A medical organization in the U.S.that datesback hundreds of yearsis embarking on a blockchain pilot.

The Medical Society of Delaware,first formed in 1776, has revealed it willbuild a proof-of-concept focusing on the pre-authorization process for care providers and medical insurers. By improving the efficiency of that step, the society said it hopes care can be delivered more quickly.

As a further benefit, the trial will also create a chain of patient records that can be accessed by insurers and medical care providers.

Partnering on theproject ishealthcare tech startup Medscient, which itself leverages technology developed by blockchain-focused startup Symbiont.

Andrew Dahlke, vice president of the Medical Society of Delaware, said in a statement:

"We are confident that this proof-of-concept will not only address this particular pain point, but will lay the groundwork for streamlining other healthcare administrative issues as well."

Those involved with the project are due to make a presentation at theMedicaid Enterprise Systems Conference, to be held later this month in Baltimore,Maryland.

The newscomes shortly after Delaware became the first U.S. state to pass a law allowing the use of blockchain to create and store business records, including stock ledgers an effort that wasfirst unveiledin 2016.

Medical files image via Shutterstock

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Medical Society of Delaware Tests Blockchain to Improve Healthcare Access - CoinDesk

I am a father, husband and board-certified clinical psychiatrist at St. Josephs Hospital in Syracuse and medical director of CPEP (Comprehensive Psychiatric Emergency Program).

I strongly believe health care is a right for all. It should be available without a cost burden as a healthy person is a productive person. Also, health care is not a commodity like an iPhone but essential to our wellness as a society. Yet the United States is the only industrialized country where health care is a commodity where people make profits on the back of sickness. Health care coverage for millions of Americans continues to be up in the air with little focus on long term solutions, as seen in "Bipartisan experts urge next steps on health care push" (auburnpub.com, 8/7/2017).

The president and many Republicans continue their obsession with getting rid of Affordable Care Act (ACA) despite polling and activism that shows the public prefer improving and expanding coverage. All parties seem to agree that the ACA in its current form is not affordable for many businesses and individuals. I continue to see working class people at my clinical practice who are suffering under this system. Often their employers cannot afford these health care costs. Medications are unaffordable and appointments are skipped. Emergency room care drives expenses up. Meanwhile, health insurance CEO salaries continue in the millions on the backs of those who are helping society.

We need to follow the most efficient model for administering healthcare: improved, expanded Medicare for all. Traditional Medicare has 2-percent administrative costs, as compared to private insurance company which can be as high as 12 percent and are profit oriented. Profits should not be the driving force to health care. It allows disparity of care and brings immeasurable hardship to the needy. Senators like Kirsten Gillibrand and others are supporting Medicare for all. There are 116 co-sponsors for the bill in the U.S. House of Representatives. In New York, we are one state senator away from passing the New York Health Act, which would also provide universal coverage using the improved Medicare model. State Sen. Valesky is a co-sponsor, along with 30 other senators, and deserves praise. Our businesses and our patients demand that we cover everyone without wasting money. Let U.S. Rep. John Katko and state Sens. John DeFrancisco, Patty Richie and Pam Helming know they need to act now to support improved and expanded Medicare.

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Letter: Profits should not drive health care - Auburn Citizen

In his Aug. 4 letter to The Advocate, Stanford Bardwell makes quite clear his opinion we should each mostly look after our own health care and pay for what we can afford, supplementing personal savings with major-medical insurance for catastrophes. This concept worked fairly well for a brief period in our history. People with low-paying or no jobs may have lacked adequate care because they couldnt afford it, but that is still the case for many today.

Here are just two of the many reasons a return to such a system would not work today:

1. Medical inflation. I suggest anybody who has been to the doctor, had lab tests, taken prescription drugs or received medical care for any number of conditions take out the bills and look at the totals stated. For the sake of argument, lets assume the charges bear some semblance to the actual cost of the services. Do you honestly believe most people could easily pay these bills, in full, from savings or any other liquid assets?

Kudos to Lloyd Ray for his letter of July 24 on solving the health care debate in Congress.

2. Changes in services ordered. Go to a doctor for something he or she cannot immediately treat. Note the number of expensive tests, specialist referrals and ancillary treatments physicians now order. This was not always the case not by a long shot, and not least because many of these options simply did not exist. Do you believe all these extras are essential? Do you believe most people could afford to pay to pay for these, even if the costs were more reasonable? At what level should major-medical insurance kick in?

Bardwell is a well-respected and successful person. His letter reflects a disturbing lack compassion for those less privileged. Comparing easy health care access to opioid addiction is appalling. Attacking Hillary and the last administration with unfounded conspiratorial allegations about the ACA is ridiculous. The ACA was a compromise neither Clinton nor Obama would have proposed.

Our current health care system is expensive, irrational, inefficient, ineffective and inequitable. The ACA provides for more coverage, but it does little to address any of these issues. Mr. Bardwell presents a simple solution, but as Einstein is credited with saying, Things should be made as simple as possible, but no simpler. Mr. Bardwells letter does not meet that test.

We live in neither a third-world nor a let them eat cake country, and we should all hope we never do.

Stephen Winham

retired state budget director

St. Francisville

See more here:

Letters: Don't oversimplify health care - The Advocate

Rep. Doug LaMalfa (R-Calif.) held a contentious town hall in Chico, Calif., on Aug. 7. (Nolan Ford/North State Public Radio)

The people of Californias 1st Congressional District made their congressman see red Monday morning.

Like other Republican lawmakers before him, Rep. Doug LaMalfa (Calif.) held a town hall on the ongoing health-care debate and the effort, led by President Trump and the GOP, to repeal and replace the Affordable Care Act.

And like some of his colleagues, LaMalfa was met with boos, catcalls and verbal barbs shouted from the 400-person-strong audience at the Chico Elks Lodge in Northern California, recorded on video and audio by North State Public Radio.

It was the most recent of a declining number of health-care-focused town hall meetings charged byemotional pleas and debates between constituents and their representatives, meetings that have sparked anxiety among GOP lawmakers heading home to face tough questions.

The audience was armed with blunt questions, harsh comments and red placards they used to signal their disapproval of audience queries or LaMalfas responses. Green cards were used to show approval.

