Everyone seems to agree that health care is the next big industry waiting to be disrupted. But who will force that change on a massive system full of conservative players? Three possibilities present themselves:

Ive seen plenty of evidence to support each of these three scenarios, and I think that your position in the system and personal philosophy, more than any evidence, probably determine how youll cast your vote. In this article Ill list some of the activities in health care that illuminate the chances for each scenario to come alive, drawing on the recent Strata Rx conference put on by OReilly Media.

Many reformers, notably Clayton Christensen, have declared current hospitals and other health institutions irreparabletoo caught up in the treatment and payment models they have used for decades. Other people in the health care field are equally committed to change, determined to do it through the health institutions themselves. I believe, from what Ive read and heard of Dr. Eric J. Topol, that he falls in this category.

Another leader I would place here is Jonathan Bush, cofounder and CEO of athenahealth. The vibes I pick up from him react very negatively with government regulations. He believes the market can bring about reform, one of the solutions in his keynote at StrataRx.

In a five-minute Ignite! talk, Lisa Maki suggested turning the high cost of health care into an opportunity for change. Maki seems to be an adherent to the same market-driven point of view as Jonathan Bush, believing that converting health care into a market with transparency and patient choice can bring about the change. Makie held up the PokitDok site as a way to help patients find out what theyre spending.

Two talks by representatives of the Department of Health and Human Services at Strata Rx could have health care reformersalong with anyone interested in a more collaborative and responsive governmenton their feet cheering. So long as shutdowns dont cripple agencies plans, theres a lot government can do to stoke the health care revolution.

Bryan Sivaks speech paid homage to the power of independent developers, open data sets, and power to the patient. He marked the milestone of HHS releasing 1,000 data sets, which they are seeking to combine with other peoples data. And he announced a pilot test bed at hospitals and other data users so developers can test their apps on real systems. This will reduce the risk of deploying apps, which very important to these naturally conservative institutions.

Claudia Williams continued this theme by highlighting the value of data to patients and describing the contributions of BlueButton Plus, a tool that tries to standardize patient access to data, and Direct, an HHS project to make secure data exchange simple.

HHS is not intent, of course, on changing the health care field purely through its own dictats (notwithstanding the paranoid fears of a few fringe commenters). Rather, it hopes to provide tools for change in collaboration with private actors, who have always contributed to projects such as BlueButton Plus and Direct. That, together with incentives for improving quality and providing payment for outcomes, will hopefully create a new environment where the drive and intelligence of the private sector can find a way forward.

Not a single trouble, actually, but many. Lets look first at what an ACO is: a collaboration among providers and possible payers to give patients integrated care. Several models for ACOs already exist, of which the biggest is Kaiser Permanente (I dont include the Veterans Affairs system because of its unique characteristics). CMS now defines ACOs in detail for reimbursement purpose.

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Where are the chances for change in health care top-down or bottom-up?

LAPLACE Representatives of the Louisiana Healthcare Education Coalition invited St. John the Baptist Parish residents to sit in on a informative presentation about the key changes imposed by the Affordable Care Act, also known as Obamacare.

The health care reform law was actually passed in 2010, but changes that will go into effect January 2014 have thrown it into the spotlight more recently. The law is designed to ensure access to quality, affordable health care coverage and will require most Americans to have some form of health insurance. Insurance providers can no longer deny coverage to citizens with pre-existing conditions.

An online health care marketplace is designed to provide coverage options for those who do not receive insurance from an employer or are not enrolled on a government mandated health care plan, such as Medicaid, Medicare, CHIP or TriCare. Citizens who receive coverage from work or a government program do not need to worry about using the online marketplace. Subsidies are also available to help pay for health insurance premiums for those who earn between 100 and 400 percent of the federal poverty level projected income.

Open enrollment for the online marketplace officially began on Oct. 1. Citizens who wish for their coverage to take effect Jan. 1, must enroll by Dec. 15, though the enrollment period will last until March 31, 2014.

Incarcerated people, those who reside in the country unlawfully, those who are claimed as a dependent on someones taxes, those who earn more than 400 percent of the federal poverty level and those who are unable to prove residency in one state are not eligible for coverage under the ACA.

Thus far, four Lousiana insurers have applied to participate in the marketplace: Blue Cross and Blue Shield of Louisiana, Humana, Louisiana Health Cooperative and Vantage. Humana has limited its coverage to Jefferson Parish, while Vantage will be limited to northern Louisiana.

