TUCSON, Ariz., Sept. 26, 2012 /PRNewswire/ — At this year’s 29th Congress of the International Academy of Pathology (IAP 2012), Ventana Medical Systems, Inc. (Ventana), a member of the Roche Group, will unveil the latest versions of its Virtuoso digital...
Monthly Archives: September 2012
Archived Cyto-econferences Available from ASC
Archived Cyto-econference Available Beyond Diagnostic Error! Tips for Avoiding the Medicolegal Morass in Cytopathology Everyone is aware of the medicolegal impact of a false negative Pap test, and cytologists implement quality assurance practices to minimize these errors. There are other...
Quantitative Digital Pathology with Image-Pro Premier Software
The advent of affordable, high-resolution digital capture techniques is good news for the research pathology communities. Costs to collect, display and analyze large format images have dramatically shrunk in recent years. The ability to evaluate data in entire tissue sections,...
DOD Hiring Pathology Informatics Assistant (Bethesda, MD)
Job Title:Pathology Informatics Assistant (Office Automation) Department:Department of Defense Agency:TRICARE Management Activity Job Announcement Number:NCJT12131640751530 SALARY RANGE: $37,983.00 to $49,375.00 / Per Year OPEN PERIOD: Sunday, September 23, 2012 to Saturday, September 29, 2012 SERIES & GRADE: GS-0303-06 POSITION INFORMATION:...
AccelPath, Inc. Acquires DigiPath Solutions, LLC
Mergers and acquisitions in the digital pathology space continue. Recent news of Accelpath's acquisition of DigiPath Solutions below. Following the sale of Aperio recently, standalone digital pathology companies are fewer and far between. BioImagene was acquired by Roche/Ventana for $100...
Over 40 Presenters Confirmed for Pathology Visions 2012
At Pathology Visions 2012, the annual conference of the Digital Pathology Association (DPA), there will be over 40 presenters covering a broad range of topics relevant to digital pathology. The DPA, a non-profit organization that promotes education and awareness of...
Hopes stem cell therapy can help diabetes sufferers
Scientists are hoping recent developments in the usage of stem cell therapy to treat common health problems can be transferred to diabetes.
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NASA’s Mars Curiosity Rover Report #8 – Video
28-09-2012 16:40 A NASA's Mars Curiosity rover team member gives an update on developments and status of the planetary exploration mission. The Mars Science Laboratory spacecraft delivered Curiosity to its target area on Mars at 1:31:45 am EDT on Aug. 6, which includes the 13.8 minutes needed for confirmation of the touchdown to be radioed to Earth at the speed of light. The rover will conduct a nearly two-year prime mission to investigate whether the Gale Crater region of Mars ever offered conditions favorable for microbial life. Curiosity carries 10 science instruments with a total mass 15 times as large as the science payloads on NASA's Mars rovers Spirit and Opportunity. Some of the tools, such as a laser-firing instrument for checking rocks' elemental composition from a distance, are the first of their kind on Mars. Curiosity will use a drill and scoop, which are located at the end of its robotic arm, to gather soil and powdered samples of rock interiors, then sieve and parcel out these samples into the rover's analytical laboratory instruments.
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ANSI Nanotechnology Standards Panel Announces New Co-Chairs from Public and Private Sectors
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ANSI Nanotechnology Standards Panel Announces New Co-Chairs from Public and Private Sectors Register Now for October 30 NSP Meeting in Washington, DC New York September 27, 2012
The American National Standards Institute (ANSI) is pleased to announce that Shaun Clancy, Ph.D., and Ajit Jillavenkatesa, Ph.D., have agreed to serve as the co-chairs of the ANSI Nanotechnology Standards Panel (NSP), which will hold its next meeting on October 30, 2012, in Washington, DC.
Dr. Clancy is the director of product regulatory services for Evonik Degussa Corporation, and is the current chair of the American Chemistry Councils Health, Product, and Science Policy Committee. Dr. Jillavenkatesa is the senior standards policy advisor for the National Institute of Science and Technology (NIST) of the U.S. Department of Commerce (DoC), and serves as executive secretary of the Subcommittee on Standards within the National Science and Technology Councils Committee on Technology. Both Dr. Clancy and Dr. Jillavenkatesa serve as active members of the ANSI-accredited U.S. Technical Advisory Group (TAG) to International Organization for Standardization (ISO) Technical Committee (TC) 229, Nanotechnologies. Dr. Clancy is also the current chair of ISO TC 229s Task Group (TG) 2, Consumer and societal dimensions of nanotechnologies. Dr. Clancy and Dr. Jillavenkatesas joint leadership of the ANSI-NSP reflects the role of the NSP as a public- private-sector collaborative for the coordination and discussion of nanotechnology standardization issues.