LaMalfa saw his fair share of red over his responses. He did not help himself, occasionally veering into sarcasm over concerns ranging from health care to climate change.

[To hold a town hall or not? Its a lose-lose situation for many Republicans right now.]

Out of a sea of moments threatening to boil over, one stood out as particularly tense.

I think that your vote to throw 22 million people off of health is reprehensible and in the service of the rich, a resident told LaMalfa on his efforts to defund Planned Parenthood.

I hope you suffer the same painful fate as those millions that you have voted to remove health care from. May you die in pain, he added.

The comments drew a stream of groans from the audience in a rare moment of sympathy for LaMalfa.

We pray for our constituents too, sir, LaMalfa, who took office in 2013, quickly countered.

Once dotted on Republican lawmakers schedules early in the Trump administration,town halls in VFW halls, rotary clubs and school gyms have become flash points of partisan politics, where local activists marshaledopposition against conservativeleaders in the months leading up to Julys vote, when the Senate rejected a partial repeal of Obamacare.

Town halls have become a damned-if-you-do, damned-if-you-dont situation for GOP lawmakers hoping to sell their message to voters, some in reliably red districts where constituents have used new health-care laws to their advantage, such as receiving coverage for preexisting conditions.

[GOP lawmakers wouldnt come to a town hall so voters brought literal empty suits]

Some lawmakers have refused to hold the meetings. Others have prescreened participants in the hopes of excluding activists who do not live in their districts. That decision has drawn fire.

Even when you had the conservative outrage over Obamacare, I dont recall anyone trying to preselect attendance. The unwillingness to take criticism or any heat from a legislative decision is really unusual,Norm Ornstein, a congressional ethics expert, told The Washington Post in May.

Videos and tweets from events have gone viral, prompting Congress to slow the pace of town halls in recent months. Over the July 4 recess, only three GOP senators announced decisions to hold town halls. Sens. Ted Cruz (Tex.), Jerry Moran (Kan.) and Bill Cassidy (La.) all voiced concern over the health-care bill. Only Cassidy broke ranks to vote against the full repeal-and-replace measure.

LaMalfas district is comfortably red. He cruised to his last victory by 15 percentage points, and Trump soundly defeated Hillary Clinton in the presidential election there.And for his part, LaMalfa has held other town halls recently, with one each in March and April, according to the Los Angeles Times. LaMalfa spokesman Parker Williams told The Post that he plans to hold more town halls in the coming weeks and months.

I think things went about as well as could be expected, given the high emotions in our country at present, Williams said, calling the town hall alargely cordial and productive conversation.

[A town hall in Kansas shows Republican struggles with health-care bill]

Mondays meeting might be a test case in how to manage a crowd. As the audience appeared to get agitatedduring LaMalfas meandering explanation of Medicaid costs, he stopped to address the civility of the participants.

Ive got the mic, folks, okay? If we want to have a positive interaction, if you want to do any more of these, then we need to have LaMalfa said, before being cut off by boos, hisses and laughter among audience members who appeared to take his tone as a condescending lecture. Scores of red cards waved back and forth.

The districts voters have also watched LaMalfas voting record to roll back environmental regulations.

A Chico woman who identified herself as Barbara Richman told LaMalfa that 50 years ago, she could see uninterrupted views of Mount Shasta, a towering nearby volcano buttressed by glaciers. Those views are now filled with haze, she said.

Unlike what you have said, mankind is playing some role in this, she said.

LaMalfa took aim at regulations in response.

Indeed, mankind is preventing forest management that keeps our forests from burning.

He barely finished the sentence. Boos erupted, and red cards shot up.

Iowa congressman walks out of a TV interview and into an angry town hall meeting

A Republican senator defended Betsy DeVos at a town hall. Boos drowned her out.

Originally posted here:

'May you die in pain': Another GOP lawmaker grilled at health-care town hall - Washington Post

Saul Loeb/AFP/Getty Images

Politics

By MATT LATIMER

August 08, 2017

Its easy these days to disparage President Donald Trumps instinctshow, after all, could he get rid of The Mooch, easily the best character on his reality TV show? But there is one thing the president was right about from the start: The Republican Party probably should have left Obamacare repeal well enough alone. At least, that is, until the party had gotten its act together.

When the president decided to go against his instincts and support Obamacare repeal, he was thinking undoubtedly what pretty much everyone who didnt live and work in Washington, D.C., thought: that members of Congress did have their act together. That those who voted over and over again to repeal Obamacare in meaningless show votes would actually repeal it when they had their first real chance. That a party vowing to swiftly enact a plan to replace Obamacare once in full control of Congress would have an actual replacement plan in mind. That when an ailing Senator John McCain was flown in to cast a decisive vote on the bill, the decision would have worked in Republicans favor instead of leaving them at the receiving end of a bracing censure. Or that when Senator Lisa Murkowski voted in favor of allowing debate on Obamacare repeal and replacement, she wouldnt then vote no on every method to accomplish it. Who is running strategy now? Jamie Lannister.

Story Continued Below

And yet, ironically, the GOPs complete, even historic, ineptitude has managed to work in the partys favoras the president might saybig league. Quite unbelievably, the party has an opportunity to emerge in a better position from this mess. Of course, its hard to argue that a GOP-led Congress, currently with an approval rating even lower than that of O.J. Ive lived a conflict-free life Simpson, can do much worse.

First, lets give the president his due: From the earliest days of the administration, perhaps sensing Washingtons love affair with inertia, Trump called for letting Obamacare fail on its own. One might strongly disagree with various methods that might lead to this failuresuch as refusing to shore up wobbling health care marketsbut his point, from a political perspective at least, was valid. If the federal government is to enact something as sweeping and controversial as a total rewrite of Americas health care policy, a sense of national crisis is essential. Over the past few months, the crisis mentality worked against the Republicansbecause Americans were convinced that the crisis was Republicans trying to take away something theyve been given (such as one of Obamacares most popular provisionsprotection for pre-existing conditions). Voters tend not to like losing things they think theyve gained. This explains in part why Obamacare, which has dragged down the Democratic Party through multiple election cycles, is suddenly more popular than ever.

