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Monthly Archives: October 2015

A Med School Teaches Science And Data Mining

Medicine, meet Big Data.

For generations, physicians have been trained in basic science and human anatomy to diagnose and treat the individual patient.

But now, massive stores of data about what works for which patients are literally changing the way medicine is practiced. “That’s how we make decisions; we make them based on the truth and the evidence that are present in those data,” says Marc Triola, an associate dean at New York University School of Medicine.

Figuring out how to access and interpret all that data is not a skill that most physicians learned in medical school. In fact, it’s not even been taught in medical school, but that’s changing.

“If you don’t have these skills, you could really be at a disadvantage,” says Triola, “in terms of the way you understand the quality and the efficiency of the care you’re delivering.”

This KHN story also ran on NPR. It can be republished for free (details). logo npr

That’s why every first and second year student at NYU Medical School is required to do what’s called a “health care by the numbers” project. Students are given access to a database with more than 5 million anonymous records — information on every hospital patient in the state for the past two years. “Their age, their race and ethnicity, what zip code they came from,” Triola lists, as well as their diagnosis, procedures and the bills paid on their behalf.

The project, funded in part by an effort of the American Medical Association to update what and how medical students are taught, also includes a companion database for roughly 50,000 outpatients. It’s called the Lacidem Care Group. (Lacidem? That’s “medical,” backwards). It contains data from NYU’s own faculty practices — scrubbed to ensure that neither the patients nor the doctors can be identified. Students can use tools provided by the project to “look at quality measures for things like heart failure, diabetes, smoking, and high blood pressure,” says Triola. “And drill down and look at the performance of the practice as a whole and individual doctors.”

(Left to right) Christine Schindler, Mary Quien and Micah Timen hold a study session. Timen worked as an accountant before medical school; his database project tracked the relative costs of a hip replacement throughout New York compared to the relative costs of a fast-food hamburger.(Photo by Cindy Carpien for KHN/NPR)

(Left to right) Christine Schindler, Mary Quien and Micah Timen hold a study session. Timen worked as an accountant before medical school; his database project tracked the relative costs of a hip replacement throughout New York compared to the relative costs of a fast-food hamburger. (Photo by Cindy Carpien for KHN/NPR)

Some students have taken to the assignment with relish. Second-year student Micah Timen is one. Timen likes numbers. A lot. A former accountant before applying to med school, he keeps a spreadsheet to track his study hours before a test. An upcoming test is on the digestive system. “So I know I have 18 hours and 40 minutes left to make sure I feel comfortable walking into my exam,” he says.

For his project, Timen wanted to know if the cost to patients of hip replacement surgery around the state vary as much as the cost of a fast-food hamburger. Timen says they tried comparing hip replacement costs using The Economist magazine’s famous Big Mac Index, which measures purchasing power between currencies. “But when you call McDonald’s, they don’t give you prices over the phone,” he said. So he tried Plan B: “Burger King gave it to me.”

Using his “Whopper Index” instead, Timen found, not surprisingly, that the price of a giant burger sandwich is higher in New York City than, say, Albany. So, too was the amount patients paid for their hip replacements. But the margin was much wider for health care than for hamburgers, meaning patients are paying more in some places than simple geography would suggest. Timen says he’d like to explore why that might be, “but unfortunately med school is a little bit time-consuming,” so that may have to wait.

Still, it turns out the classes appeal not just to data “junkies,” like Timen, but also to those who were not already steeped in crunching data.

“I really have no statistical background,” says Justin Feit, also a second year student. “I don’t even know how to use Excel well.”

So Feit was partnered with Jessica Lynch, who already has a PhD — in physics. She says that if medicine wasn’t moving in the direction of more data interpretation, “I don’t know if I would have gone into medicine.”

Together Feit and Lynch looked at the rates of cesarean births around the state – and, like the cost of hip replacements, found that C-section rates varied widely. But their project will get more than just a grade. A faculty member at NYU is using it as part of a bigger research project headed for publication.

