly technical or overblown. While it is not the only problem in health care, though, I assure you that it is one of the most central, driving literally hundreds and hundreds of billions of unnecessary dollars every year, and distorting care and cost patterns all through health care. For anyone interested in deeper health care policy dynamics, this is a must read. 

Roy Poses, MD

Posted 8/26 on Health Care Renewal

It has been a year since we wrote about the RUC, the American Medical Association's Relative Value System Update Committee. There is only one thing new since then. Politico just made another attempt to shed some light on this obscure committee and its outsize effect on health care.

Friday, August 22, 2014

Employers should demand hospital participation in quality and safety survey

Originally Posted on Health News Colorado 8/22/14

By Robert Smith

The Leapfrog Group recently issued the results of its 2013 Leapfrog Hospital Survey, an in-depth examination of seven key areas of hospital quality and safety: medication errors, maternity care, high-risk surgeries, Intensive Care Unit (ICU) physician staffing, serious adverse events, safety practices and hospital-acquired conditions (HACs) – including infections in ICUs, pressure ulcers, and injuries.

The report, prepared by Castlight® Health, is based on hospital performance data gathered through the Leapfrog Hospital Survey of 1,437 U.S. hospitals in 2013, the highest hospital participation rate to date in the annual survey.

Selection in Health Insurance Exchanges – Risk or Risk-Adjustment?

Originally posted on August 20, 2014 by 3M Clinical and Economic Research | Reposted on 8/22/2014

Richard Fuller, 3M Health Informatics

The initial focus of media and industry scrutiny during the launch of health insurance exchanges was primarily the potential for adverse enrollee selection of insurance products. Healthier enrollees would opt for less comprehensive packages (or avoid enrollment), while the sicker would obtain more comprehensive coverage. The net result of this situation is the adverse selection-induced, so-called “death spiral.” In fact, the exchanges appear to have successfully captured significant numbers of younger enrollees, with the majority of enrollees opting for the benchmark silver levels. High-cost individuals within the community rated pool are accounted for by the 3Rs – reinsurance, risk-corridors and risk-adjustment, with reinsurance and risk-corridors being phased out as the initial shock of transitioning to the new insurance structure is absorbed.

Will employer-sponsored health insurance survive?

Will the link between employment and health insurance survive?

That’s one of the serious questions that a new report from the Employee Benefit Research Institute (EBRI), a nonprofit research organization based in Washington, D.C., raises about the future of employee benefits.

Paul Fronstin, head of the health research and education program at EBRI, noted that the Affordable Care Act “levels the playing field like it's never been before,” as employees will not necessarily have to depend on getting health coverage through work.

“Employers are just not sure if they'll be offering coverage in the future,” he added.

In fact, the U.S. Congressional Budget Office estimates that 3 million to 5 million fewer Americans will obtain coverage through their employer each year from 2019 through 2022 than would have been the case without the ACA.

Read the full story via Employee Benefit Adviser here.

Thursday, August 21, 2014

Politico: The Secret Committee Behind Our Soaring Health Care Costs

Note from Brian: Some of you may be aware that, in the 3 years prior to my involvement with NBCH, I spearheaded a campaign to highlight and correct the massive influence of a little known AMA committee called the Relative Value Scale Update Committee, or RUC. I worked on this effort with six wonderfully dedicated Augusta, GA primary care physicians, led by Paul Fischer.

Yesterday, reporter Katie Jennings Politico published a very nice Politico investigative article providing background on the effort. More background is here.
L-R: Bob Clark MD, Becca Talley MD; Paul Fischer MD;
Edwin Scott MD; Rob Suykerbuyk MD, Les Pollard MD

Monday, August 18, 2014

IRS Webcast on Reporting Health Care Coverage under Tax Code Section 6056

NBCH thanks the American Benefits Council for the information provided in this post.