Yet it is astonishing how determined Republicans seem to have been to replicate the very process that led to Obamacares enactment in the first place. For the past several election cycles, the consistent GOP complaint, after all, was that the villainous Obamacare was a rushed law, cobbled together in secret and passed without a single vote from the other party. If anything, this years Republican effort was more rushed, more secret and far less popular. According to one congressional historian, Trumpcare, as the House plan was called, was the most unpopular bill contemplated by Congress in at least three decades (and there were some doozies over that period, let me remind you.)

Indeed, the Republicans missed the most important lesson of Obamacare: Because the law passed without a single Republican vote in the House or the Senate, all of Obamacares miscues or early, inevitable missteps fell on one party. And one party alone. At least one study, and there are others, found that those Democrats who voted for Obamacares passage lost an average of about 6 points in polls, costing Democrats 66 House seats in 2010 alone.

Had Congress actually passed an Obamacare replacement law, with a bare majority of votes, loved by nearly no one, endlessly assailed by the new media, its consequences would be the GOPs to bear. And unless the health care of Americans vastly improved, premiums magically went down, and editorial writers across the country suddenly proclaimed they had been wrong and that Trumpcare was the elixir we needed after all, the GOP would pay an ugly price. When Obamacare was passed, Republicans warned about death panels determining whether patients lived or died. If Trumpcare had passed, the death panels could have been applied to their own political future. Having escaped that fate by the thinnest of margins, the GOP now has an opportunity to turn things around. How would they do this? Through an approach that has become increasingly un-Washingtonlike in recent years: focusing on what that people actually want and, heres the real surprise, giving it to them.

So what does the GOP do now?

First, the Republican Congress can show Americans that it knows how to run a railroad, so to speak, by actually fixing railroads. And bridges. And highways. Oh, and the tax code. You know, things that are popular, needed, and just might get at least a handful of the Democrats to pick up a phone call from the White House every once in a while.

Second, if elected Republicans truly want to enact a massive rewrite of the health care system (and lets be honest, many dont), then they need to wait for a new health care crisis to develop. This will come. And soon. Americas health care system, as it is currently structured, is unsustainable. Premiums will continue to rise. Insurers will continue to shut down operations in various locales. There will continue to be complaints and horror stories from governors and mayors about the toll being taken on their communities. Only when there is a mass consensus that something sweeping needs to be done to fix the system will Congress find the fortitude to act. And at that point, you might at least get help from a Democrat or two. If Obamacare taught anything to anyone in Washingtona city allergic to lessonsbipartisan buy-in, no matter how minimal, is crucial.

Until then, Obamacare is more secure than ever. That, ironically, may turn out to be the biggest legacy of the largest Republican congressional majority in nearly 90 years. If they dont start getting something meaningful accomplished soon, it may be their only legacy.

Matt Latimer is a former speechwriter for President George W. Bush. He is currently a co-partner in Javelin, a literary agency and communications firm based in Alexandria, andcontributing editor at Politico Magazine.

See the original post here:

The GOP's Monstrous Health Care Fail Might Just Have Saved the Party - POLITICO Magazine

Health and Human Services Secretary Tom Price indicated Tuesday that the Trump administration still believes Congress should act on healthcare.

Republicans in Congress failed in late July to pass a healthcare bill that would repeal and replace portions of Obamacare. Though the administration pressed them to continue the effort, Senate leaders have said they are prepared to move on to other priorities. They are expected to hold bipartisan hearings in September aimed at stabilizing the exchanges where people can buy tax-subsidized coverage, but divisions already have emerged over which approaches might receive bipartisan support.

Price made the statements after conducting a press briefing in Bedminster, N.J., on the opioid epidemic. When he was finished with his remarks, reporters asked him about planned cuts to Medicaid in the Senate healthcare bill, which advocates have decried as counterproductive to tackling the opioid epidemic.

"Nobody is interested in cutting Medicaid," Price said. "The fact of the matter is that the president's budget and the proposals that were before Congress were an effort to try to secure and make a Medicaid system work for patients. That's the goal we had."

One version of the Senate healthcare bill aimed to tie the growth in Medicaid spending to the standard rate of inflation, rather than to medical inflation, which is higher. The Congressional Budget Office estimated that the change, which would be scheduled to go into effect in 2025, would result in cuts to the program of $770 billion over a decade. The plan also would have rolled back Obamacare's Medicaid expansion, which covered low-income people, beginning in 2021.

See the original post here:

Tom Price: 'Healthcare challenge is not dead' - Washington Examiner

Large employers say the cost of health-care plans will grow 5 percent next year, to an average cost of more than $14,000 per employee. The increases, reported in a new survey of 148 large companies, were attributed largely to expensive specialty drugs and individuals with high medical costs.

The average 5 percent hike is modest in comparison to thedouble-digit premium increasesthat insurers that sell plans in the Affordable Care Act marketplaces have been requesting, citingthe financial challenges of the marketplace and threats by the White House to discontinue federal subsidies.

"Its the fifth year in a row that employers are saying their costs will rise 5 percent. Its not great, because it's still multiples ofwage increases and general inflation ... but its not the volatility youre seeing in the public exchanges," said Brian Marcotte, president of the National Business Group on Health, a nonprofit organization whose members are large employers, including 73 Fortune 100 companies.

According to the survey, employers will shoulder approximately 70 percent of those health costs, leaving employees on the hook for an average of $4,400, through premiums, out-of-pocket costs and contributions to health savings accounts.

The survey found that an ongoing shift toward high-deductible plans will continue, with 40 percent of employers offering one as the only plan option next year -- an increase from last year. Nearly all employers -- 90 percent -- will offer at least one high-deductible plan in 2018.

The average deductible in such a plan was $1,500 for an individual and $3,250 for a family, although the employer often makes a contribution to a health savings account that significantly reduces the cost to individuals.

Marcotte said that much of the current debate over health care has been about the question of access: whether people have health insurance.

In the employer-sponsored health plan world, where there is greater stability, the focus islargely on containing costs. Companies areincreasing their use of cheaper telemedicine consults, with nearly all employers offering plans that allow phone and videoconferencing with doctors if it is allowed in their state. More employers are opening on-site health centers. There's also a growing push toward health plansthat reward employees for activities that result in more efficient care, such as reduced premiums when they actively manage chronic diseases.