The federal government will reap a hefty fine from those who choose not to enroll when they do not already have a health care plan. According to Keith Ray, a representative of the Louisiana Healthcare Education Coalition, failure to comply means confiscation of tax refunds starting at $95, or 1 percent of a citizens total income for first year without health coverage. The fine can grow to up to $695, or 2.5 percent of income by 2017.

Ray said the online marketplace has experienced quite a few glitches and unanswered questions. He went on to speak of the websites software and design defects.

This is something that is really different. So when we say they are many unanswered questions, thats just a fact. There are unanswered questions, and there are a lot of glitches, said Ray, who added that LHEC did not intend to denigrate or promote the new health care act.

As with any large-scale event of this magnitude, we expect to spend the first couple of weeks after the marketplace opens working with the government and other partners to identify and quickly resolve any issues so we can make the experience as smooth as possible, said Blue Cross Blue Shield of Louisiana CEO Mike Reitz last week.

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Health care reforms explained

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Gupta hits the road to talk health care
Dr. Sanjay Gupta hits the road in the CNN Express to show people how the Affordable Care Act will affect them.

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Health Care Help
How to sign up for health care.

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Health Care Help - Video

Judge Napolitano: #39;Nonsense #39; for Obama And Democrats to Say Congress Has to Fund Health Care Law
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ST. LOUIS COUNTY (KSDK) - More than 200 SSM Health Care positions will be eliminated, according to Steve Van Dinter, a spokesperson for SSM Health Care.

There are approximately 12,000 employees in the St. Louis area, and 206 positions will be eliminated.

Overall, SSM Health Care employs approximately 30,000 employees, and 586 of those positions will be eliminated. That is less than 2 percent of total positions.

Van Dinter says most of the positions are administrative, and not directly involved with patient care. Roughly 50 percent of the reductions will be through attrition.

These layoffs don't come as a surprise to health care experts.

Tim McBride a health care expert and professor at Washington University says he is not at all surprised by the job cuts.

He says this has been a growing trend for hospitals before health care reform came into the picture.

Just this year we've seen BJC lay off 160 workers, Liberty Hospital, a hospital in Kansas City, lay off 130 and the University of Missouri Health Care announce they will not fill 90 vacancies in the coming year.

Mcbride says while yes, there will be many more that have health insurance, they will be urged to go to primary care physicians not straight to the emergency rooms.

"That means that big systems like SSM and BJC need to restructure and take some of the dollars out their big health care systems and move them towards doctor's offices," said McBride.

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SSM Health Care eliminates 206 position in area

The nations new health care law is complex, convoluted and controversial.

But in the long run, cancer survivor and health care reform advocate Charlie Kulander believes the Affordable Care Act, or Obamacare, will help millions of Americans.

Ive found myself becoming somewhat of an Obamacare evangelical, the local freelance writer said this week. Its a complicated piece of legislation, with many moving parts, but it is the greatest piece of social legislation since 1965, and will save countless lives.

Kulander said he hates to wade into the political debate over the 906-page law. But he thinks its wildly inappropriate that someone would tell another person not to sign up for insurance through the new health care marketplace at http://www.healthcare.gov.

The one thing that sticks in everybodys craw is the individual mandate, which requires most Americans to carry some form of health insurance, Kulander said.

Some people may be eligible for exemptions from the individual mandate, he noted. Regardless of the controversy over that provision, though, Kulander is convinced that the overall law has something for everyone.

That includes himself, his wife and his nephew all of whom were diagnosed with cancer in recent years.

Kulander and his wife received the news within eight months of each other almost five years ago.

The couple had maintained their health insurance policies over 25 years, and they were paying exorbitant premiums to remain covered, Kulander said.

Even so, their deductibles and out-of-pocket expenses were high, and they ultimately wound up taking on debt in order to pay for their medical care.

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Cancer survivor becomes health care reform advocate

Kumamoto, Japan (PRWEB) October 11, 2013

As the worlds governments were signing a global treaty aimed at phasing out the use and emissions of mercury, Health Care Without Harm and the World Health Organization launched an initiative to achieve the Minamata Conventions goal to end the manufacture, import and export of mercury-based medical devices by 2020.

Today marks the culmination of a fifteen-year Health Care Without Harm effort that began with a single hospital in Boston, evolved into a global campaign that engaged the health sector on every continent, and has now resulted in a worldwide treaty, said HCWH President and co-founder Gary Cohen. It is also a day to redouble our efforts to phase-out mercury thermometers and blood pressure devices everywhere.

