More news on Medicare Health Support: Mass. Senator Kerry weighs in.....

According to DMAA eNews Feb 12:

"An influential Senate lawmaker last week told a health policy publication that he would consider legislation to keep Medicare Health Support (MHS) operational past the scheduled end of the pilot's first phase.

If he succeeds, Sen. John Kerry, D-Mass., would block a recent and controversial decision by the Centers for Medicare and Medicaid Services (CMS) to end the pilot this year without providing continuity of services to the 68,000 beneficiaries in MHS. In an unexpected announcement Jan. 29, CMS said it would begin closing out five MHS programs this summer as each reached the end of the three-year Phase I pilot. Transition to a second phase could be delayed up to three years while CMS evaluates Phase I results, the agency said.

In an e-mail last week to the online newsletter Inside CMS, Kerry blasted the CMS decision and pledged to explore a legislative remedy. "This hold-up places red tape right over a solution that works for 68,000 seniors who rely on this program for the care they need," Kerry told the publication.

"The Bush Administration complains that we aren't doing enough to control costs, yet they are halting a promising pilot mid-stream, cutting seniors off at the knees," Kerry told Inside CMS. "The government should be encouraging solutions that help solve our nation's healthcare crisis, and I am looking at legislative options to fix this short-sighted decision."

DMAA and others decried the CMS decision, saying it will strand thousands of Medicare beneficiaries and their physicians without important chronic care coordination support. "These beneficiaries, as well as their providers and family caregivers, enthusiastically welcomed these services, as evidenced by participation rates, satisfaction measures and a demonstrated willingness to take important steps toward better health," DMAA President and CEO Tracey Moorhead said in a Jan. 30 statement.

Further, DMAA argued, the CMS claim of poor Phase I results is not supported by the findings of an interim MHS report last year and serious flaws in the program design and operation have hampered Medicare Health Support Organizations' efforts."

Gadgets and Disease Management, Part 3: Nanotechnology

Speaking of gadgets, what do persons working in the disease management industry need to know about “nanotechnology?”

After alighting on some interesting references (here and here and here) I found out that the term refers to the precise assembly of atoms or molecules in novel cellular or subcellular forms. While the term in a medical context conjures up an image of weenie machines doing good stuff one chromosome at a time, it usually pertains to old substances in new architectures. One example is arraying silver (which is toxic to bacteria) on plastic catheters to prevent infection. Other novel atomic-level designs of injectable lipids, proteins and even DNA have the potential to deliver “payloads” (for example, chemotherapy) that bind to biologically defined targets. That means a tracer could be used to torpedo a hiding tumor cell or signal the presence of an otherwise undetectable protein or cell-type. It appears earliest iterations coming to market will be categorized less as “devices” and more as pharmaceutical agents.

The disease management blog was a little disappointed, believing we were on the verge of nanogadgets. Alas, there are few useful reports of “nanorobots,” “nanodevices,” and “nanostructures” (coupled with nanodisease nanomanagement of course) swarming through the bodies of the chronically ill, repairing telomeres, dissolving atheroma and resuscitating exhausted beta cells. I’m afraid this atomic-level stuff hasn’t bubbled up to our level of populations…. yet.

Do not despair, however, because the disease management blog discovered ‘nano’ is a very cool prefix to use among your colleagues, especially if you combine it with lots of other opaque futuristic lingo. Consider the otherwise staid observation:

“Advances in medicine will lead to new diagnosis and treatment.”

Thanks to the nanoglitter of this new nanojargon, you can now confidently declare:

“Advances in nanomedicine will lead to quantum leaps in proteogenomic multi-scale microsystem technology.”

As an added bonus, the 'nano' prefix is a useful item to keep in the populationate tool box.

Postscript. My spouse has periodically given invaluable input into the content and editing of the disease management blog, for which I am forever grateful. Her shrewd response to this particular post was to ask if the return on investment from the time and effort to write it should be measured in nanodollars. I told her the check will come in a really really small envelope.

Gadgets and Disease Management, Part 2

Just imagine for a minute a glucose meter "bluetoothed" to a cell phone with text communication linked to a disease management program:

DMNurse51 (12:25:14 PM): hey Auto response from

Kris101(12:25:14 PM): hold on...brb

DMNurse (12:25:25 PM): ok

DMNurse(12:25:35 PM): in cafeteria?

Kris101(12:31:51 PM): WU?