Not all cost-containment efforts may succeed. A study by the Rand Corp.found that,instead of replacing visits that would have otherwise taken place in person, most telemedicine consults were new utilization -- made up of complaints that would never have triggered a visit to the doctor. The ease of picking up the phone could thus increase the use of health-care resources; the researchers found that yearly spending on acute respiratory illness increased by $45 per user.

An emerging concern for employers is the cost of specialty drugs, expensive medications that can cost thousands or tens of thousands of dollars a month. A quarter of employers cited specialty drugcosts as the biggest driver of spending in 2017, and 80 percent ranked it in the top three contributors to rising costs. In contrast, three years ago only 6 percent of employers cited it as the major contributor to high spending.

Original post:

Large employers say health plans will cost more than $14000 for an employee in 2018 - Washington Post

Durham, N.C. Blue Cross Blue Shield of North Carolina on Tuesday named a top official in the federal Centers of Medicare and Medicaid Services as the company's next president and chief executive.

Dr. Patrick Conway will start at Blue Cross on Oct. 1, succeeding Brad Wilson, who announced in February he would retire late this year after seven years in charge of North Carolina's largest health insurer.

Conway is deputy administrator for innovation and quality at CMS the most senior non-political executive at the agency and director of the Center for Medicare and Medicaid Innovation. He is one of the driving forces behind the national movement to value-based care, with health care payments tied to quality and innovation.

"Dr. Conway is a national and international leader in health system transformation, quality and innovation," Frank Holding Jr., chairman of Blue Cross' Board of Trustees, said in a statement. "His unique experiences as a health care provider and as a leader of the worlds largest health care payer will help Blue Cross NC fulfill its mission to improve the health and well-being of our customers and communities."

A practicing pediatric hospitalist, Conway joined CMS in 2011 as chief medical officer. He previously oversaw clinical operations and research at Cincinnati Childrens Hospital Medical Center. He was elected to the National Academy of Medicine Institute of Medicine in 2014 and has received the Presidents Distinguished Senior Executive Rank and HHS Secretarys Distinguished Service awards.

He earned a bachelor's degree from Texas A&M University, graduated from Baylor College of Medicine and completed a pediatrics residency at Harvard Medical School's Children's Hospital Boston.

"Blue Cross NCs role in transforming the health care system in North Carolina is a model that other plans aspire to and that I want to work with the Blue Cross NC team to further improve," Conway said in a statement. "I look forward to collaborating with Blue Cross NC employees, health care providers and employers to deliver the best health outcomes and best service experience at the lowest cost for our customers."

Read more here:

Blue Cross names top federal health care official as CEO - WRAL.com

What happened

After reporting second-quarter earnings and offering up guidance for 2017, shares ofTenet Healthcare(NYSE:THC) have fallen 14.6% as of 2:30 p.m. EDT on Tuesday.

Tenet Healthcare's year-over-year same-hospital patient revenue improved 0.4% as a 1.9% increase in revenue per adjusted admission was largely offset by a 1.4% drop in adjusted admissions. Tenet Healthcare also reported that bad-debt expense increased over the period as more uninsured patients sought out care.

IMAGE SOURCE: GETTY IMAGES.

Overall, the company's net revenue declined 1.4% in the quarter, to $4.8 billion, and its net loss expanded 19.6%, to 55 million, or $0.55 per share. On an adjusted basis, the net loss per share was $0.17. The company's top and bottom line was shy of what industry watchers were expecting.

In terms of uncompensated care expenses, those costs increased 13.6% year over year, to $1.375 billion.

The poor quarterly performance led management to adjust its full-year forecast lower. It now expects full-year revenue of between $19.1 billion to $19.4 billion and a net loss of between $90 million to $115 million. On an adjusted basis, the company is forecasting earnings per share (EPS) of between $0.69 to $0.99, a wide range that reflects a lot of uncertainty in the marketplace. Previously, Tenet was guiding for revenue of at least $19.7 billion and adjusted EPS of at least $1.05.

The lower expectations do little to add confidence to investors that Tenet Healthcare is turning a corner, and that's particularly a problem because decisions in Washington, D.C. could result in more people canceling their health insurance. Until Tenet Healthcare demonstrates that it's right-sized itself, and uncertainty surrounding health insurance markets is resolved, there are probably better investments to make.

Todd Campbell has no position in any stocks mentioned. His clients may have positions in the companies mentioned.The Motley Fool has no position in any of the stocks mentioned. The Motley Fool has a disclosure policy.

Originally posted here:

Why Tenet Healthcare Shares Dropped 14.4% Today - Motley Fool

MSNBC

Trump's health care antics carry consequences for consumers MSNBC The pattern is familiar: the public learns of discouraging news about the health care system; the right seizes on the news as evidence against the Affordable Care Act; and a closer look at the news shows the developments are less about Obamacare and ... Report: Healthcare failure costs Senate Republicans $2M in donationsThe Hill How to Compromise on Health CareBloomberg GOP donors withhold $2 million amid Senate failure on health plan, sources sayCNN International ABC News all 156 news articles »

Link:

Trump's health care antics carry consequences for consumers - MSNBC

For decades, officials who work with veterans have sympathized with rural residents like Graham, but have had little to offer. Now, by testing new ideas through pilot programs like the van rides provided by Volunteers of America North Louisiana, the VA is developing models and spreading them across the country to get more rural veterans the health care they need.

VA expansion

Just 20 miles from where the dirt road to Grahams driveway begins, in Texarkana, theres a VA outpatient clinic. But the clinic doesnt provide chemotherapy. It, like many local clinics for veterans, provides basic physical and mental health care, but not emergency care or some specialized services.

While there is a general lack of doctors and hospitals in rural areas, the situation is even worse for veterans who rely on the VA, said John Hoellwarth, a spokesperson for American Veterans, the nations largest veterans organization. In recent years, the VA has set up more community-based clinics, and the Obama administration created a program, called Choice, that allows non-VA clinicians to serve rural veterans and receive reimbursement from the VA. But the problem persists.