Triola says he hopes that will happen more and more.

“With literally millions of records, these in-class student projects often involved more patients than the published literature. It’s incredible,” he said.

And the concept of having students learn to use health data is catching on quickly. Triola says NYU is offering its database and program to other medical schools; seven are already incorporating it into their curriculum.

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Alaskans Face Tough Choices Because Of High Insurance Costs

Gunnar Ebbesson is used to paying a lot for health insurance, but the small business owner from Fairbanks got a shock recently when his quote came in for next year’s coverage.

“I don’t understand who can afford this? I mean who really can afford this?” he says.  “I can pay it, but I can’t afford it.”

The premium for his family of five came to more than $40,000 a year. That’s for a bare bones plan with a $10,000 deductible that he buys through the marketplace set up by the Affordable Care Act.

This story is part of a partnership that includes Alaska Public Media, NPR and Kaiser Health News. It can be republished for free. (details)logo npr

Customers can begin buying plans on HealthCare.gov starting on Nov. 1 and do so through Jan. 31, 2016.  Rates for individual health plans went up an average of 7.5 percent nationally. Within that not-too-alarming average are outliers. Some states saw their average rate go down; others saw a big percentage leap from a reasonable starting price. For instance, Boise, Idaho, saw a 30 percent spike in premiums from about $210 to $273 a month.

But Alaska is a special case.  It has the highest premiums in the country, and it has seen some of the highest percentage increases over the past two years. That makes paying for insurance especially difficult for families like the Ebbessons.

Ebbesson doesn’t qualify for a subsidy to help pay for insurance because his family income is more than $142,000 a year. But, he says, his insurance costs more than his mortgage.

Enrollment Season

Looking for health insurance? Enrollment opens Nov. 1, and here’s what you need to know:

  • Exchanges Face Sign-up Challenges As Health Law’s 3rd Open Enrollment Begins
  • Enrollment Guide: A Few Tips To Help You Shop For A New Marketplace Plan
  • Marketplace Customers Could See Higher Premiums, No Coverage For Out-Of-Network Care
  • Premiums For Key Marketplace Silver Plans Rising An Average Of 7.5 Percent, HHS Says

“I’m not able to put money in retirement, savings for my kid for college, my ten year old. Believe me I could find lots of stuff to do for my future with $40,000,”  he says.

Ebbesson supports the Affordable Care Act. He calls the Alaska rates a wrinkle in the law that needs to be fixed.

The average 2016 premium for a Ȉ-year-old in Anchorage is $719 a month – more than double the national average, according to an analysis by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

Most Alaskans, and most Americans, qualify for a subsidy that rises with premium increases – insulating consumers from big jumps. But about 5,0Ǡ Alaskans pay full sticker price.

“We want people to have access to affordable coverage and that’s not happening right now in the marketplace in Alaska,” says Eric Earling, a spokesman with insurer Premera Alaska.

Premera is one of only two companies selling on Alaska’s exchange. Earling says even with the high prices, the company is losing millions of dollars on Alaska’s tiny individual market.  In the first six months of this year, 37 Premera customers filed over $11 million in claims, Earling says.

“The important thing is they deserve access to coverage, and we’re glad they have it,” he says. “The trick is creating a sustainable environment where those costs can be absorbed in a way that doesn’t adversely impact all consumers.”

Premera is backing legislation to use Alaska’s high risk pool, which will allow the biggest claims to be paid by a special fund.

Victoria Cronquist shops for lower cost health insurance at her Anchorage home. She may drop coverage. (Photo by Annie Feidt/APRN)

Victoria Cronquist shops for lower cost health insurance at her Anchorage home. She may drop coverage. (Photo by Annie Feidt/APRN)

The state’s Division of Insurance hasn’t taken a position on the idea.

Victoria Cronquist is a dental hygienist in Anchorage. She doesn’t care what the solution is, as long as it helps her find more affordable insurance.

“It’s just getting too expensive,” she says. “I’m up against the wall. I can’t do it all.”