The Minamata Convention calls for the end of the manufacture, import and export of mercury-containing fever thermometers and sphygmomanometers. HCWH and WHO have been working together for this objective of mercury-free health care since 2008 by supporting the deployment of accurate, affordable, and safer non-mercury alternatives around the world.

Over the course of HCWHs fifteen-year effort and its more recent collaboration with WHO, many countries and regions, including the European Union, the United States, Argentina, Chile, Costa Rica, Nicaragua, the Philippines, Nepal, Sri Lanka and Mongolia have already embraced mercury-free health care. Many more are on track to do so, including Brazil, India, China, South Africa and Mexico.

The tireless and committed work of nurses, doctors, and hospital leaders, along with NGOs, government and UN officials, has shown that switching to mercury-free health care is accurate, affordable, and also inevitable, said Josh Karliner, HCWH Director of Global Projects. The treaty enshrines this inevitability.

The WHO-HCWH Global Initiative for Mercury-Free Health Care is now gearing up to support health professionals, hospitals, health systems and ministries of health as they seek to implement the Minamata Convention. The Mercury-Free Health Care Initiative will provide guidance and technical support, while continuing to expand awareness raising and mobilization in the health care around the world. It aims to both shift demand toward alternative devices, and to educate societies as to the overall health impacts of mercury.

While the Minamata Convention is a huge win in terms of greening the health sector, HCWH remains critical of some of the Minamata conventions shortcomings. This is particularly true when it comes to the treatys weak strictures around mercury emissions that come from coal fired power plantsfactories that are expanding around the world. If the expansion of coal-based energy generation is not curbed, said Dr. Peter Orris, a Senior Adviser to HCWH, mercury emissions from coal threaten to undermine the mercury reduction the treaty is achieving elsewhere, curtailing its overall health benefits.

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Health Care Without Harm, World Health Organization to Help Achieve Convention Goal of Ending Manufacture, Import and ...

OAKBROOK TERRACE, IL--(Marketwired - Oct 10, 2013) - A viewpoint published in the October 2013 issue of Health Affairs contends that American health care will not get better or be safer until issues related to overuse of health services, process improvement tools, and organizational culture are addressed. The article "Improving the Quality of Health Care: What's Taking So Long?" by Joint Commission President and CEO Mark R. Chassin, M.D., FACP, M.P.P., M.P.H., acknowledges that the lack of more rapid progress in fixing known problems is frustrating, and suggests that the task requires new approaches.

Nearly 14 years after the Institute of Medicine report To Err Is Human; Building a Safer Health System jolted health care professionals and the public alike by revealing that preventable health care adverse events cause more deaths than traffic accidents or breast cancer, Chassin contends that the way health care conducts improvement is itself in need of improvement. His Health Affairs commentary builds on his previous efforts to help health care make progress toward high reliability, which represents an extraordinarily high level of safety sustained over long periods of time -- safety levels achieved today by industries such as commercial air travel, nuclear power, and amusement parks. Chassin proposes three strategies:

"Harm-free health care does not exist today, but that should not prevent us from aspiring to achieve that goal," says Chassin.

Chassin's proposals to improve health care come more than two years after he and the late Jerod M. Loeb, Ph.D., executive vice president for health care quality evaluation, The Joint Commission, collaborated on the article "The Ongoing Quality Improvement Journey: Next Stop, High Reliability," also published by Health Affairs. The April 2011 article contended that health care could make major improvements in quality and safety by adapting lessons learned from other industries with consistently excellent safety records. They recently followed up on the April 2011 piece with a second article "High-Reliability Health Care: Getting There from Here," in the September 13 issue of The Milbank Quarterly, that provides a roadmap of specific changes hospitals should undertake to achieve the ultimate goal of zero patient harm by adapting lessons from high-risk industries.

The Joint Commission is leading this effort in its work with more than 20,000 accredited health care organizations. Joint Commission standards (Leadership, National Patient Safety Goals, Quality Improvement) emphasize the need to create a culture of safety and to continuously improve performance. In addition, the Joint Commission Center for Transforming Healthcare is helping health care organizations use RPI to create customized solutions to quality and safety issues such as hand hygiene, reducing errors in hand-offs between caregivers, wrong site surgery, surgical site infections, preventing falls that injure patients, and others.