Many rural veterans rely on a combination of VA health insurance and other forms of insurance, such as private insurance, Medicaid (the joint federal-state health insurance program for the poor and disabled), or Medicare (federal health program for the elderly), according to census data. The number ofveterans enrolled in Medicaidincreased by about 340,000 under the Affordable Care Act, according to an analysis by Families USA, a nonprofit that advocates for high-quality, affordable health care.

For veterans in rural areas, Medicaid could mean the difference between them getting care, and them not getting care, said Andrea Callow, Families USA associate director of Medicaid initiatives.

To improve care for rural veterans, the VA needs to expand both the services it provides and the services it pays others to provide, said Margaret Puccinelli, chairwoman of the Veterans Rural Health Advisory Committee, which makes recommendations to Secretary of Veterans Affairs David Shulkin.

Because of the geographic isolation for many vets that are eligible, you have to approach it as creatively as possible, Puccinelli said.

The U.S. House of Representatives last weekvoted to fund the Choice programfor another six months, which would allow lawmakers more time to agree on changes to the program. The bill now goes to the Senate. The program, which is open to veterans who live more than 40 miles from a VA clinic or hospital or who face long wait times, has been plagued with problems from the start, including difficulty for veterans trying to make appointments, and long wait times for reimbursement.

Medicaid could mean the difference between them getting care, and them not getting care

New approaches

The Volunteers of America North Louisiana program was one of five to receive $2 million from 2014 to 2016 from the VA Office of Rural Health, which develops models for care that can be replicated nationwide.

The idea of shuttling veterans to and from their appointments is not new. The VA has had a transportation program for decades, under which Disabled American Veterans donates vans to the VA that volunteers use to take veterans to medical appointments.

But the Volunteers of America North Louisiana program was different: It used paid drivers, picked rural veterans up at their homes, and transported veterans in wheelchairs, which the other program does not do.

Graham tried using the Disabled American Veterans program in his area. But the pickup location is in Texarkana, and Graham said rides werent available at the times he needed them.

Volunteers of America North Louisiana knew there was a need, but it was overwhelmed by the response, said Gary Jaynes, the organizations director of veteran services. In the two years the program was running, it provided 2,229 rides to veterans, logging nearly 300,000 miles and saving veterans nearly $400,000 in travel expenditures, Jaynes said.

Most of the Office of Rural Healths $250 million budget for programs goes to rolling out promising models in local VA clinics. A few approaches that have stuck include using home-based rehabilitation for veterans who have heart attacks, and using telehealth for patients with HIV or multiple sclerosis.

Like Volunteers of America North Louisiana, the Nebraska Association of Local Health Directors received a $2 million grant. The Nebraska nonprofit used its money to place 10 coordinators in local health departments to spread the word about services available to veterans and teach health workers how to find veterans in need of help. The Nebraska program ended up referring about 600 veterans to services in and out of the VA, and created a statewide network of people working toward the same purpose, said Teri Clark, the projects director.

We didnt reach just a couple veterans, Clark said. Instead, we changed the system.

Telehealth expansion

On the way to the VA, just before crossing into Louisiana, Graham gets the hiccups. His cancer exhausts him, and makes it hard for him to digest food. He rubs his chest, recalling a time he had to drive himself home from chemotherapy.

I got the cold sweats, he said, as Texas ranches flew by outside the car window. I got sick as soon as I pulled up in the yard.

The VA knows that providing telehealth to rural veterans makes many long trips unnecessary.Telehealth makes veterans healthier, reducing hospital admissions by 35 percent, and saves them money about $2,000 per patient each year, according to a 2014 VA study.

In addition to driving veterans to appointments, the Volunteers of America bought a telehealth van equipped with communications equipment and broadband internet, which is used to see patients across state lines.

Graham now feels too sick and tired to work, but he used to be a chef. He cooked at the convention center and a cafe in Shreveport. Then he was kitchen manager at a seafood restaurant in Texarkana. He laughs remembering all the energy he had at opening day in 2013, as he ran around trying to feed a hundred guests at once, with food orders stuffed in his shirt pocket.

A couple years later, he was raking leaves and he got dizzy. When he got to the hospital, they found his cancer. He quit his job, sold his truck and signed up for Medicaid.

On his rides with Volunteers of America North Louisiana, Graham bonded with his drivers and fellow riders. Veterans appreciated the program so much that they started calling their representatives in Congress. Now, clinic officials plan to meet with Jaynes and congressmen to discuss ways to keep the services in operation.

Thomas Klobucar, acting director of the Office of Rural Health, said his office is still evaluating the results of the Volunteers of America North Louisiana program, and will report to Congress by October on its findings.

Continued here:

Rural veterans face long paths to health care - PBS NewsHour

With Republicans unable to advance a health care bill in Congress, President Donald Trump's administration may find itself in an awkward role as caretaker of the Affordable Care Act, which he still promises to repeal and replace.

The Constitution says presidents "shall take care that the laws be faithfully executed." So as long as former President Barack Obama's law is on the books, that doesn't seem to leave much choice for Trump, even if he considers "Obamacare" to be "a disaster."

"It's either caretaker or undertaker," quipped economist Joe Antos of the business-oriented American Enterprise Institute. "I think in the end it's going to be 'caretaker' because they'll finally realize nobody is going to blame Obama. Having the thing blow up is going to be considered in the public eye to be Trump's fault."

Every move by Trump's health chief will be scrutinized by Democrats for evidence of "sabotage," a charge they're already making. Meanwhile, the administration will try to use its rule-making power to bend Obama's law toward Republican priorities.

The Trump administration's first sign-up season, for 2018 coverage, starts in about three months, on Nov. 1.

Some things to watch for:

INTENSE SCRUTINY

Consumer organizations, state officials, Democrats, insurers, and groups representing various health care interests will keep close tabs on the actions of Health and Human Services Secretary Tom Price and his deputy, Seema Verma, who runs the federal agency that administers health insurance programs.

"We are going to hold HHS accountable to fully implement the law," said lawyer Mara Youdelman, who heads the Washington office of the National Health Law Program, an advocacy group. "The Affordable Care Act is the law of the land, and everyone who is working for the administration should be committed to upholding the law of the land."

Former Obama administration officials intimately familiar with the program will be looking over the shoulders of the Trump team Twitter accounts at the ready.