Nanotechnology, linked to nanoscale science and engineering, involves the understanding and control of matter at the nanoscale (approximately 1-to-100 nanometers), where unique phenomena allow for innovation and novel technological applications. Formed in 2004, the ANSI-NSP serves as the cross-sector coordinating body and works to provide a forum for standards developing organizations (SDOs), government entities, academia, and industry to identify needs and establish recommendations for the creation or updating of standards related to nanotechnology and nanomaterials.
The ANSI-NSP meeting on October 30, 2012 will be from 12 p.m. to 5 p.m., at the offices of the law firm Sidley Austin LLP (1501 K Street NW, Washington, DC. The meeting will consider whether current nanotechnology standards activities meet existing stakeholder needs, as well as discuss the impact of existing standards on research and development and possibilities for greater collaboration between stakeholders in this area.
Attendance at the meeting is free. Individuals planning to attend the October NSP meeting may register online here. For more information, visit the event Web page or contact Heather Benko (hbenko@ansi.org), ANSI senior manager, nanotechnology standardization activities.
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ANSI Nanotechnology Standards Panel Announces New Co-Chairs from Public and Private Sectors
Academy honors doctor for family medicine work
Dr. Jeffrey D. Manning, a physician and medical director of Sports Medicine Associates in Danielson, Conn., is among a select group of physicians honored by the American Academy of Family Physicians Foundation for his commitment to education in the field of family medicine. Dr. Manning was selected to receive a 2012 Pfizer Teacher Development Award based on his scholastic achievement, leadership qualities and dedication to family medicine.
In addition to seeing patients at Sports Medicine Associates and Day Kimballs Walk-In Center in Plainfield, Conn, Dr. Manning is a part-time instructor in the Department of Family Medicine at the Alpert Medical School of Brown University and the University of Massachusetts.
Dr. Manning graduated from Williams College, earned his medical degree from Pennsylvania State College of Medicine, completed his residency in family medicine at Brown University, and went on to complete a fellowship in sports medicine at the University of Massachusetts.
Stroke Connection forum The American Stroke Association presents Making the Stroke Connection: Stroke Survivors & Caregivers Forum from 11:30 a.m. to 3:30 p.m. Oct. 2 at the Worcester Senior Center, 128 Providence St., Worcester. The forum is designed to improve the quality of life for stroke survivors, their caregivers and family members by providing valuable education, tools and resources. Registration is required at no cost and will include a light lunch. To register, call the American Heart Association at (413) 735.2102, or visit http://www.heart.org/cmastrokeforum.
Diabetes A1C progam Alicia Walter, MS, RD, LDN, clinical dietitian and nutrition educator at Baystate Mary Lane Hospital, 85 South St., Ware, will present a free A1C Champion Program from 5 to 6 p.m. Oct. 3 in the Main Conference Room, Ware.
The Taking Control Diabetes A1C Champions program, sponsored by Sanofi-Aventis U.S., is a patient-led approach to diabetes education. The program will include an empowering presentation for people with diabetes, their family and friends. This patient-to-patient presentation will include information about the physical, emotional and psychological experience of living with diabetes. For more information or to register, contact Baystate Health Link at (413) 967-2488.
Chiropractic office opens Dr. Carlos Amantea, chiropractor, has opened an office at 110 Church St., Whitinsville. For more information, call (508) 572-9334.
Ronald McDonald Mobile UMass Memorial Health Cares Ronald McDonald Care Mobile provides medical and dental services to people without health or dental insurance. For more information or to make an appointment, call (508) 334-6073. If you need medical or dental insurance, call (508) 334-9300.
Free keep-well clinics The VNA Care Network offers free keep-well clinics for residents 60 and older from 9 to 11 a.m. Oct. 2 at Mount Carmel Apartments, 50 Shrewsbury St., Worcester; noon to 2 p.m. Oct. 2 at Canterbury Towers, 6 Wachusett St., Worcester; 10 a.m. to noon, Oct. 3 at Centro Las Americas, 11 Sycamore St., Worcester; 9 to 11 a.m. Oct. 4 at the Senior Center, 250 Main St., Marlboro.
