78 posts categorized "Health Policy"

10/31/2013

Mayes Students 'Already Know More About ACA than Most Docs'

MetrauxLed by Stephen Metraux PhD, interim director of the Health Policy Program, masters and doctoral students in the Department of Health Policy and Public Health are examining the Patient Protection and ACA as it evolves in real time. Here's what he has to say about the course:

Last summer, the faculty the Department of Health Policy and Public Health at University of the Sciences decided to implement a seminar course devoted to the Affordable Care Act for the Fall 2013 semester.  We realized with the exchanges set to come online in October, this would be a unique opportunity to observe and assess policy as it unfolded, and that it would likely entail a wild, unpredictable ride.  As the person who first pitched this idea, I got to facilitate the class.

The course consists of three touch points – studying the nuts and bolts of the ACA based on reading about the act and its implementation; a series of speakers who would come into the class and give in-depth presentations  related to specific aspects of the ACA; and taking time each class to discuss the week’s events related to the ACA.  Taken together, the class has been exciting, interesting and informative. 

The speakers so far have included community perspectives from hospitals, physicians and public health providers, as well as University faculty talking about the economics, political science and occupational therapy perspectives of the ACA.  The nine students enrolled in the class have each taken one of the nine titles (i.e., sections) of the original ACA and have delved into the details.  And finally, the government shutdown, the debacle of healthcare.gov, and the individual policy cancellations have been the backdrop behind a greater awareness and a greater understanding of the headlines.

Based on this, students from the class will, in the upcoming days, provide brief entries for this blog related to specific ACA-related topics upon which they are focusing.  The first entries in this series came from Tom Godfrey, a physician and PhD Health Policy student:


My contribution to this is a top-ten list of general themes about the ACA that have become clear through this course. 

10. To focus on the individual mandate is to miss 90 percent of the ACA.
  9. If you are sick and poor before the ACA you will likely remain sick and poor after the ACA.
  8. The ACA is sitting on the shoulders of over a century of health care reform efforts.
  7. It is possible to have too little income to benefit from the ACA.
  6. Public health never gets the money it needs.
  5. The ACA just ain’t socialized medicine in any form.
  4. To work, the ACA must hit the health care trifecta: simultaneously expanded coverage, improved quality, and reduced costs.
  3. Opponents hate the ACA; proponents see it as a set of necessary compromises.
  2. No one knows whether and how the ACA will work.

[insert drum roll…]

  1. Students in the class already know more about the ACA than most physicians.

Stay tuned.


10/28/2013

Mission Impossible: How to tell if your patients are taking their medications

As a pharmacy student, I’ve been drilled rigorously that medication adherence is a vital cornerstone to effectively treating patients and achieving positive clinical outcomes. Yet with so much emphasis dedicated to ensuring that patients are taking their medications, it is estimated that approximately 20-50% of patients are non-adherent. With such high numbers of patients not adhering, it is crucial that pharmacists find tools and strategies to monitor and improve adherence.

The simplest way to find out if a patient is taking a medication is to ask.  There is a simple 4 question assessment to better gauge whether or not patients take their medications. This scale, the Morisky scale, allows for pharmacists to not only interact with their patients, but also allows him to ‘score’ the interaction and get a better idea of their patient’s compliance. A study using the scale observed that if a patient was found to be compliant, there was a 93% chance that they were indeed compliant (high sensitivity). But the study does lack specificity as indicated by the finding that if a patient was found to be non-compliant, there was a 53% chance that that was indeed the case. The Morisky scale is a great tool to use when interviewing a patient, but again, the low specificity leaves a level of ambiguity.

A more direct, but still primitive method of determining patient compliance is a pill count. While the method is simple, the accuracy of the information gathered is directly dependent on the patient.  Unfortunately, patients could manipulate the number of pills in the vial and you still aren’t certain whether the medication is being taking as directed.  However, one study showed that unannounced pill counts by phone improved compliance in AIDs patients and this method could feasibly be applied to other realms of practice.  While pill counts are an acceptable first line of defense against non-compliance, more advance methods are available.  

With the level of automation in pharmacy nowadays, digital records of refill and prescription pick-ups are simple to compile and interpret. A pharmacist can easily access a patient’s records and observe their refill habits.  It can be determined if the patient is picking up their medications on time and in line with when their quantities should be depleted if the drug is being taken as directed. But as with the pill count, the use of a pharmacy record is limited. The patient could be using multiple pharmacies and the patient’s actual habits cannot be assessed by simply looking at when they come in for a refill. Records are important, but what if a doctor or pharmacist could actually verify the exact time when their patient takes their medication?

