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Galen Senior Fellow Doug Badger and Heritage Research Fellow Jamie Bryan Hall shed new light on the core problem that health policy experts have focused on for decades—covering the uninsured. Badger and Hall find, based upon their analysis of Census Bureau data, that “More than 99 percent of Americans have access to health coverage, regardless of their income or medical condition.”                                                                                            A doctor speaks to patients at his office in Peoria, Ill., in 2013. (Jim Young/Reuters) A topic for political disagreements, discussion,  and solutions, access to health care,  in the United States is broken down in this article . (one of the best, I have read, and one I would recomme...

In today's post from STAT I . have included pertinent comments from other readers Speculation abounds about what artificial intelligence can do for medicine. It's time to put it to the test — perhaps an obesity-related Turing test. Top 15 Promising AI Applications in Healthcare By  Shailendra Sinhasane  In  If you read high-profile medical journals, the high-end popular press, and magazines like Science or Nature, it is clear that the medicalization of artificial intelligence, machine learning, and big data is in full swing. Speculation abounds about what these can do for medicine. It’s time to put them to the test. From what I can tell, artificial intelligence, machine learning, and big data are mostly jargon for one of two things. The first is about bigger and bigger computers sifting through mountains of data to detect patterns that might be obscure to even the best trained and most skilled humans. The second is about automating routine and even complex tasks that huma...

https://www.vizientinc.com/-/media/documents/sitecorepublishingdocuments/public/july2019dpf_slides_summary_public.pdf https://www.vizientinc.com/-/media/documents/sitecorepublishingdocuments/public/july2019dpf_drugpriceforecast_public.pdf One of the most driving forces for increasing health care costs in the United States is the cost of pharmaceuticals.  If you compare drug prices in the U.S. with the U.K. E.U., Mexico or South American countries there is a great disparity. Increases in drug prices cannot be compared using overall global prices when there is actually much price variation when looking at specific drug classes. There are large fluctuations in price when pharma companies are merged, or purchased by venture companies who anticipate great demand for a product.  Some well-known brand pharmaceutical manufacturers have disappeared from the market place.  Not all companies make huge profits.  Some companies barely make a profit, if any. There are many orphan ...

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Industries are catching on to the inefficiency of data silos.  Health care is its own silo. Expanded connectivity and the exponential growth of technology are enabling smart health communities, which could offer a modern take on community-based well-being and disease prevention. Five core components industry and government stakeholders can consider in the shift to health and well-being Expanded connectivity and the exponential growth of technology are enabling smart health communities (SHC), which could offer a modern take on community-based well-being and disease prevention.  HISTORICALLY, health care was delivered in the community. Physicians made house calls; birth and death happened inside the home. As the modern hospital developed, health care migrated inside its walls. Meanwhile, the concept of health became increasingly medicalized, and separated from people’s daily lives. One example of an SHC is the YMCA’s decades-old National Diabetes Prevention Program (DPP), which ...

UnitedHealthcare has announced it will begin site of service medical necessity reviews for certain surgeries when surgery is performed in an outpatient hospital setting. In California, the reviews will begin Dec. 1. The site of service policy is not unique to UHC, and Oxford, Cigna Anthem, and others use the same protocol. The policy limits the circumstances in which UnitedHealthcare will pay for certain surgeries performed in a hospital outpatient setting, determined by the insurer whether or not the site of service for the procedure is medically necessary. Other states that will see reviews starting on or after Dec. 1 are Colorado, Connecticut, New Jersey, and New York. The policy will not apply to providers in Alaska, Kentucky, Massachusetts, Maryland or Texas. "Medical necessity reviews for the site of service occur during our prior authorization process and are only conducted if the surgical procedure will be performed in an outpatient hospital setting," UnitedHealthca...

The University of California, Irvine presented each member of the class of 2023 a handheld/smartphone portable ultrasound device.  This represents a considerable upgrade for the stethoscope treasured by so many neophyte physicians.  No longer would the treasured stethoscope hanging from the neck of students, nurses and nurse practitioners be the status symbol. Ultrasound machines are usually those large instruments wheeled around from room to room with a large display.  It required a  physician order to have an ultrasound technician to perform the test.  Now the ultrasound will become ubiquitous.  For most diagnostic purposes it will be carried in a pocket by the physician for immediate use.  And for most studies, it will be adequate.  If a more advanced ultrasound is needed it can be ordered.  In 90 % of cases, it will be used to rule out serious problems in an emergency department, urgent care center, nursing home or even at home. Normally ...

In a small trial, drugs seemed to rejuvenate the body’s ‘epigenetic clock’ , which tracks a person’s biological age. A person’s biological age, measured by the epigenetic clock, can lag behind or exceed their chronological credit: Patrick McDermott/Getty A small clinical study in California has suggested for the first time that it might be possible to reverse the body’s epigenetic clock, which measures a person’s biological age. For one year, nine healthy volunteers took a cocktail of three common drugs — growth hormone and two diabetes medications — and on average shed 2.5 years of their biological ages, measured by analyzing marks on a person’s genomes. The participants’ immune systems also showed signs of rejuvenation. The results were a surprise even to the trial organizers — but researchers caution that the findings are preliminary because the trial was small and did not include a control arm. “I’d expected to see slowing down of the clock, but not a reversal,” says geneticist St...

by Greg Slabodkin Managing Editor, Health Data Management Last year, the Cleveland Clinic cared for more than 2 million patients—an unprecedented number. However, president and CEO Tom Mihaljevic, MD, says it’s a small fraction compared with what the health system can and should be doing. “The care that we deliver today is of paramount importance to those in need,” Mihaljevic told an audience this week at the Cleveland Clinic’s 2019 Medical Innovation Summit. “What we strive to do is to touch as many people as possible with the highest quality care.” Mihaljevic said the Cleveland Clinic has an “ethical mandate to grow” and a moral obligation to relieve human suffering. However, he acknowledged that the provider organization “touches far fewer lives than what our brand recognition, our reputation would suggest.” According to Mihaljevic, the Cleveland Clinic’s market share in the United States is only half a percent. As a result, the Cleveland Clinic has an ambitious plan to double the n...

We know how important it is to have insurance so that we can get health care. As a physician, parent and patient, I cannot overemphasize that having insurance is not enough. Physicians often prescribe expensive medications or tests for my patients. But for insurance companies to cover those treatments, I must submit a “prior authorization” to the companies, and it can take days or weeks to hear back. If the insurance company denies coverage, which occurs frequently, I have the option of setting up a special type of physician-to-physician appeal called a “peer-to-peer.” Here’s the thing: After a few minutes of pleasant chat with a doctor or pharmacist working for the insurance company, they almost always approve coverage and give me an approval number. There’s almost never a back-and-forth discussion; it’s just me saying a few keywords to make sure the denial is reversed. Because it ends up with the desired outcome, you might think this is reasonable. It’s not. On most occasions, the “...