The Internal Revenue Service (IRS) will host a webcast on Thursday, August 21 at 12:00 pm ET to describe how applicable employers should report health care coverage under Internal Revenue Code Section 6056, as established by the Patient Protection and Affordable Care Act (PPACA).

Code Section 6056 requires every applicable large employer (generally, an employer that employed on average at least 50 full-time employees or equivalents) to file a return with the IRS that reports the terms and conditions of the health care coverage provided to the employer's full-time employees during the year. Form 1095-C is to be used to satisfy this requirement. Form 1094-C is to be used to transmit these returns.

On March 5, the Internal Revenue Service (IRS) issued final regulations on Section 6056 reporting, followed by the release of draft forms on June 23. Official instructions for completing the forms have not yet been released. These reporting requirements will not be effective until 2015 (first reporting is due in early 2016).

The August 21 IRS webcast will cover:
  • Internal Revenue Code Section 6056
  • Who is required to report
  • What elements are required to be reported
  • When Applicable Large Employers must report
  • How do government entities designate reporting
Speakers for the webcast will include Tennille Francis, Tax Law Specialist, IRS office of Federal State & Local Governments; Stephen Tackney, Deputy Division Counsel/Deputy Associate Chief Counsel, IRS office of Chief Counsel; and Ligeia Donis, Senior Technician Reviewer, Employment Tax Branch, IRS office of Chief Counsel. Tackney and Donis have both appeared on the Council's P4P ... Preparing for PPACA webcast series on implementation topics.

Interested employers can register for the IRS webcast here.

Population Health Alliance Webinars

The Population Health Alliance is launching a new Webinar series based on the framework they released a few years ago. The Webinars are free, begin this Thursday at 12 pm ET and will be offered every other Thursday. Click on the link below to learn more and to register.

Fred Goldstein, PHAs Executive Director and a very experienced and successful population health manager, will speak on approaches that work at NBCH's Annual Conference in November.

Thursday, August 14, 2014

40 Percent of Americans Will Develop Diabetes, CDC Projects

Approximately two out of every five Americans will develop type 2 diabetes at some point during their adult lives, according to new U.S. government estimates.

The ongoing diabetes and obesity epidemics have combined with ever-increasing human lifespans to increase lifetime risk of type 2 diabetes to about 40 percent for both men and women, said lead study author Edward Gregg, chief of the epidemiology and statistics branch in the division of diabetes translation at the U.S. Centers for Disease Control and Prevention (CDC).

Read the full story here.

Infographic: Insights from the Towers Watson/NBGH Employer Survey on Purchasing Value in Health Care

See the Infographic here.

Wednesday, August 13, 2014

U.S. Employers Changing Health Benefit Plans to Control Rising Costs, Comply with ACA, National Business Group on Health Survey Finds

Note from Brian. This press release from our colleagues at the National Business Group on Health bears disappointing news, in my view. The primary strategy for controlling excessive health care costs among respondents to the survey described here - 136 of the nation's largest firms - is to push more risk onto employees and their families.

In the face of evidence of wild overtreatment, egregious unit pricing and a lack of care coordination, large employers, especially if they work together, have the clout to push back. They could refuse to patronize organizations that have these predatory practices, and work with organizations that can demonstrate significantly better health outcomes at lower cost.

I believe there are better, more productive approaches than simply offloading more cost on workers. But they do take collaboration, focus and careful planning.

In any case, see below.


Survey shows costs would increase 6.5% without plan changes; 5% with changes

August 13, 2014

For more information contact:
Ed Emerman

WASHINGTON, August 13, 2014 – Health care benefit costs at large employers are expected to increase 6.5% in 2015, slightly lower than this year’s rate of increase. Most employers, however, say they will be able to stem increases even more as a result of changes they are making to their benefit plans, according to an annual survey released today by the National Business Group on Health, a non-profit association of nearly 400 large U.S. employers. The survey also found that the number of employers offering workers a consumer-directed health plan (CDHP) as the only health benefits option is expected to surge by nearly 50% next year.