The future of medication adherence monitoring could come in the shape of a digital pill. A transmitter the size of a grain of sand can be embedded inside a pill which then can send a text, email, or  tweet to the patient/health care provider when it was taken. This technology could do wonders for patients with high risk disease states like cancer or HIV. While this sounds like science fiction, Proteus Digital Health claims that this incredible technology will be available to
drug companies within the next three years.  

While it seems like a daunting task at times, medication adherence monitoring is an important aspect of what we do as pharmacists. By utilizing the tools discussed, we should be able to improve ompliance and make a positive impact on patient outcomes.

Mackenzie F. Blair, PharmD '15

10/18/2013

The Government Shutdown from a Pharmacy Student's Perspective

With the government shutdown finally being resolved this Thursday, the affect it has had on the American public has taken the form of closed National Parks and a bickering Congress. But the impact of the shutdown goes far beyond what the media and pundits are discussing in their daily rundowns. As healthcare professionals, there are serious ramifications that endangered the public health and the ability of us to treat patients who desperately need care.

While the shutdown didn’t interrupt vital services provided by Medicare, Medicaid, and Veterans Affairs, agencies like the Center for Disease Control (CDC) and Food  and Drug Administration (FDA) were forced to furlough the majority of their employees. The FDA had been forced to furlough 60% of their inspectors which  prevented the FDA from effectively being able to inspect the companies that prepare the food we eat every day. The CDC was unable to monitor outbreaks of disease in the country and even led to 300 people falling ill with salmonella. In addition to  hamstringing the ability of government agencies to protect citizens from disease and contaminated food, the government shutdown also had a negative impact on how clinical trials were being conducted. 

With so much vital research being funded by government grants, and overseen by government agencies, the country’s medical researchers took a serious blow. The National Institute of Health (NIH) in Bethesda, Maryland was being described as a ghost town with countless experiments that relied on live animals and cell lines being put in jeopardy after 73% of its staff were furloughed. With the government shutdown, NIH scientists were not permitted to work and were only given 4 hours to mothball their laboratories at the beginning of the shutdown. From October 1st to the end of the shutdown this Thursday, only 12 patients with extreme circumstances were permitted to enter clinical trials at NIH. A program that accepted hundreds of patients a week was being forced to turn those people away. One such patient who was turned away was Michelle Langbehn. Diagnosed with a rare cancer, Michelle’s only hope for treatment was a study being conducted by NIH; but with the shutdown, NIH simply could not afford to start new trials or support the addition of new patients.

In addition to NIH, college research and academia were also affected. The impact was so great that the University of Michigan created a Q&A page for their researchers which now states that everything is back up and running as of October 17th. Visitors to the vital resource PubMed were greeted by this: “PubMed is open, however it is being maintained with minimal staffing due to the lapse in government funding. Information will be updated to the extent possible, and the agency will attempt to respond to urgent operational inquiries.” PubMed is a resource that is used by thousands of healthcare professionals and students and its limited capacities, as caused by the shutdown, could have very well negatively influenced a pharmacy student’s education or more importantly a clinical decision.

With the shutdown finally over and the Nation’s leaders continuing to point fingers of blame as the media attempts to assign winners and losers in the battle that raged on Capitol Hill, what seems to be lost in all the rhetoric is that patients were denied treatment and researchers were being prevented from discovering tomorrow’s cures. The shutdown might be over for now, but its impact on our public health and medical fields could be felt for years to come.

Mackenzie F. Blair, PharmD '15

10/10/2013

The Pennsylvania Insurance Marketplace

In our last blog, we discussed the state-run exchange operating in Maryland.  In contrast, Pennsylvania, home to some 1.3 million uninsured, is letting the federal government run the exchange.    Back in 2011, it seemed as though PA would be taking the same approach as Maryland by developing its own insurance exchange system.  In 2012, they even went as far as developing a  conceptual draft for a state-run exchange and went even further by putting forth a request for quotations to implement such an exchange.   However, just before the decision to run a state-based exchange was to be filed with the federal government, Gov. Tom Corbett announced that it would be irresponsible to “put Pennsylvanians on the hook for an unknown amount of money to operate a system under rules that have not been fully written.”   As such, PA residents in need of health insurance must use the federal marketplace.    