This year, she pays $1,600 a month for herself, her husband and two kids, ages 16 and 20. She gets a stipend from her work to help pay that premium, but her rate is going up to $2,600 a month next year. And her stipend isn’t going up. Cronquist says she may cancel her insurance.

“To be quite frank, to have a $2,600 monthly premium payment and all this is stressful to me. Extremely. And that increases my odds of getting ill! That’s the other way I look at it,” she says.

Cronquist doesn’t take the decision lightly. Her family has dropped health coverage in the past. And they paid the price when her daughter ended up in the ICU a few months later.

Ebbesson also has a difficult decision ahead.  He’s thinking about dropping his policy and saving money instead. Ebbesson says his family could fly to Thailand for any big medical procedures that were necessary. If something catastrophic happened though, it would put his family in a tough position.

“It’s a scary proposition. There’s always bankruptcy but, my goodness, why should I be having to even think about things like that related to my health insurance?” he says.

The high rates will push more Alaskans into a category that allows them to avoid paying the penalty for going uninsured. The law includes an “unaffordability” exemption if the lowest cost insurance amounts to more than eight percent of income.

This story is part of a reporting partnership with NPR, Alaska Public Media and Kaiser Health News.

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It’s Open Enrollment Time: What To Know About Obamacare Costs

Enrollment Season

Looking for health insurance? Enrollment season is here, and here’s what you need to know:

  • Exchanges Face Sign-up Challenges As Health Law’s 3rd Open Enrollment Begins
  • Enrollment Guide: A Few Tips To Help You Shop For A New Marketplace Plan
  • Marketplace Customers Could See Higher Premiums, No Coverage For Out-Of-Network Care
  • Premiums For Key Marketplace Silver Plans Rising An Average Of 7.5 Percent, HHS Says

KHN’s Mary Agnes Carey appeared on PBS NewsHour to talk about the impending open enrollment season to buy health insurance coverage on healthcare.gov and online state marketplaces.

Consumers can buy plans starting Sunday.

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California Targets African Americans And Latinos In New Round Of Obamacare

Covered California still faces major challenges in enrolling African-Americans and Latinos as the state’s health insurance exchange launches its third open enrollment period Sunday.

“We know we’ve come up short in who’s enrolled today,” Covered California Executive Director Peter Lee said at a recent media briefing on the exchange’s marketing and outreach plans. “Of those who are still uninsured, we want to make sure we reach them.”

About 2.4 percent of the exchange’s approximately 1.3 million enrollees are African-American, only about half of the blacks considered eligible for subsidies because of their income. Another 30 percent are Latino; 37 percent are considered eligible for subsidies, according to Covered California data.

In contrast, enrollment of whites and Asians has exceeded eligibility projections, meaning that Covered California was better able to reach those groups. The state’s enrollment data is not exact, because more than a quarter of enrollees decline to state their race.

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This KHN story can be republished for free (details).

While many more California Latinos and African-Americans have become insured since the passage of the Affordable Care Act, including through the state’s Medi-Cal expansion and employer-based insurance, Covered California’s experience echoes that of other states trying to ensure that their minority populations get the health coverage they need, said Larry Levitt, senior vice president at the Kaiser Family Foundation.

About 55 percent of the nation’s remaining 32.3 million uninsured under age 65 are people of color, including 34 percent who identify as Hispanic/Latino and 14 percent who identify as black, according to Kaiser Family Foundation data. (KHN is an editorially independent program of the foundation.)

In California, about 2.2 million Californians remain uninsured but are eligible for Medi-Cal or Covered California insurance plans, Lee said. They are more likely to be Latino and African-American, and younger and slightly more affluent than current enrollees, who may have qualified for subsidies or Medi-Cal, the state’s version of Medicaid. Covered California’s open enrollment runs from Nov. 1 to Jan. 31, 2016.

Covered California has earmarked about $50 million for marketing and another $13 million for navigators, trained counselors who help people learn about and sign up for coverage. The exchange was expected to unveil its new advertising campaign Friday, including ads specifically targeted to Latinos and African-Americans.