For more information, call (888) 663-3688, ext. 5603, or visit http://www.vnacarenetwork.org.
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UMass Med professors are sleuths of the genome
WORCESTER Two professors at the University of Massachusetts Medical School are playing a role in a global effort to unlock the mysteries of the human genome, which is the complete set of genetic instructions for humans.
Medical school professors Job Dekker and Zhiping Weng participated in an international consortium of scientists from 32 institutions that made headlines this month with its findings. The scientists involved in the Encyclopedia of DNA Elements project, or ENCODE, announced that parts of the genome often dismissed in the past as junk DNA actually play an important role in regulating what genes do.
Through the projects research, scientists have gained an understanding of 80.4 percent of the human genome, the UMass Medical School professors said.
That is a tremendous improvement in our understanding of the genome, said Mr. Dekker, who holds a doctorate and is professor of biochemistry and molecular pharmacology and co-director of the schools Systems Biology program.
Researchers involved in the project used a range of experimental approaches to understand what pieces of DNA are regulating genes. The research labs of Mr. Dekker and Ms. Weng, who holds a doctorate and is the director of the medical schools program in bioinformatics and integrative biology, worked on separate projects that contributed to the effort.
The findings of the international project appeared in 30 papers published in the journals Nature, Genome Research and Genome Biology. Mr. Dekker was the lead author of one of the Nature papers. The results of Ms. Wengs efforts were published in Genome Research. The consortiums work received funding from the National Human Genome Research Institute, part of the National Institutes of Health.
The professors touted the data produced by ENCODE which built upon the Human Genome Project completed in 2003 as the basis for further study in the genetic causes of human disease and a potential boon for pharmaceutical and other medical research.
For the past decade, Mr. Dekker has helped develop methods to create three-dimensional models of folded chromosomes. Those models can be used to determine which parts of the genome touch each other, according to the medical school.
Scientists have believed for a number of years that a regulatory element could control a gene by physically interacting with that gene, Mr. Dekker said. His goal is to measure the three-dimensional structure to see which regulatory elements physically touch what genes, he said.
We have gone from this view of the genome where we have here and there a gene and then large sections of unknown of territory, Mr. Dekker said. We now have a much richer picture of the genome, where we can see genes, and we can set lots and lots of these regulatory elements.
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Liberty eliminated from playoffs
It was a short playoff run for the Liberty.
Tina Charles had 25 points and 14 rebounds and Kara Lawson scored 15 points all on 3s, including two late in the fourth quarter as the Connecticut Sun closed with a 14-0 run to beat the Liberty 75-62 on Saturday night at the Prudential Center to advance to the Eastern Conference finals.
I had some looks in the second half and I was missing them. I dont usually miss those, Lawson said. I kept telling them on the bench theres one coming. I didnt know there were two coming.
Cappie Pondexter scored 20 points to lead the Liberty.
They are a great team and played well all year, Pondexter said. Tina, the MVP of the league, played outstanding. Asjha made key buckets in the third quarter that gave them a run.
Lawson hit a 3 with 3:58 left start the Suns game-ending run. She was fouled and converted the free throw for the four-point play that put the Sun ahead for good, 65-62.
Plenette Pierson had just rallied the Liberty from a five-point deficit, scoring with 4:20 left to put the Liberty ahead 62-61.
After Jones hit a jumper with just under three minutes remaining to push Connecticuts advantage to six, Lawson made another 3 to make it 70-62.
Asjha Jones scored 18 points to help the Sun complete the two-game sweep.
When it was time to step up all of the best players stepped up tonight, Connecticut coach Mike Thibault said. Our three All-Star players stepped up. It was terrific, but we had great performances from a lot of people. It was as ugly start that you can get that nobody would like to watch, but one of the best things about this team is we hung in there on the road.
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Liberty Plaza: Experts say rethinking ways to get more people into park is more important than redesigning it
While Ann Arbor city officials begin to consider a redesign of Liberty Plaza, experts point to the areas outside the parks boundaries as catalysts for the plaza's improvement.
