A Hybrid, Public/Private Model of Health Care

Occupy Healthcare is a movement to influence and impact the future of healthcare, as well as an online community to discuss healthcare reform issues. Recently they invited me to submit my perspectives, and below is what I sent.

Occupy Health Care – a proposal from Wayne Caswell, Modern Health Talk

Historically, the biggest impact in health outcomes has come from public health initiatives such as clean water, sewage systems, and immunization programs. But that success is minimized by a “sick care” system that is profoundly broken, with perverse incentives to view patients as customers, treat symptoms, and pay practitioners for each test, drug and procedure.

ACA is meant to fix that, with more emphasis on positive outcomes and overall health & wellness, both to minimize the need for medical care in the first place and thus reduce costs, and to maintain a healthy and productive workforce that contributes to a vibrant economy. ACA is a good start, but there’s still more work to be done, and it won’t come from private industry or the insurance model, because natural incentives prevent it.

Contrasting Incentives

I believe that the key to health reform is getting the incentives right, and that means getting private insurance companies out of BASIC health care entirely. Their profit motive gives them an incentive to increase costs, knowing that higher costs = more insurance customers paying higher premiums. What I propose instead is a hybrid public/private model that capitalizes on contrasting incentives, eliminates the need for health insurance, and saves over $1 trillion per year.

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CAPABLE means Home, not Nursing Homes, for Seniors

Source: Newswise (6/26/2012) — Nursing homes do not have to be inevitable destinations for frail older adults. Many—even those with long-term health problems—can remain at home and be independent. All it takes is a little help to change “disability” to “capability”.

A handyman with a few nails to fix a wobbly bannister can make the difference between staying at home and a nursing home stay. Visits from a nurse or occupational therapist can help simplify a bewildering medication regimen or improve the ability to get around the house and neighborhood. Simple, inexpensive steps may change the equation for thousands of seniors, but in reality, services like these are rarely available for many at greatest need—the poorest and sickest older adults receiving Medicare and Medicaid.

CAPABLE, short for “Community Aging in Place, Advancing Better Living for Elders,” and a $4 million Health Care Innovation Award from the U.S. Department of Health and Human Services Center for Medicare and Medicaid Services, is about to change that reality. Read More …

The Caregiver: Key to mHealth

By David Lee Scher, MD

The caregiver is an individual who attends to the needs of a child or dependent adult.

Parent as caregiver for her child

There is an estimated ten million caregivers over the age of 50 caring for their parents in the USA.  Caregivers attend to people who are predominantly relatives (86%), with 36% being parents and 14% being children.  One third of caregivers take care of two or more people.  Much has been said about the need for patient engagement and people taking more responsibility for their own care, however caregivers have the unique responsibilities of their own care as well as their charged.  That being said, they require mHealth tools that address both issues.  I will discuss the role of mHealth and the role of the caregiver.  This will not be an endorsement of any specific product.

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Adult Day Centers

eoy appeal mary 2Mary is all smiles these days as she boards the Elderhaven van. At Elderhaven Adult Day Health Center Mary spends the day dancing, listening to music, playing games, and laughing with the new friends in her “crocheting group.”

Last holiday season, Mary’s situation was very different.  Her multiple health and cognitive issues challenged Mary’s family in balancing the demands of caregiving and the demands of working full-time. This overwhelming situation prompted Mary’s family to make the difficult decision to place Mary in a nursing home.

Things began to change earlier this year when one of Mary’s relatives began volunteering at Elderhaven. He observed the loving care extended to the seniors by the Elderhaven staff, and the entertaining activities enjoyed by the clients– dancing, playing games, exercising, and making new friends. After touring the center, Mary’s family enthusiastically agreed that this would be an option that would allow Mary the joy and dignity of living at home with family. Mary would be in a safe and stimulating daytime environment. Mary’s hypertension and other chronic illnesses are now carefully managed each and every day by our full-time nurse.

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IBM Software Aims to Extend Seniors’ Independent Living

IBM Software Aids Research Aimed at Extending Seniors’ Independent Living

IBM "Smart CondoEDMONTON, Alberta and MARKHAM, Ontario, Nov. 8, 2011 /PRNewswire via COMTEX/ — [CASCON]

IBM today announced its software is being used to correlate data from sensors capturing patient activity and replicate that in a virtual world with avatars that represent the elderly subjects in a unique pilot aimed at providing health researchers and students with insights on how to care for Canada’s aging population.

Since June, 2011, University of Alberta researchers in collaboration with Edmonton’s Glenrose Rehabilitation Hospital have been using IBM software to study elderly clients who volunteer to stay in a model, self-contained “independent living suite” at the facility. The suite is instrumented with sensors and equipped with smart devices collecting information about their daily activities.

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Stratus Video Call Center is like a Virtual Waiting Room

Stratus Video Call CenterAs healthcare providers gear up for telehealth, they’ll face new issues such as 24×7 remote monitoring and the need to support virtual doctor visits by telepresence over the Internet. I wrote before here and here, there must be compatibility among different video systems, including the enterprise class-systems in hospitals and consumer-class systems in PC & mobile devices.

Until today, the two prominent solutions I knew about  were Vidyo and a Lifesize Communications technology called ClearSea. Both are cloud-based services that translate between incompatible video systems, but now there’s another option.

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The Hazards of Hospitals (an infographic)

Hazards of Hospitals infographicWhy US Hospitals aren’t nearly as Safe as you think

The infographic below is under a Creative Commons license. Here are some highlights:

We all think of the hospital as a place we go to get better. But hospitals in the United States are making people sicker at alarming rates. Between overtired interns, germ-covered doctors, and haphazard record keeping, you might find yourself in more trouble than you were when you checked in.