Price so far has sent mixed signals. His department recently canceled contracts for community groups to provide sign-up assistance in 18 cities. His official rhetoric about the law has been harsh, maximizing its faults without recognizing the health benefits of 20 million more people with insurance.

But the department did work with Alaska on a waiver that's been praised for helping to stabilize that state's insurance market. And early on, the agency issued a regulation that made several changes insurers had requested to help things run more smoothly.

About 10 million people are signed up for private insurance in subsidized markets, and 11 million more have coverage through expanded Medicaid.

DON'T OVERLOOK THAT COMPUTER SYSTEM

Few things were as damaging to Obama's aura of cool competence as the failure of the HealthCare.gov computer system when it went live in the fall of 2013. Few people managed to sign up that first day, and it took weeks for a technological rescue team to sort through layers of problems, restoring acceptable functionality.

After that chastening experience, Obama administration officials constantly kept tinkering with the website, trying to improve its technical capacity and usability for consumers.

It's unclear what the Trump administration has been doing since he took office in January. No media preview of 2018 open enrollment has been announced.

The administration may have made its own job harder by cutting in half the sign-up season for next year. This time, open enrollment will run from Nov. 1-Dec. 15. Previously, it ran through Jan. 31.

In earlier years, Dec. 15 was a big day for the computer system because it was the last opportunity to sign up for coverage effective Jan. 1. This year the Dec. 15 crunch could be even more overwhelming, because it's also the last chance for most people to sign up for the coming year.

The day falls on a Friday a sort of "Black Friday" for health insurance sign-ups.

"The system has to be ready at the start, and they have to be prepared to detect problems, especially when they hit the end," said Antos.

UNCERTAINTY OVER SUBSIDIES

The clearest signal Trump could send of his administration's good faith would be to remove the uncertainty around billions of dollars in payments to insurers. That money reimburses the insurers for reducing copayments and deductibles for people with modest incomes.

The "cost-sharing" subsidies are called for in the health law, but they are under a legal cloud because of a lawsuit brought earlier by House Republicans, questioning whether the law included a specific instruction for the government to pay the money. The case is on hold before a federal appeals court; the administration has continued making monthly payments.

After the Senate's GOP health bill failed, the president sent out a series of tweets in which he seemed to threaten to stop the payments.

"If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies...will end very soon!" said one of Trump's Twitter messages.

Experts say the money is not a bailout, but a government obligation. GOP leaders in Congress want the payments continued.

Without a subsidy guarantee from Trump, some insurers have been seeking double-digit premium increases, on top of raises that reflect underlying medical costs.

"This month-to-month uncertainty is just corrosive," said former HHS Secretary Kathleen Sebelius, who served in the Obama administration.

LOSING GROUND?

Obama's law reduced the U.S. uninsured rate to a historic low of about 9 percent.

That was widely seen as an indicator of progress under the health overhaul, and one of the main problems for the recent Republican bills is that they would have significantly increased the number of uninsured people.

Amid confusion about the future of the ACA, there are signs that coverage is already beginning to erode.

A major survey called the Gallup-Sharecare Well-Being Index recently estimated that the number of adults without health insurance grew by about 2 million this year.

What happens next is in the hands of the Trump administration.

Online: http://www.HealthCare.gov

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Caretaker for Obamacare? Trump's health care role may shift - ABC News

Sen. Orrin HatchOrrin HatchFive tough decisions for the GOP on healthcare GOP debates deep cut to corporate tax rate Overnight Healthcare: GOP states move to cut Medicaid | Senate passes key FDA funding bill MORE (R-Utah) raised some eyebrows when he used a colorful phrase to argue that it was time for Republicans to move from the healthcare debate to tax reform.

Were not going back to healthcare. Were in tax now," Hatch told Politicoon Wednesday in a story published Monday.

"As far as Im concerned, they shot their wad on healthcare and thats the way it is. Im sick of it.

"As few of you were alive during the Civil War, here's a valuable jargon lesson on 'wads' and the shooting of them," Hatch tweeted.

As few of you were alive during the Civil War, here's a valuable jargon lesson on "wads" and the shooting of them. https://t.co/dOYvcfgImO pic.twitter.com/wk9aaNb3s2

Hatch's office linked to an online version of the Oxford dictionary.

While the phrase Hatch used has taken on a sexual connotation, it also has meanings that are far from blue comedian material.

The Oxford dictionary's definition for the phrase is that it means someone has spent all of their money.

Hatch's Civil War reference is a nod to the definition of "wad" described by Merriam-Webster as "a soft plug used to retain a powder charge or to avoid windage especially in a muzzle-loading gun."

The comments come after the GOP plan to repeal and replace ObamaCare collapsed last month.

Some lawmakers are pushing forRepublicans tocontinue their healthcare push in an effortto fulfill their longtime campaign promise to repeal and replace former President Obama's signature domestic achievement.

Others are arguing that Republicans should move on to otheragenda items, such as tax reform.

Senate Majority Leader Mitch McConnellMitch McConnellFive tough decisions for the GOP on healthcare McConnell on healthcare failure: 'Feel better, Hillary Clinton could be president' George Will warns grotesque is becoming normal for GOP MORE (R-Ky.)said this past weekend he doesn't like to "dwell on situations where we come up a little bit short."

Even on the night when we came up one vote short of our dream to repeal and replace ObamaCare, heres the first thing I thought about: feel better, Hillary Clinton could be president," he said during an appearance at a Republican event in Kentucky.

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Hatch on GOP's ObamaCare repeal push: 'They shot their wad on healthcare' - The Hill

DENVER Colorado has some of the best health care in the country, according to a new report from WalletHub.

The Centennial State landed in 13th place on WalletHubs list of the best states for health care.

What does that mean, exactly?

In its effort to rank each state (and Washington, DC), WalletHub looked at a range of factors, including cost, access and health outcomes. That means states were graded on things like out-of-pocket medical spending, hospital beds per capita, doctors and clinics per capita, the share of insured adults and children, life expectancy and rates of diseases like diabetes, cancer and heart disease.

In essence, the report aims to measure not just availability of health services, but also their value and efficacy, in order to give a more comprehensive picture of health care in each state.