Mayor John Hieftje told AnnArbor.com there are plans in the works to redesign the park, including potentially bringing the park up to street level instead of having a two-tiered sunken design. While the changes may bring some improvements, experts believe the areas right around the park play a bigger role in any future improvement.
Amy Kuras, the citys park planner, said the development around any urban space is what determines the success or failure of the space. Kuras said the immediate area around Liberty Plaza the Liberty Square building and the Kempf House is not a foot traffic generator. Whether the new underground Library Lot, and whatever development eventually is built atop it, changes the number of pedestrians at the corner remains to be seen.
Without establishments bringing in different groups of people, Liberty Plaza becomes a spot with a crowd of regulars who may not look kindly on outsiders, according to Kuras.
I would love to see it used more by all kinds of people, Kuras said. How we arrive at that, Im not sure what the answer is at this point. Its not just changing the configuration of the park.
Kuras compared Liberty Plaza to Sculpture Plaza, another concrete plaza at the corner of Fourth Avenue and Catherine Street. She said one of the reasons Sculpture Plaza has become a successful and popular area is because of the restaurants and shops that draw customers who utilize the space.
Kirk Westphal, an Ann Arbor documentarian who studied the city from a pedestrians point of view for a masters degree in urban planning, said Sculpture Plaza is the ideal situation thanks to the businesses surrounding it.
Liberty Plaza has what Westphal calls a key ingredient to success: Foot traffic along Liberty Street. However, there are not enough people actually going into the plaza.
Any urban space that lacks foot traffic through it can be problematic, and the key is getting a diversity of users, Westphal said. Its not about keeping unemployed people out, its about making sure there are enough people in total using the space.
When the park was completed in 1978, there was a restaurant in the 330 E. Liberty St. building next door, along with a book store in the bottom floor. Kuras said this brought more foot traffic into the plaza, but there were still problems from the start.
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Liberty boys' soccer success a team effort
Indians' balance another reason for 8-0-0 start
Liberty goalkeeper Julian Spina makes a save during their game against Tuxedo on Thursday.CHET GORDON/Times Herald-Record
By WILLIAM MONTGOMERY
Published: 2:00 AM - 09/30/12
LIBERTY Through the first eight games of the season, the Liberty boys' soccer team isn't lacking for offensive firepower.
Freshman striker Gustavo Romero (14 goals, three assists) and senior midfielder Pedro Garcia (nine goals, 13 assists) are tied for first place atop the Section 9 scoring list with 31 points apiece.
Liberty improved to 8-0-0 with a 3-2 overtime victory Thursday at Tuxedo, but the reason for the Indians' success doesn't lie in the pursuit of scoring records. In fact, head coach Debbie Simpson has tried to instill the opposite message in her players: it doesn't matter who scores.
"We don't care who's leading the team in goals or assists," she said. "We're just working the ball down the field. Their goal is to win games, not to see who has the most goals."
"She's right. It really doesn't matter," said senior defender Christopher Symanski. "I'm pretty sure almost everyone on the team has scored a goal, even the goalie."
Of the 20 players on the roster, 17 have recorded at least one goal or one assist, including starting goalkeeper Julian Spina, who has two goals to his credit. Since Liberty has outscored opponents by a 49-7 margin so far, Spina has gotten some time in the field as reserve goalkeeper Ignacio Feijo gains experience in net.
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Taiwan rally against Japan over disputed islands
TAIPEI (AFP) - Hundreds of Taiwanese rallied Sunday to press Taipei's claim over disputed East China Sea islands at the centre of a major row between China and Japan.
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Statford Career Institute Helping Students Prepare for Growing Careers in Healthcare
Scranton, PA (PRWEB) September 30, 2012
Stratford Career Institute has added four new modules to their Health Care Aide distance learning course. The newly updated course is now available to students.
The Health Care Aide course curriculum covers biological and technical studies, as well as career tips for those new to the healthcare industry. Coursework includes learning about medical terminology, structure and function of the human body, patient care and safety, current healthcare trends, technology, communications and more.
Each new module also contains a section on how this particular area of study translates in a career as a health care aide. Certain sections also include employment strategies, professionalism, ethical considerations, and resume pointers. The course also takes special consideration regarding the importance of self-care in a career as an aide in a health service profession.
The Health Care Aide course is one of eleven medical career training courses offered by Stratford that focuses on the fundamental components involved in an entry level career in healthcare.