DMNurse51 (12:32:13 PM): did u check u’r noon glucose?

Kris101 (12:32:17 PM): lol no forgot

Kris101(12:32:26 PM): can check b4 1

DMNurse (12:33:39 PM): ‘k. I’ll call mom & let her kno.

I recognize there are HIPAA issues, getting informed consent from an adolescent to participate in something like this isn't easy and that there's malpractice risk. None are insurmountable.

I confess to not authoring a "I'll notify your doctor" in the scenario above, but a) I don't think most docs have the resources to respond to one missed blood glucose meter check and b) wouldn't mind "outsourcing" tasks like this and c) are very supportive of "systems of care" that handle inevitable minor mishaps.

Note that DM Nurse51 could be located the physician's office, out of state or across the globe in India. Note that the nurse was alerted by an ABSENCE of a blood glucose reading.

Idealistic yes. Unrealistic not at all, particularly because glucose meters enabled with bluetooth are already out there. Interactive data bases linked to decision support algorithms are already at hand. There are nurses armed with protocols that know what to do and how to do it.

In the opinion of the disease management blog, medical device manufacturers are perfectly positioned to tie it all together and it's just a matter of time until market forces make it happen so that it becomes a standard of care. What mom wouldn't pay to have this kind of support for their insulin requiring diabetic child?

pavlov revisited

One morning, as I was making school lunches, I dropped a bunch of cheese on my dog's head (I had been slicing it onto sandwiches and had turned to talk to my older son. Multi-tasking before sufficient caffeine intake has never been my strong suit).

Now, whenever I am making lunches, the dog dances with excitement, his eyes sparkling with hope and joyful anticipation.

I want to live my life like that. Life is good. And you never know when cheese might fall from the sky.

Gadgets & Disease Management: The Coming Emergence of Medical Device Manufacturers in Population Care

This link to an article named Gadgets that keep you healthy made the Disease Management Blog ponder the role of medical devices in population-based health care. I'm certainly not alone in struggling with the topic, but thankfully I don't have to be like Inverness and be quite so complicated about it. The image of this eye-socket gadget internet-enabled health-vixen speaks to the topic in a much better way.

It's not uncommon for disease management programs to grapple with the role of "hardware" in their programs. Should IVR-enabled scales be offered in heart failure? Should USB-ported peak flow meters be given for free if there is an asthma diagnosis? What is the role of kits that allow home measured A1Cs? I now wonder if that thinking is becoming increasingly backwards. Maybe a better question is to ask is whether population-based health support should be included with the gadgets.

Consider one device that is the topic of the Gadget article: the glucose meter. Being VERY simplistic.....

In the "insurance" business model, meters are an a) expense, b) a mandate c) an exercise in good will d) something that has yet to be proven in prospective randomized control studies to reduce claims expense. Think deductions, co-pays, co-insurance and limits (directed at the strips).

In the "clinical revenue-based" business model, providers want a) payment, b) payment or c) payment for their support of a glucose meter. Think unbundling, coding, direct patient billing and, when all else fails, blaming managed care one more time.

In the emerging consumer-centric business model, glucose meters may well go the way of other consumer goods: either turn into commodities and die or be coupled to support services that ultimately have the potential to create more revenue for the manufacturer than the device itself. Think service contracts and value-adds that morph into an ongoing revenue stream. Smart automobile manufacturers now sell reliable transportation, not cars. Smart computer manufacturers sell information technology, not beige boxes. Should meter manufacturers sell blood glucose control? Should cardiac stent manufacturers include services that minimize the risk of re-occlusion of the involved artery? Will gastric banding manufacturers compete on the degree of weight loss at one year?

The disease management blog predicts the gadget manufacturers are creating a new chapter in disease management, characterized by mergers, acquisitions, partnerships, contracting "coopetition" and OWAs. And note the article above was from India, leading me to believe this is a global phenomenon. It will be interesting to see how the U.S. physician community and health insurers will respond. The eminently savvy readers of this blog probably have a prediction about that, and I agree with you.

Speaking of vixens, as a public service to the gender-male readers of this blog, if you are lucky to have a significant other, this is a reminder of an approaching high profile day. Gentlemen, do yourselves a favor and think at least a card. I don't know why either, but the kind with excessive romance is best and you get bonus points if she wants to show it to her girlfriends. You've been forewarned.