Uninsured Pennsylvania residents are able to purchase health insurance through Insurance Market place at www.healthcare.gov.   Navigating through the federal marketplace, a family of 4 making $50,000 a year and living in Philadelphia will be able to purchase a Silver level plan for $9,216 annually.   With the appropriate tax credits, the same Silver plan premium becomes $3,365, for a tax-credit savings of $5,851.  The same family could choose a lower-level Bronze plan for only $1,446 annually, still taking into account the $5K+ tax credit.  Taking this lower level plan might save money in premiums, but is likely to result in higher out-of-pocket costs.   For a calculator to help figure out the costs without registering through the Market Place, see here.

 No matter, by January 1st, 2014, all citizens will be required to maintain health coverage in some fashion – if not a penalty will be levied.  For 2014, the penalty will be 1% of income to a maximum of $95 and $47.50 per uninsured adult and child, respectively.   By 2016, these penalties will rise to 2.5% of income or a maximum of $675 per adult ($347.50 per child).  

During its first week of operation, the website users have experienced trouble registering.  The troubles were largely due to high traffic and site overload – a statement in-and-of-itself that Americans are looking for a better way to obtain health insurance.  Once these glitches are resolved, we will get a chance to really see how America is taking to the new age of healthcare
purchasing.

10/04/2013

The Maryland Health Connection is Coming to an Insurance Plan Near You

While many states chose not to act after the passage of the Affordable Care Act to see if the  legislation would get the Supreme Court’s seal of approval, Maryland jumped into action.  Being one of the first 6 states to have their insurance exchanges approved by the federal government, Maryland should have been more than ready for the October 1st deadline that passed this Tuesday.  Spearheaded by Governor Martin O’Malley, Maryland opted to assume the responsibility of operating a state-run system versus a federally managed  exchange. While Maryland chose to operate their own exchange, states run by more politically conservative legislatures have generally opted to let the federal government operate their state exchanges.  State-run exchanges allow for more tailored programs to address the needs of individual states and those people that reside in them, but put the burden of running the program on the state rather than the federal government.   

Branded as the Maryland Health Connection, the Maryland exchange is expected to provide approximately 150,000 of Maryland’s 770,000 uninsured citizens and save the state $850 million over a 10 year period. Maryland’s exchange is governed by a nine member board composed of both experts and representatives for those who will be covered by the exchanges. Maryland Health Connection gives purchasers the ability to compare approximately 45 plans from six different carriers and determine their eligibility for financial assistance to lessen the monthly cost of having insurance. Maryland even opted to expand their Medicaid coverage. Marylanders living at, or slightly above, the poverty line  will be automatically enrolled in the program, and at no cost.  To enroll an individual, a family or a business, one can go to Maryland Health Connection and follow the prompts as instructed.

While the websites were intended to streamline the process and limit confusion, initial reports are coming in that there are glitches in the websites that have hindered peoples’ attempts to enroll; Maryland’s exchange website experienced ‘technical difficulties’ opening day as reported by the Baltimore Sun. Other obstacles include lack of education regarding the law. One such account was documented by the Huffington Post about a Hagerstown, Maryland man, Joseph Kriner, who didn’t know what he was required to bring to enroll himself and his two granddaughters. Armed with only pictures of his family and the wish to get his granddaughters medical attention, he was told to return with the proper documentation. The story of Mr. Kriner is a somber one, but it brings to light the kind of conditions many Americans find themselves in from day-to-day. These people need help and it is the goal of the Affordable Healthcare Act to make quality healthcare available to those who could otherwise not afford it. While the law has its flaws, and the websites are not currently working optimally, it is difficult to deny that this is indeed a step in the right direction.

In future posts we will be examining Pennsylvania’s federally-run exchange program and gauge the impact the opening of the exchanges has had thus far.

Mackenzie F. Blair, PharmD  ’15

10/02/2013

Dean of Mayes College Weighs In on Affordable Care Act

APeterson_250x350Andrew Peterson PharmD, PhD, John Wyeth Dean of Mayes College of Healthcare Business and Policy, recently published an article titled, "Healthcare Exchanges Open for Business" in the Star Life Sciences Medical Monitor.

As of Oct 1, 2013, many U.S. citizens will be able to purchase health insurance through an online marketplace called the Healthcare Exchange. Purchasing insurance through this mechanism is not available to employees who choose to receive insurance through their employer, or citizens who receive Medicare or Medicaid. 

Click here to read the entire article...

As of today, Oct 1st, 2013, many US citizens will be able to purchase health insurance through an online marketplace called the Healthcare Exchange. Purchasing insurance through this mechanism is not available to employees who choose to receive insurance through their employer, or citizens who receive Medicare or Medicaid. - See more at: http://www.starlifebrands.com/healthcare-exchanges-open-for-business/#sthash.6jehUNdO.dpuf

The MarketPlace is Open!