Founded in 1951, The Joint Commission seeks to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. The Joint Commission evaluates and accredits more than 20,000 health care organizations and programs in the United States, including more than 10,300 hospitals and home care organizations, and more than 6,500 other health care organizations that provide nursing and rehabilitation center care, behavioral health care, laboratory and ambulatory care services. The Joint Commission currently certifies more than 2,000 disease-specific care programs, focused on the care of patients with chronic illnesses such as stroke, joint replacement, stroke rehabilitation, heart failure and many others. The Joint Commission also provides health care staffing services certification for more than 750 staffing offices. An independent, not-for-profit organization, The Joint Commission is the nation's oldest and largest standards-setting and accrediting body in health care. Learn more about The Joint Commission at http://www.jointcommission.org.

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Improving Health Care Quality, Safety Defies Simple Solutions

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Altarum headquarters in Ann Arbor. Photo by Dwight Burdette via Wikimedia Commons.

ANN ARBOR (WWJ) Heres more evidence that something is keeping health care price and spending increases low in the American economy.

The Ann Arbor health care consulting firm Altarum Institute reported Wednesday that national health care prices in August 2013 were 1 percent higher than in August 2012, down one-tenth from the July 2013 level and equal to the May 2013 rate, which was the all-time low in Altarums history of recording the data, which extends back to January 1990.

The 12-month moving average, at 1.5 percent, is a new low for the Altarum data. Hospital price growth fell to 1.5 percent, its lowest rate since 1.3 percent in December 1998, while physician prices grew a scant 0.3 percent.

Hospital price growth plays a dominant role in the total index via its spending weight, and its low August reading was complemented by a decline in home health prices (down 0.2 percent) and durable medical equipment (down 0.1 percent), plus moderate growth otherwise.

National health expenditures in August 2013 grew 3.8 percent over those of August 2012 and kept the annualized growth rate at 3.8 percent for 2013 to date. The health spending share of GDP was 17.4 percent in July 2013, the same as at the conclusion of the Great Recession in June 2009. Thats well below the 18 percent share that has been previously reported over the past few years and is strictly due to a change in GDP accounting that occurred in July 2013.

These data come from the monthly Health Sector Economic Indicators briefs released by Altarum Institutes Center for Sustainable Health Spending, http://www.altarum.org/HealthIndicators.

Due to the federal government closure, labor data for September, scheduled for Oct. 4 release, were not reported. Altarum says it will issue a new HSEI Labor Brief about the growth of health care employment when new labor data are ready.

Health care prices have been growing more slowly than prices in the rest of the economy for four consecutive months, said Charles Roehrig, director of the center. If this continues for the rest of 2013, we may find that spending growth for 2013 has dropped below the record low 3.9 percent growth experienced since 2009.

Altarum Institute provides research and consulting to the health care industry. Based in Ann Arbor, it has additional offices in the Washington, D.C., area; Portland, Maine; and San Antonio, Texas.

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Health Care Spending Growth Remains At Historic Low

These are complicated times in the affairs of Washington and the nation, with death stars everywhere and all of them a struggle to comprehend. The partial government shutdown, the debt limit squeeze just around the corner, sequestration, how they fit with the health care law, how they don't _ it just goes on.

So we've cooked up some questions about this grim galaxy and taken a stab at answers:

Q: Which is better, "Obamacare" or the Affordable Care Act?

A: When late-night comedian Jimmy Kimmel asked people this question, they thought they could choose between the two, and they opted for the nice-sounding Affordable Care Act as the way to go in health care.

They are, of course, the same. Opponents of President Barack Obama's health care overhaul came up with the catchy nickname "Obamacare" and it spread to the point that even Obama uses the term sometimes. The difference is in how people say it. Republicans tend to spit it out. Obama says Republicans will stop calling it "Obamacare "when it becomes really popular.

On the other side of this, there's been a strong trend in Washington in recent decades of giving backslapping names to laws. Even laws have spin now in their titles. It's like naming your baby Precious.

When Franklin Roosevelt set up public pensions in 1935, he didn't call it the Happy Retirees Act or the Justice for Deserving Seniors Act or the Golden Years Contentment Act. He called it the Social Security Act. In those apparently more serious and less pandering times, perish the thought of a No Child Left Behind Act.

A nice title is no guarantee of results. Many people in both parties want to leave No Child Left Behind behind because they feel it's leaving children behind.

The full name of Obama's law is the Patient Protection and Affordable Care Act. Indeed, patients have new protections against losing their insurance. But the many questions about how affordable insurance and medical care will turn out to be aren't put to rest by a law's reassuring name.

There's no doubt dressed-up labels help sell things, though. Orange roughy has done much better in the seafood marketplace since its name was changed from slimehead.

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The shutdown, the debt and health care: a primer

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