According to data from the U.S. Bureau of Labor Statistics, the job growth rate for personal care aide jobs is 70%. Stratfords course is an excellent opportunity for individuals to get an education that could help them take the first step toward gaining solid employment in the rapidly growing healthcare industry, said Dr. Claude Major, Director of Education for Stratford Career Institute.
Stratford officials said that upon graduating from this course, students are well-prepared to take the first step toward a number of health care aide jobs in a variety of healthcare offices and facilities.
Individuals interested in learning more about the Stratford Career Institutes Health Care Aide course can request a free career information packet by calling 1-800-254-4070 ext 9980 or by visiting the schools website scitraining.com.
Similar to Stratfords popular high school diploma program, the Health Care Aide course is completed through guided, independent study. Students complete lessons at home on their own time, and submit exams online, through the mail, or in combination. Instructors are available via e-mail and toll-free phone and students have access to an online student center.
About Stratford Career Institute
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Statford Career Institute Helping Students Prepare for Growing Careers in Healthcare
Lower sin tax, less health care for poor
(Editor's Note: This is third of a 4-part special report on sin taxes.)
MANILA, Philippines - When the sin tax reform bill is compromised, so are health care plans for the poor.
This is because under the proposed bill, about 85% of annual incremental revenues from excise taxes on so-called sin productstobacco and alcoholwill go the government's universal health care (UHC) program.
If lower taxes on the products are adopted, a large portion of the investment the program planned for the upgrade of public hospitals, which cater primarily to the poor, will not push through.
Worse, it's possible that the number of poor families that were promised health insurance under the program will not be fully covered.
The Senate, through the ways and means committee chaired by Ralph Recto, appears bent on further watering down the measure that had already accommodated compromises in the House of Representatives.
The original version of House Bill (HB) 5727, authored by House appropriations committee chair Joseph Emilio Abaya, was projected to generate for government P60 billion in the first year of implementation. But what the House eventually passed cut the revenues to practically half, at P31 billion.
With lower revenues, funds for the UHC will also be reduced.
What we plan to spend on UHC will be reduced significantly, said Department of Finance (DoF) Assistant Secretary Teresa Habitan.
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Health care scholars critique Romney, draw skepticism
Massachusetts health care scholars who worked on the groundbreaking state and federal health reform laws released findings on Thursday that they say show Republican candidate Mitt Romneys health care policies would raise costs and lower the number of people insured.
Middle class families would pay substantially more out of pocket, Ron Pollack, executive director of Families USA, said in a conference call.
Pollack began the call by saying the group is a 501 (c) 4 and non-partisan. However, the studys numbers were broken out for three battleground states Ohio, Florida and Virginia. Pollack said the breakdown was made due to the number or reporters listening in from those states.
Josh Archambault, director of health care policy at the Pioneer Institute, was skeptical of the groups conclusions and said the organization has not laid out the models developed by MIT professor Jonathan Gruber that were used to arrive at the conclusions.
Obviously Grubers model is a black box. Hes never fully explained the assumptions that hes making, said Archambault. Pioneer has Romney ties including former Lt. Gov. Kerry Healey and campaign adviser Beth Myers, who both serve on Pioneers board.
While the scholars that wrote the study acknowledged they were basing their conclusions on a composite of Romneys public statements rather than a detailed health care plan endorsed by Romney, they said the major factors such as repeal of the Affordable Care Act have been addressed in the candidates statements.
The most important things Romney has talked about you can model, said Pollack.
The conclusions of the Families USA study were not flattering toward Romney as the former Massachusetts governor aims to defeat President Barack Obama.
Pollack said that by the end of the next presidents term, in 2016, Romneys health care policies would result in out-of-pocket annual health care payments of $11,481 for families buying non-group health care insurance, which they say is nearly twice the payments under Obamacare. According to the study, the number of uninsured across the country will fall to 25.3 million under Obamacare but would rise to 67.2 million their interpretation of Romneys plan.
Archambault raised potential health cost drivers under Obamacare, which he said the Families USA study did not address. Archambault said under the ACA, employers might be tempted to drop their employees from company plans, telling them that they will receive a raise but will have to use a health connector plan.
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Save money with smart open-enrollment changes
WASHINGTON Employers will soon be offering workers their yearly opportunity to make changes to their health care benefits. All too often this open-enrollment period has required combing through pages and pages of confusing insurance terms.