Colorado ranked especially well in certain health issue-related measures, with the fourth-lowest cancer rate in the country and the third-lowest rate of heart disease, according to WalletHub.

Hawaii came in at the top of the list, while Louisiana landed at the bottom.

Here are the top 15 states overall, according to WalletHub:

1. Hawaii 2. Iowa 3. Minnesota 4. New Hampshire 5. District of Columbia 6. Connecticut 7. South Dakota 8. Vermont 9. Massachusetts 10. Rhode Island 11. Maryland 12. Kansas 13. Colorado 14. Maine 15. Utah

To read the full report, log on to wallethub.com.

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Report: Colorado among states with best health care - The Denver Channel

Ahead of Septembers Healthcare Security Forum, Healthcare IT News will be hosting a Twitter chat on Aug. 24 to explore the current healthcare cybersecurity landscape. The discussion will be moderated by Healthcare IT News Associate Editor Jessica Davis (@JessieFDavis).

Kicking off at 3 p.m., the event will feature two security experts:

Last year was a wakeup call for the healthcare sector, with more than 27 million healthcare records stolen in 2016 across 450 reported data breaches. And 26.8 percent of these were caused by ransomware, hacking or malware, according to the 2016 Protenus 2016 healthcare data report.

And this year isnt fairing much better: The latest Protenus reporting found at the current rate 2017 will exceed last year with more than one health data breach per day.

Combined with the U.S. Department of Health and Human Services Health Care Industry Cybersecurity Task Force report that found three out of four healthcare organizations operate without a designated security person, now is the time for healthcare to rapidly improve its cybersecurity posture.

The chat will highlight these challenges and some of the major cybersecurity questions facing the healthcare sector:

RSVP for the event by adding the Twitter chat to your calendar.

Have some pre-chat thoughts and insights of your own? Share on Twitter using #HITSECURITY before the event on Aug. 24.

Twitter:@JessieFDavis Email the writer: jessica.davis@himssmedia.com

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#HITSECURITY Twitter chat to zero-in on state of healthcare cybersecurity - Healthcare IT News

Colorado Governor John Hickenlooper and Ohio Governor John Kasich say the next step toward changing the Affordable Care Act -- after lawmakers failed to follow through on health care reform-- should now include a bipartisan effort.

"Let's get a bipartisan group of people together, and include some governors, who are the guys who have to- the people who have to implement these plans, and look at how do we stabilize private markets, how do we, you know, deal with these high-cost pools, and what's the best way," Democratic Gov. Hickenlooper said on CBS News' "Face the Nation" on Sunday.

"There are some basic remedial steps that can improve our health care system without having to throw everything out the window," he added.

Hickenlooper noted that Americans will be "surprised" at the number of senators willing to "roll up our sleeves, and work on a bipartisan basis, and see how far we can go."

Kasich, who has been collaborating with Hickenlooper in recent weeks, echoed Hickenlooper's comments, saying that once lawmakers realize the system is "melting down," he's hopeful Congress can put aside their philosophical differences and provide a bipartisan solution.

"I think there is a hunger in the Congress at least in the Senate to try to do what they went to do, which is to solve problems. And you can't solve immense, difficult problems without both sides," Kasich said on Sunday.

When asked what compromises both parties would likely be making in such a bipartisan effort, Kasich said Democrats may have to be willing to allow more choices in the insurance marketplace to help drive costs down, while Republicans will have to admit that "there's going to be a group of people out there who are going to need help."

When asked for specific ways in which a revised policy could include a bipartisan solution on the issue of individual mandates, Hickenlooper said, "The key here is to recognize that when you let healthy people not be part of the pool, you're going to concentrate people with serious health issues, so much more expensive insurance risks, into the market. And that's of course going to raise the cost for everyone."

He added, "whether it's a mandate or a reinsurance type pool, that's where we can sit down."

Kasich said that while differences may persist in Washington, putting aside which party "wins" in the end could help ensure a successful outcome.

"If you don't worry about which party gets the credit or which politician gets the credit, it can work," he said. "Now, I can't guarantee you that Hickenlooper and I are going to agree on this, but I'm hopeful."

2017 CBS Interactive Inc. All Rights Reserved.

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Govs. Hickenlooper, Kasich urge bipartisan effort to move forward on health care - CBS News

Quora Questions are part of a partnership between NewsweekandQuora, through which we'll be posting relevant and interesting answers from Quora contributors throughout the week. Read more about the partnershiphere.

Answer from Michael Lee, Public Policy Analyst:

Health care policy involves a lot of political challenges. Leaving aside the policy questions for the momentlets just talk politicsthe challenges include:

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With a stunning late-night vote, Republican Senators John McCain, Lisa Murkowski, and Susan Collins crossed party lines voting against the GOP's "skinny repeal" version of Obamacare reform. Zach Gibson/Getty

So when talking about the Republican health care proposal this year, even leaving aside the policy issues, we have a new government entitlement in the form of ACAs insurance subsidies that now has a constituency (both via the insurance industry and the covered individuals) that doesnt want things to change! But reversing field (even if Republicans were interested in building on ACA) isnt too workable either, because it would require new tax revenue to cover more people.

Remember, Democrats in 2010 passed ACA even though it had a lot of problems and didnt really reflect their policy priorities. And they did it because it moved the ball in their direction and they were convinced that theyd be rewarded by the voters for providing a new benefit. That hasnt happened quite yet, but voters still agitated against the Republican proposal because it would have reduced health insurance coverage compared to current law.

It remains to be seen where we go from here.

Why is the health care bill considered such a hard problem? originally appeared on Quora - the place to gain and share knowledge, empowering people to learn from others and better understand the world. You can follow Quora on Twitter, Facebook, and Google+. More questions:

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Quora: Why Is Health Care So Difficult to Solve? - Newsweek

For what its worth, most hospitals and health systems have realized the value in investing in big data. Theyre eagerly raking in a plethora of data, focusing solely on the collection aspect.

But thats insufficient, Gray Matter Analytics president and CEO Sheila Talton proposed during an event last week at Chicago-based startup incubator MATTER.

The real story is: How do you have data thats accessible that can actually become information? Because data is not information, she said.