Some of the statistics presented include:

  • You’re 30,000 times more likely to die from a hospital visit than a plane crash.
  • 1 in 5 patients suffer harm from medical errors.
  • 1.7 million infections are contracted in hospitals each year.
  • 99,000 die from them.
  • More die from infections each year than from car accidents, breast cancer or aids.

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Mayo Clinic’s Healthy Aging & Independent Living Lab

Mayo Clinic Creates Healthy Aging and Independent Living Lab

Tuesday, June 07, 2011

ROCHESTER, Minn. — Mayo Clinic Center for Innovation (CFI) is pleased to announce a new “living lab” within the Charter House, a continuing care retirement community in Rochester. Charter House has 400 residents and is physically located in Rochester and physically connected to Mayo Clinic. Rochester is one of the nation’s best cities in which to reside, according to Money Magazine.

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Alternative Solutions for Funding Long Term Care

As we age, there’s less need for life insurance and more need for Long Term Care insurance. This guest article describes  converting a life policy into long term care. Some say long term care is only justified if you have enough assets to protect. And can’t we rely on home healthcare instead of expensive institutional care? Let us know what you think in the comments below.

Wealth … Care Planning

Driven by crisis, alternative solutions emerge to pay for long term care

Chris Orestis, Life Care Funding Groupby Chris Orestis, Life Care Funding Group

On February 4th, 2011, Federal Reserve Chairman Ben Bernanke gave a dire warning in a speech before a gathering of top financial policy reporters at the National Press Club in Washington, D.C. “The two most important driving forces for the federal budget are the aging of the U.S. population and rapidly rising health-care costs,” said Bernanke. He warned that the costs of caring for the rapidly growing population of seniors in the U.S. will be an unsustainable burden for the U.S. budget and a constant impediment to economic recovery. As 10,000 Baby Boomers a day started turning 65 on January 1, 2011; the big three entitlement programs, Social Security, Medicare and Medicaid, are all in the red and creating havoc for government budgets at the federal and state levels. This has become the number one concern of the Federal Reserve about the U.S. economy.

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MEDCottage: a place for mom

MEDCottage

MEDCottage introduces new way to care for loved ones

Home health care can avoid higher costs of institutional care in a nursing home or assisted living facility, but making space may be an issue. Fortunately, there are many options. You can give grandma the spare bedroom, convert a garage into living space, remodel the home, or add a small cottage on your property.

That last option is the idea behind MEDCottage, a charming modular home that serves as a “mini-medical facility.” It’s designed like a deluxe trailer for the elderly, but it doesn’t look like a trailer. I like the idea of relying on experts to integrate various systems, where the combined value is greater than the sum benefits of each part.

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You Really Are Paying a lot More For Health Care

Julie Rovner posted this article on the NPR Health blog, but she didn’t include my reader comments, so I’m summarizing key points here and adding my comments afterwards.

  • The good news – Health costs rose 7.3% last year, which was the slowest rate in more than a decade but still nearly 5 times faster than the Consumer Price Index.
  • The bad news – Since 2002, the annual health care cost for American families has more than doubled from about $9,000 to over $19,000.

So what’s driving the increases? It’s not Obama Care, the new federal health law.

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Verizon, Healthsense Bring Solutions to Assisted Living

Alliance Will Promote Cost-Effective Monitoring and Response Systems

NEW YORK (4/27/2011) – Verizon and Healthsense will help bring cost-effective wellness and health monitoring services to planned senior-living communities, under an agreement announced today. [mHealthTalk editor: Healthsense also provides solutions for home healthcare.]

The new services will be offered to senior or assisted-living housing developments utilizing Verizon’s advanced FiOS all-fiber-optic network. Healthsense’s Wi-Fi based technology systems will provide increased independence for residents and added assurance that they are safe.

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Home Health Care: What to consider

By Dr. Robert Schreiber and Pat Kelleher (reprinted with permission of Massachusetts Medical Society)

Our population is rapidly aging. By 2030, nearly 72 million people in the U.S. will be 65 or older. And not only are we aging faster, we’re also living longer: A report just released by the Centers for Disease Control charted U.S. life expectancy in excess of 78 years, the highest it’s ever been.

Additionally, chronic diseases, such as diabetes, arthritis and Alzheimer’s, are affecting more and more people. Whatever the medical condition, whatever one’s age, however frail one may be, the desire remains strong to stay in one’s home, living as independently as possible. Home care may provide some help.

Currently, about 8 million Americans require some kind of medical care in the home, a number that will jump dramatically as people live longer, want to stay at home avoiding nursing homes or other living arrangements, and pressure mounts to control soaring health care costs. If you’ve thought of home care for yourself or a loved one, here are some things to consider.
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You Can’t be too Careful

Mark SegrestBy Mark Segrest

Wayne Caswell and I have teamed up to create a site for discovering and sharing information about today’s Home Health and Aging issues. Wayne will provide technically refined analysis, and I’ll present perspectives from my own family experience.  My Goal here is to share my experience and start discussions on subjects that help other families. So please feel free to comment on any of my posts. I feel we all need all the help we can get.

I will address family issues of having an older relative to care for. My number one suggestion is to PLAN AHEAD, since being ready for the arrival of Grandma will make life much easier for all.

My story includes four phases and some suggestions that could improved the experience.
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