Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday July 27 at 1pm PST 4pm EST are Olympic rower for 2 countries and DiME CEO Jennifer Goldsack, (@GoldsackJen); patient advocate Robin Farmanfarmaian (@Robinff3); Kim Bellard (@kimbbellard); and medical historian Mike Magee @drmikemagee.
You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.
BY KIM BELLARD
On one of the Sunday morning news programs Governors Spence Cox (UT) and Jared Polis (CO) promoted the National Governors Association initiative Disagree Better. The initiative urges that we practice more civility in our increasingly civilized political discourse. It’s hard to argue the point (although one can question why NGA thinks two almost indistinguishable, middle-aged white men should be the faces of the effort), but I found myself thinking, hmm, we really need to do that in healthcare too.
No one seems happy with the U.S. healthcare system, and no one seems to have any real ideas about how to change that, so we spend a lot of time pointing fingers and deciding that certain parties are the “enemy.” That might create convenient scapegoats and make good headlines, but it doesn’t do much to solve the very real problems that our healthcare system has. We need to figure out how to disagree better.
I’ll go through three cases in point:
Health Insurers versus Providers of Care
On one side, there are the health care professionals, institutions, organizations that are involved in delivering care to patients, and on the other side there are health insurers that pay them. Both sides think that the other side is, essentially, trying to cheat them.
For example, prior authorizations have long been a source of complaint, with new reports coming out about its overuse in Medicaid, Medicare Advantage, and commercial insurance. Claim denials seem equally as arbitrary and excessive. Health insurers argue that such efforts are necessary to counter constantly rising costs and well documented, widespread unnecessary care.
Continue reading…BY KIM BELLARD
OK, for you amateur (or professional) epidemiologists among us: what are the leading causes of death in the U.S.? Let’s see, most of us would probably cite heart disease and cancer. After that, we might guess smoking, obesity, or, in recent years, COVID. But a new study has a surprising contender: poverty.
It’s the kind of thing you might expect to find in developing countries, not in the world’s leading economy, the most prosperous country in the world. But amidst all that prosperity, the U.S. has the highest rates of poverty among developed countries, which accounts in no small part for our miserable health outcomes. The new data on poverty’s mortality should come as no surprise.
The study, by University of California Riverside professor David Brady, along with Professors Ulrich Kohler and Hui Zheng, estimated that persistent poverty – 10 consecutive years of uninterrupted poverty – was the fourth leading cause of death, accounting for some 295,000 deaths (in 2019). Even a single year of poverty was deadly, accounting for 183,000 deaths.
“Poverty kills as much as dementia, accidents, stroke, Alzheimer’s, and diabetes,” said Professor Brady. “Poverty silently killed 10 times as many people as all the homicides in 2019. And yet, homicide firearms and suicide get vastly more attention.”
The study found that people living in poverty didn’t start showing increased mortality until in their 40’s, when the cumulative effects start catching up. The authors note that these effects are not evenly distributed: “Because certain ethnic and racial minority groups are far more likely to be in poverty, our estimates can improve understanding of ethnic and racial inequalities in life expectancy.”
Continue reading…BY KIM BELLARD
I was at the barbershop the other day and overheard one barber talking with his senior citizen customer about when – not if – robot AIs would become barbers. I kid you not.
Now, I don’t usually expect to heard conversations about technology at the barber, but it illustrates that I think we are at the point with AI that we were with the Internet in the late ‘90’s/early ‘00s: people’s lives were just starting to change because of it, new companies were jumping in with ideas about how to use it, and existing companies knew they were going to have to figure out ways to incorporate it if they wanted to survive. Lots of missteps and false starts, but clearly a tidal wave that could only be ignored at one’s own risk. So now it is with AI.
I’ve been pleased that healthcare has been paying attention, probably sooner than it acknowledged the Internet. Every day, it seems, there are new developments about how various kinds of AI are showing usefulness/potential usefulness in healthcare, in a wide variety of ways. There’s lots of informed discussions about how it will be best used and where the limits will be, but as a long-time observer of our healthcare system, I think we’re not talking enough about two crucial questions. Namely:
Now, let me clarify that these are less unclear in some cases than others. e.g., when AI assists in drug discovery, pharma can produce more drugs and make more money; when it assists health insurers with claims processing or prior authorizations, that results in administrative savings that go straight to the bottom line. No, the tricky part is using AI in actual health care delivery, such as in a doctor’s office or a hospital.
Continue reading…BY KIM BELLARD
Two new books have me thinking about healthcare, although neither is about healthcare and, I must admit, neither of which I’ve yet read. But both appear to be full of ideas that strike me as directly relevant to the mess we call our healthcare system.
The books are Atlas of the Senseable City, by Antoine Picon and Carlo Ratti, and Recoding America: Why Government Is Failing in the Digital Age and How We Can Do Better, by Jennifer Pahlka.
Dr. Picon is a professor at The Harvard Graduate School of Design, and Professor Ratti is head of MIT’s Senseable Lab. Drawing on the Lab’s work, they write: “We hope to reveal here an urban landscape of not just spaces and objects, but also motion, connection, circulation, and experience.” I.e. dynamic maps. Traffic, weather, people’s moment-by-moment decisions all change how a city moves and works in real time.
Dr. Picon says.