Most healthcare organizations have gotten the data gathering process down pat, and theyve become experts at utilizing data to report what happened. However, the industry needs to keep moving forward so that data can be used to get descriptive insights, predictive insights and prescriptive recommendations.

Systems are clearly impeded from making good use of the data they have. Part of the problem is the fact that much of the data is siloed.

For other organizations, its simply a budget issue. The majority of health systems can hardly obtain the financial resources to maintain their existing tools, let alone implement new processes and programs.

When a hospital does hop on the bandwagon and begin to manage data, its often pulled into believing in a one-size-fits-all model. Every tool and solution that a certain hospital utilizes will work for me, the hospital thinks.

Yet thats not the case, Talton stressed. Each hospital has a different patient population and budget, meaning it requires its own unique solution.

The need for better data integration is especially applicable in this day and age as the healthcare sector pushes for value-based care.

Value-based care is here to stay, Talton said. That continuum is continuing.

Since the industry is moving toward shared risk models, figuring out how to use data is more important than ever. Health system leaders need to ask, How do we manipulate and manage our data? How can we use it to make the lives of our clinicians easier?

On top of asking these questions, everyone from payers to providers needs to be finding ways to share data with each other. Only by doing so can the healthcare field glean meaningful insights and information.

In closing, Talton shared her belief of what a health systems number one focus should be: Becoming a data-centric entity. But it also boils down to planning for the long term. Instead of focusing solely on installing one-off solutions and collecting data, systems must consider their ultimate goals.

Photo: from2015, Getty Images

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In healthcare, big data alone isn't enough - MedCity News

When Nicole Thurman first noticed the health issues that CHG Healthcare was treating its own employees at its Salt Lake City clinic anxiety, substance abuse and post-traumatic stress disorder, among others it became apparent that the medical staffing firm needed to hire a mental health counselor.

We have a young population, so we have an opportunity to help with mental health issues before they turn into substance abuse issues or physical health issues, says the senior director of talent management. I look at this as preventative care.

The staffing firm, which temporarily places physicians in hospitals and clinics, is still in its first year offering mental health counselors to its employees but this benefit has earned $1.73 on every dollar it spends on its Salt Lake City on-site clinic. The ROI was based on claims where high costs claims that cost more than $25,000 were not factored, according to CHG Healthcare.

The mental health counselors are solely available for about 1,300 CHG healthcare employees in the Salt Lake City location. CHG Healthcare plans to roll out the service to 600 employees in the Fort Lauderdale office this January, and is still thinking about its approach for bringing mental health services to locations with fewer than 100 employees. The company started out in Salt Lake City to find doctors and medical professionals for the rural west but it now has four subsidiary companies that all operate under CHG Healthcare. So far, only the Utah-based CHG Healthcare offers this service to its employees.

CHG Healthcare added three counselors to its on-site clinics in November 2016 and said about a third of the 75 visits each month are related to mental health.

We have a really high stress, high intensity workplace because most of our people are recruiters. They need to make their numbers, Thurman says. [The counselors] see a lot of people with anxiety, home and work-life balance problems, depression, marital issues, substance abuse, financial wellness. If we didnt have our clinic here, [our employees] would go elsewhere.

See also: This app tells you when youre depressed. Who else does it tell?

The clinic offers services such as primary care, health coaching, orthopedic injury treatment, pediatric services and womens health, among a myriad of other services, so its impossible for the company to know if an employee is seeking mental health services or treatment for a bad back, Thurman says.

Thurman declined to reveal the cost of the mental health services out of concern that it would deter other employers from offering similar services. However, she says the service is easily scalable.

Originally, the mental health services started out as a referral system, where CHG healthcare leaders could direct their employees. From there, CHG Healthcare has expanded its advertising to fliers, benefit brochures, online communications and physician assistant-led lunch-and-learn sessions, Thurman says.

There is an undercurrent that happens here, she says. Its all word of mouth. Someone will have a good experience and tell someone else. Its exciting to me because that stigma is broken down.

Thurman admits that the company has a good culture built upon trust, which makes a service like mental health counseling more widely used by employees.

Its convenient, its no cost and its high quality, Thurman says of the benefit that is not charged to the employees. Thats why it works.

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Mental health services increase ROI for CHG Healthcare - Employee Benefit News

Sen. Ron Johnson, R-Wis., said it is probably time for legislators to focus on areas of work like taxes and the economy while continuing to negotiate on a healthcare bill in the background.

Johnson was asked by CNN's Jake Tapper about a tweet from President Trump aimed specifically at Congress' upper chamber, stating, "Unless the Republican Senators are total quitters, Repeal & Replace is not dead! Demand another vote before voting on any other bill!"

"I really do think we probably ought to turn our attention to the debt ceiling and funding the government and tax cuts until we can really get all the parties together," Johnson said. "From my standpoint that really is getting the governors, House members, senators [and] the White House on the same page in terms of healthcare."

Tapper noted that Trump has also been critical of the Senate for leaving town with numerous campaign pledges by Republicans and the president himself still unfulfilled or languishing, such as funding and construction of a border wall, tax cuts, and plan to repeal and replace of Obamacare.

"My preference would have been to stay in session, to grapple with those issues I was talking about," Johnson said. "At the same time, getting back to the state, talking to constituents -- on Friday I traveled with Agriculture Secretary Sonny Perdue and had some really informative discussions with farmers and agriculture interests in the state. We are not on vacation. We really are working. I continue discussions on healthcare as well as taxes with my colleagues even though we're not in Washington, D.C.

Johnson went on to note that Obamacare markets are still unstable, and that the issues around healthcare "aren't going away."

With regards to the ongoing Russia investigations, a bipartisan Senate bill was introduced that would protect special counsel Robert Mueller from being fired by President Trump.

"I don't see that Bob Mueller is going to be fired," Johnson said. "But at the same time I was pretty vocal, saying I would have preferred the congressional committees, the House and Senate Intel Committees finish their work, issue their report before we begin thinking about special counsel. Let's face it, the history of special counsel, special prosecutors, sometimes they go off the rails, they start going on witch hunts. And we have enormous challenges facing this nation. We don't really need that kind of distraction."

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Sen. Ron Johnson: Put healthcare reform on back burner and focus on other legislative issues - Washington Examiner