Disease Management, Wellness, Benefit Design, Innvovation & Coalitions - The Path to Real Shareholder Value

In addition to being notified by email of having won the "UK NATIONAL LOTTERY," the disease management weekend blog received this interesting tidbit from the Google Alerts: AstraZeneca grants $1.5M to NCDOT.

The disease management blog's clickclickclicking revealed that the ERISA-exempted North Carolina State Health Plan covers over 600,000 state employees, teachers, retirees, current and former lawmakers, state university and community college personnel, state hospital staff and their dependents. The Plan also includes disease management programs. The provider those programs? Health Dialog.

Thanks to AstraZeneca (AZ for short), a segment of the state employees, i.e. those in the North Carolina Department of Transportation (NCDOT) are being given an additional benefit: "wellness programs" that are targeting tobacco use, stress, physical activity and nutrition habits. It appears to this blog that the grant from AZ is really going NC Prevention Partners, a statewide coalition that includes the North Carolina hospitals, Blues, State Department of Insurance and State Medical Society. I suspect that Health Dialog will not only have a role in evaluating the "impact" of this initiative but actually delivering some of the services: hint: and 800 number and the use of the word "coaches."

Thoughts:

Once again, it's the ERISA-exempted plans outside the DC beltwayosphere that are taking the leadership in piloting novel benefit designs that include population care.

The disease management industry is morphing. Wellness embedded in a multi-dimensional care management program is just one example. It ain't your mother's call center for diabetes anymore.

The disease management industry, despite what its detractors say, is not all about grabbing a piece of the insurance premium and returning value to its shareholders. It can be about coalitions that lead to something being greater than the sum of its parts. THAT is shareholder value.

The press release heralds the coming achievement of "cost savings through reduced health care claims and improved employee outcomes." If the North Carolina State Health Plan was so confident of that, why did it take outside money to make that happen? If they truly believe in the value of wellness in the preservation of human capital leading to reduced claims expense down the road, the taxpayers shouldn't mind the investment.

What happens when the money runs out in three years? Suppose there aren't any hard savings but NCDOT employees are abusing less tobacco, exercising more and eating their veggies? How will past savings translate into future administrative expense?

The answer to that may lie in the evaluation of outcomes. I can only hope our friends in Health Dialog do a transparent and complete job of evaluating the impact of this initiative. Given the degree of skepticism out there about disease management outcomes, it may take a neutral independent third party and an upfront commitment to share the results in a peer reviewed public forum.

As an aside, I looked at the North Carolina State Health Plan formulary and did not discern favorable placement of AZ's products for the state employees. Maybe the grant truly is motivated by a desire to do good. And good thing they're not relying on the UK NATIONAL LOTTERY for financial support - I'm keeping all that money and have no intention of sharing it.

Here's to Health Dialog's and the NCDOT's and the NC Prevention Partners' success. Cheers!

two finished objects and a felted bag

I have several almost finished knitting projects kicking around the house. Yesterday, and the day before, I bit the bullet and finished two of them.

This is the "Heartbreakingly Cute Baby Kimono" from Mason-Dixon Knitting. For months all it needed was for me to sew the little cords on for the tie.

The lighting is not great in this shot but it really is heart-breakingly cute (how could a new-born sized kimono, not be?). This one's going to the Warm Hands Network.


These socks have been languishing for a few weeks, needing only one toe to be finished. The photo really does not do justice to the Fleece Artist yarn. The socks are REALLY thick but very comfortable. I just haven't been brave enough to check how comfortable they'll be with shoes on.

The bag below is from a free pattern from Black Sheep Bags. It's called a Booga Bag and I stumbled on it when I was yearning for a felted bag (seriously, I was. They're strong and light. And I think they're cool).

Since I first stumbled on the pattern, it's become a bit of a knitting craze. If you feel like it, go to Flickr and do a search for 'Booga' you get 2,563 results and the overwhelming majority are pictures of this bag.

This is what it looked like before I felted it:

And this is what it looks like, after being machine washed in hot water and rinsed in cold:

I had been warned that this is not a big bag, but the thing is tiny. It looks like I'll be able to fit my wallet, keys (if I can find them), a lipstick and maybe a tiny notebook and a pen.

Maybe I shouldn't have run the bag through the whole wash cycle. Thoughts?

I like how it looks, though and the way the colours blended together. And it will be a nice light purse.

I'll post more pics once I make the holes for the straps and add them on.

You have no idea how much clutter I had to move out of the way to take EACH of these pictures.