These maps are a new way to apprehend the city, They’re no longer static. Maps provide a way to visualize information. They’re crucial to diagnosing problems. I think they provide a new depth…It’s a little bit like the discovery of the X-ray. You can see things within cities that were not previously accessible. You don’t see everything, but you see things you were not able to see before.
So I wondered: what would a dynamic map of our healthcare system look like?
I’m telling you, just a map of what happens between drug companies, PBMs, health plans, pharmacies, and patients would open people’s eyes to that particular insanity in our healthcare system. Now repeat for the millions of other ecosystems in our healthcare system. If that kind of dynamic mapping — showing all the complexities, bottlenecks, circuitous routes, and redundancies within the system — wouldn’t lead to health care reform, I don’t know what would.
Continue reading…BY KIM BELLARD
If you live, as I do, anywhere in the Eastern half of the country, for the past week you’ve probably been thinking about something you’re not used to: wildfires. Sure, we’ve all been aware of how wildfires routinely plague the West Coast, particularly Oregon and Washington, but it’s novel for the East. So when the smoke from Canadian wildfires deluged cities through the East and Midwest, it came as kind of a shock.
For a day last week, New York City supposedly had the worst air quality in the world. The next day Philadelphia had that dubious distinction. The air quality index in those cities, and many others, got into the “Maroon” level, which means it was hazardous for everyone. Not just for the elderly and other “sensitive” groups, and not just some risk for some people, but hazardous for everyone.
If you didn’t know about AirNow.gov before, you should now.
New Yorkers are used to smog and air quality that is less than idyllic, but smoke from wildfires, containing fine particulates that easily get into the lungs, weren’t something anyone was prepared for. “Wildfires were not really a scenario, in all honesty, that I recall us specifically contemplating,” Daniel Kass, New York City’s deputy commissioner for environmental health from 2009 to 2016, admitted to NBC News.
“People on the East Coast aren’t used to seeing these types of situations. There was a much slower response,” Peter DeCarlo, an associate professor of environmental health and engineering at Johns Hopkins University, also told NBC News. “We can probably learn a thing or two from our West Coast friends.”
Continue reading…
Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday June 8 at 1PM PT 4PM ET are privacy expert Deven McGraw (@healthprivacy); Queen of employer benefits Jennifer Benz (@Jenbenz); THCB regular writer and ponder of odd juxtapositions Kim Bellard (@kimbbellard); and policy expert consultant/author Rosemarie Day (@Rosemarie_Day1);
You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.
BY KIM BELLARD
As many of you did, I followed the recent debt ceiling saga closely, and am relieved that we now have a compromise, of sorts. The House Republicans demanded a lot of things, most of which they did not get, but one area where they did prevail was in toughening work requirements for food (SNAP) and income (TANF). They somehow believe that there are uncounted numbers of “able-bodied” people sitting around on their couches collecting government benefits, a myth that goes back to Ronald Reagan’s welfare queen stereotype, and have long advocated work requirements as the remedy.
Ironically, according to the CBO, the work requirements passed may actually increase federal spending by as much as $2b, and increase the number of monthly recipients by as many as 80,000 people, but who’s counting?
All this seems timely because of some new studies that illustrate – once again — that, yes, poverty is bad for people’s health, and helping them get even a little bit more out of poverty improves their health.
Continue reading…BY KIM BELLARD
If you’ve been following artificial intelligence (AI) lately – and you should be – then you may have started thinking about how it’s going to change the world. In terms of its potential impact on society, it’s been compared to the introduction of the Internet, the invention of the printing press, even the first use of the wheel. Maybe you’ve played with it, maybe you know enough to worry about what it might mean for your job, but one thing you shouldn’t ignore: like any technology, it can be used for both good and bad.
If you thought cyberattacks/cybercrimes were bad when done by humans or simple bots, just wait to see what AI can do. And, as Ryan Health wrote in Axios, “AI can also weaponize modern medicine against the same people it sets out to cure.”
We may need DarkBERT, and the Dark Web, to help protect us.
A new study showed how AI can create much more effective, cheaper spear phishing campaigns, and the author notes that the campaigns can also use “convincing voice clones of individuals.” He notes: “By engaging in natural language dialog with targets, AI agents can lull victims into a false sense of trust and familiarity prior to launching attacks.”
Continue reading…BY KIM BELLARD
I saw an expression the other day that I quite liked. I’m not sure who first said it, and there are several versions of it, but it goes something like this: let’s make better mistakes tomorrow.
Boy howdy, if that’s not the perfect motto for healthcare, I don’t know what is.
Health is a tricky business. It’s a delicate balancing act between – to name a few — your genes, your environment, your habits, your nutrition, your stress, the health and composition of your microbiome, the impact of whatever new microbes are floating around, and, yes, the health care you happen to receive.
Health care is also a tricky business. We’ve made much progress in medicine, developed deeper insights into how our bodies work (or fail), and have a multitude of treatment options for a multitude of health problems. But there’s a lot we still don’t know, there’s a lot we know but aren’t actually using, and there’s an awful lot we still don’t know.
It’s very much a human activity. Different people experience and/or report the same condition differently, and respond to the same treatments differently. Everyone has unique comorbidities, the impact of which upon treatments is still little understood. And, of course, until/unless AI takes over, the people responsible for diagnosing, treating, and caring for patients are very much human, each with their own backgrounds, training, preferences, intelligence, and memory – any of which can impact their actions.
All of which is to say: mistakes are made. Every day. By everyone.
Continue reading…
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