Despite all the ongoing debate in DC over the Affordable Care Act, (ObamaCare),
implementation of a key component rolled out yesterday.   Now, US citizens are be able to purchase health insurance through an online marketplace called the Health Care Exchange.  Purchasing insurance through this mechanism is not available to employees who choose to receive insurance through their employer, or those citizens who receive Medicare.

A key aspect of the law is that each state has the option to setup their exchange (marketplace) or have it partially or fully run by the Federal Government.  Twenty-four states will have a State run or Partnership run marketplace and the remaining states will have a Federal Marketplace.  To qualify for as a member of the marketplace, each plan must offer a minimum set of benefits.  These benefits include Ambulatory/outpatient care, Emergency services, Prescription drugs and Preventive and wellness services as well as other essential health services.

The benefit designs are organized into one of four tiers – also called metal levels: Bronze, Silver, Gold and Platinum – each differ in costs and provider networks.. In terms of deductibles, co-payments and other charges, the Bronze plan covers 60% of a patient's health costs, the Silver 70%, the Gold 80% and the Platinum 90%.    The lower tier plans offer more restrictive plans, such as HMOs (Health Maintenance Organizations) and the higher tier plans use less restrictive networks such as  PPOs (Preferred Provider Organizations).  Patients can go to the HealthCare.gov to find out specifics for their own state. 

The purpose of the marketplace is to encourage competition, reducing the cost of health insurance all the while improving access to health care to all citizens.   However, we will not know until 2014 if the competition aspect worked and not likely for several years if the marketplace translated to more affordable insurance and cheaper health care.   See here for an entertaining and informative video of the Health Care Exchange.

09/26/2013

Mayes College Professor Published in CEA Registry

A study published in 2012 by Amalia M. Issa, PhD, chair of The Department of Health Policy and Public Health,  titled, “Cost effectiveness of gene expression profiling for early stage breast cancer: a decision-analytic model,” has been recently included in the Tufts Medical Center Cost-Effectiveness Analysis (CEA) Registry.

Issa_PortraitThis registry is a comprehensive database of more than 3,604 English-language cost-utility analyses on a wide variety of diseases and treatments. It catalogs information on more than 9,800 cost-effectiveness ratios, and more than 13,500 utility weights published in the peer-reviewed literature. The registry also details studies published from 1976 through 2012, and is regularly updated.

Many of the articles included in the registry are used by policy makers, and are used or cited in analyses performed by the U.S. Environmental Agency, Food and Drug Administration, Institute of Medicine, Medicare Payment Assessment Commission, academia and industry. All articles undergo a rigorous screening and review process prior to their selection and inclusion in the registry.

09/23/2013

Mayes College Student Discusses 'Time and Technology'

Andrew Lyle PhB'15, published an article in Star Life Sciences Medical Monitor on Sept. 20, 2013, titled, "Time and Technology."

Over time, new technology reaches different generations and target markets. As older doctors retire, newly minted medical professionals are taking over— and this new generation of healthcare professionals grew up with computers, video games, and cell phones.

Click here to this entire article.

 

09/19/2013

Learning and Living the Patient Protection and Affordable Care Act in Real Time

This fall, masters and doctoral students in the Department of Health Policy and Public Health at University of the Sciences are examining the Patient Protection and Affordable Care Act (ACA) as it evolves in real time.

MetrauxIn the seminar course led by Steve Metraux, PhD, associate professor of health policy and public health, graduate students meet weekly to discuss topics such as the politics that led to the passage of the ACA, how the ACA fits into the history of healthcare reform in the United States, the legal and constitutional aspects of the ACA, and the nuts and bolts of the ACA.

A range of experts, both from the USciences faculty and from the greater Philadelphia region will join the seminar to lead discussions and explain how the ACA impacts particular facets of health and health care.

But beyond that, the seminar will seek to capture history-in-the-making by following the day-to-day events related to the ACA as its key component, the insurance exchanges, start their open enrollment.

Issa_Portrait“Watching the biggest health policy story in years unfold week by week adds a new dimension of excitement to studying policy,” said Dr. Metraux. “This seminar seeks to provide students with the tools not only to understand how we got here, but also to assess how such policy might likely unfold.”

Amalia M. Issa, PhD, professor and chair of health policy and public health, added, “Our students are going to be on the front lines of healthcare delivery and shaping policy. They need to have an understanding of the Act, apply their critical thinking skills to the issues, and evaluate the impact of the ACA on addressing current and future problems in health systems.”

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