Saturday, August 9, 2014

Writing the Value-Based Contract


Originally Posted 8/06/2014 on The Health Care Blog

The kiss in the song from classic movie Casablanca is, at its essence, the seal of approval on a relationship. The kiss is meant to symbolize shared reward (love, potentially) and risk (two souls who share a common set of values but now have new lives) built with other people. The recognizable phrase provides a frame for distilling the rewards (opportunities) and risks in true health care innovation.

Thursday, August 7, 2014

Study: Pharmacist adherence interventions help lower overall health costs

Community pharmacists can dramatically help their patients stick to their prescription regimens, according to a new study led by researchers at the University of Pittsburgh School of Pharmacy. The findings, reported Monday in Health Affairs, also suggest that greater adherence to medications can lead to a reduction in emergency room visits and hospital admissions, thereby lowering healthcare costs for a variety of chronic conditions, including diabetes and asthma.

"The cost savings demonstrated by the Pennsylvania Project should draw the attention of many payers to the value of leveraging pharmacists in the community where their members live to improve health and wellness and reduce overall healthcare costs," said study co-author Jesse McCullough, director of field clinical services at Rite Aid. "This is another area where the value of the pharmacist to the healthcare system is demonstrated."

Read the full story via Drug Store News.  

NBCH's Opportunity Knocks - August 2014

Note: NBCH publishes the Opportunity Knocks eNewsletter to assist NBCH members and their employer members in learning about opportunities, supporting our goals of improving health, transforming health care, community by community. Please note that publication in an Opportunity Knocks eNewsletter is not meant to be construed as an endorsement of any company, product, or service by NBCH. To find out how your company can submit an opportunity for Opportunity Knocks contact Ellen Thomson.

Kmart Pharmacy On-Site Flu Clinics

Flu Facts for the Employer
  • The CDC recommends a yearly flu vaccine as the first and MOST IMPORTANT step in protecting against the flu viruses
  • Flu costs businesses approximately $10.4 billion in direct costs for hospitalizations and outpatient visits for adults
  • The flu vaccine is recommended for everyone 6 months of age and older. Pregnant women, young children, older people, and people with certain chronic medical conditions like asthma, diabetes, and heart disease are at increased risk of serious flue related complications, so getting a yearly flu vaccine is especially important for them.
  • Each influenza (of flu) season is unique and cannot be predicted. On average, approximately five to 20 percent of US residents get the flu each year. Influenza infections are associated with more than 200,000 hospitalizations and thousands of deaths annually in the US.
            Information provided by the CDC and National Business Group on Health.

How Kmart Pharmacy Can Help
  • All pharmacists are certified immunizers and trained in CPR
  • Kmart Pharmacy works with companies of all sizes and can accommodate one location or multiple locations, even in various states.
  • We will come to your workplace site and provide on-site flu clinics to make it more convenient for your staff to get a flu shot
  • We have very competitive pricing for small or large employer groups
Flu Immunization Program Pricing – 2014

Number of flu shots
Price per dose
Pricing and Services offered for non-HD influenza immunizations*
Bronze discount: Less than 50
Kmart Pharmacy will provide on-site service per signed Event License Agreement at the Bronze Discount Tier
Silver discount: 51-100
Kmart Pharmacy will provide on-site service per signed Event License Agreement at the Silver Discount Tier
Gold discount: 101 and above
Kmart Pharmacy will provide on-site service per signed Event License Agreement at the Gold Discount Tier

 Influenza season (September – December 2014)

*HD flu shots are available for $49.99

Kmart Pharmacy also offers a wide range of vaccines, including Pneumococcal, Zoster, Tetanus, Pertussis, Hepatitis A and B, Meningococcal, and Human Papilloma Virus.

For more information:
Ryan Castle
Director, Business Development – Pharmacy
(847) 286-5153