Explanations for the disproportionately low enrollments of eligible African-Americans and Latinos vary. “We’ve got people who don’t trust the government,” said Dan Daniels, coastal area director of the NAACP California State Conference,  who oversaw Affordable Care Act outreach in his region.

Daniels also cited attitudes among “young invincibles,” who are healthy enough to think they don’t need coverage and are willing to pay the mandatory penalty for not having health insurance. That penalty will rise in 2016 to $695 per person or 2.5 percent of income, whichever is higher.

Among some Latinos who are legal residents, there is fear that applying for health insurance through Covered California will jeopardize the immigration status of other family members, Levitt said.

And affordability remains a looming concern for higher-income people of color who may not be eligible for subsidies or Medi-Cal.

For example, Kemisha Roston, a 38-year-old contract lawyer from Riverside, said she makes too much money to qualify for those programs, but not enough to afford Covered California unsubsidized premiums – which top $300 per month — while she pays off student debt.

“I’m living check to check, because the market for attorneys is very saturated,” Roston said. “My health is pretty good right now, so I don’t need to go to the doctor. When I do, I go to free clinics or Planned Parenthood. I’m dismayed, because if something does happen and I don’t have health insurance, I could be wiped out.”

In addition, some community leaders and health advocates have criticized Covered California’s previous marketing and outreach efforts to both African-American and Latino communities as too generalized and impersonal. The exchange has spent more money on marketing and outreach than other exchanges, with less to show for it, said Hector De La Torre, executive director of the Transamerica Center for Health Studies.

“You have these challenges in these communities and it takes a lot more than a TV commercial to make them aware of what they need to do – you can’t do that in 30 seconds,” De La Torre said, referring to the need to educate people about the basic value of health insurance. “That’s where Covered California has not done as much as it could in reaching out to these folks. It’s a face-to-face communication effort that needs to take place.”

Charla Franklin, community outreach liaison for Healthy African American Families, an advocacy group in Los Angeles, said Covered California did well in reaching out to California’s black churches and community groups to get the word out. But the advertising campaign in her area was “so bland it was ridiculous,” she said. The exchange really needed to better inform people about specific community events and places where people could get in-person help with the complicated and time-consuming online enrollment process, she said.

Lee has told reporters recently that Covered California is stepping up its ground game and changing its messaging. Consumer surveys have shown that potential enrollees need more education on how subsidies can lower their out-of-pocket costs, he said. The U.S. Department of Health and Human Services said it will pursue a similar strategy of publicizing financial help available to many people.

“We cannot take it as a given that Californians understand that health care is more affordable because subsidies are available,” he said. “We’ll be getting back to basics.”

The exchange is also expanding its direct outreach efforts, more than doubling the number of Covered California storefronts where people can get help to enroll to 500, Lee said. The exchange also plans door-to-door canvassing in communities with the highest remaining number of uninsured people, including Culver City, Inglewood, Riverside, Oakland and Richmond.

But while Lee promised “a more intense ground game,” he also cautioned against overly high expectations for the exchange’s third open enrollment season.

“We have millions of Californians who’ve adopted a culture of coping. They don’t understand they have subsidies available to them and are making do. It’s going to be years to change to a culture of coverage.”

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Viewpoints: Budget Deal’s Key Reform On Hospital Payments; Carson ‘Muddled’ Health Plan

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Research Roundup: The Cadillac Tax; Patient-Centered Care; Medicare Advantage

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State Highlights: Calif. Appeals Court Rejects Lawsuit By Three Terminally Ill Patients; Another Court Sides With Fla. Hospitals On Shielding Medical Records

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Neb.’s Governor Takes Swipe At Proposed Medicaid Expansion; Feds Ask Calif. To Trim Back Its Funding Request For Medi-Cal Waiver

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Some First-Year Docs Still Working 30-Hour Shifts Despite Ban

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GM Contract Would Improve Newer Workers’ Health Coverage, Could Raise Employee Spending

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