But this year workers will receive help translating that jargon thanks to a new requirement that insurers provide a user-friendly coverage summary of all health plans. Combined with innovative wellness plans that reward employees for staying health, experts say millions of workers should be able to make smarter benefit decisions and save money in the process.
More than 55 percent of insured workers estimate they waste up to $750 each year because of mistakes during open enrollment, according to a recent survey by insurance provider Aflac. Here are ways to make sure you're getting every dollar's worth from your health benefits:
Make time. "I think people spend less than an hour on (open enrollment) not because they don't want to but because they feel it's overwhelming and complicated," says Rebecca Madsen, a senior vice president with UnitedHealth Group. Open enrollment generally starts in October or November for plans that begin Jan. 1.
Many insurers are trying to present benefit information in interesting, more user-friendly ways. UnitedHealth runs the website healthcarelane.com, which lets visitors explore a virtual town, where each person they encounter offers information and advice about a different health plan offering. The Department of Health and Human Services offers a more straightforward website designed to demystify health care topics: healthcare.gov .
This year's open enrollment should be easier to navigate even for those who get their information from paper and ink sources. Starting this month insurers are required to provide standardized eight-page summaries that explain key terms and cost details of their plans. The rule was passed as part of the Obama administration's health care overhaul and is intended to make it easier to compare policies and the costs and benefits of various plans.
Stay fit, save money. Most large employers now offer wellness programs designed to keep employees healthy and, ultimately, cut medical expenses. These programs often come with financial perks to increase participation. More than 81 percent of businesses with 50 or more employees offer at least one wellness benefit, such as gym memberships, quit-smoking programs and stress management classes, according to the Wellness Council of America, an insurance industry group.
These companies are trying to curb health insurance costs that have climbed more than 25 percent over the last five years, outpacing inflation.
For several years now, many companies have offered cash or gift certificates to encourage employees to participate in their programs. Some still do, but low participation rates have prompted an increasing number to offer insurance cost breaks instead.
For instance, employees enrolled in UnitedHealth's personal rewards program can cut their premiums by $1,000 per year for meeting basic health benchmarks for cholesterol, blood pressure and other measures.
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Health care experts see more choice, competition for Sonoma County patients
Published: Saturday, September 29, 2012 at 2:45 p.m. Last Modified: Saturday, September 29, 2012 at 2:45 p.m.
In the aftermath of the 2001 collapse of Health Plan of the Redwoods, the countys largest HMO, many local hospitals and doctors battled each other for insured patients who had not yet been swallowed by fast-growing Kaiser Permanente.
Shrinking government reimbursements were forcing doctors to abandon their private practices and sign up for an employees paycheck from Kaiser or Sutter Health. District hospitals searched for a lifeline that could help them stay afloat.
To be sure, many of these problems still exist, but health care experts say a new era is about to begin one of greater competition among the local health care giants and more choices for individuals.
Two weeks ago, a Sacramento-based HMO known as Western Health Advantage announced that was entering the North Bay market by partnering with a regional network of hospitals and physicians in Sonoma, Napa and Marin counties. The insurance plan is expected to compete head-to-head with Kaiser on cost and quality when it begins selling coverage plans in the North Bay next year.
At the same time, Sutter Health, which runs Sutter Medical Center of Santa Rosa, announced that it had filed for a state license that would allow it to sell its own health plan.
These moves most immediately the arrival of Western Health Advantage take place on the eve of full implementation of President Barack Obamas health care overhaul.
While the verdict is still out on whether Obamas Patient Protection and Affordable Care Act will solve the countrys health care crisis, the medical industry is nevertheless gearing up for major changes in 2014. These include launching health insurance exchanges, the expansion of Medicaid, individual and employer mandates and the prohibition of insurance discrimination based on pre-existing conditions.
Dr. Walt Mills, a Kaiser family practice doctor and the new president of the Sonoma County Medical Association, said the presidents health care overhaul and health care economics are combining to drive the system toward a more vertically integrated and patient-centered model. That means both medical providers and health plans are increasingly expected to produce results: healthier patients.
If somebody ends up in the emergency room because they didnt have access to high-quality primary care in a medical home, thats of no value to the local community, Mills said.
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Health care experts see more choice, competition for Sonoma County patients