Docs: Head to the Mount Rushmore State! Oh, Jersey, No!

So who says Washington DC. is just for politicians? It’s got doctors, doctors, doctors.

The District of Columbia has the highest number of physicians per 1,000 residents in the country — 6.9 times higher than Nevada, the lowest at 1.20, according to WalletHub’s  just released 2018’s Best & Worst States for Doctors.

WalletHub compared the 50 states and DC on a range of issues including the  average annual wages of physicians to hospitals per capita to quality of public hospital system.

The best state for docs? — South Dakota.

The worst — New Jersey.

Speaking of wallets — docs have plenty of holes in them, WalletHub says.

“The average medical-school graduate left campus with more than $190,000 of debt in 2017. The medical profession has also been undergoing intense transformation in recent years,” wrote John S Kiernan, Senior Writer & Editor for WalletHub. 

“Health-care reform, the rise of branded hospital networks and the retirement of Baby Boomers are all complicating the lives of doctors,” he wrote. — Joe Cantlupe

 

 

Never Again! Enough is Enough! We Call BS! ‘Survivors of a Cruel and Silent Nation’

Parkland, Fla.

Parkland has well-manicured lawns, new developments, and huge parks, with trails and tennis courts and basketball courts and ballfields. At the intersection of Coral Springs and Parkland is a horse riding academy, Malachi Acres, with a boarding stable, amidst the palms.  Town hall is beautiful, and residents talk about the sense of community. A resident recalls how there was a mini-scandal when there were some car break-ins in a neighborhood.  The reason, he said with a near smile: “The owners left their doors unlocked.” It’s that kind of place. A month ago, my wife and I left Parkland, heading to the airport after visiting relatives there. The Lyft driver told us why he moved to Parkland, this proud man from Brazil. For the schools, he said. For the schools.

Yesterday, it was about all of this, a sense of place,  the schools, and something much more profound:  passion, determination, unyielding force. Angry teen-agers with a grudge, clutching a sadness no one should have, fighting to curb gun violence, restrict the access to guns — assault weapons – and vowing, vowing, vowing to make politicians know they will be ousted from office if they don’t comply. So there is no more  terrible nonsense of gun violence that is taking lives, the “17 angels” — the 17 people –  students,  a football coach and athletic director, who were killed at Marjory Stoneman Douglas High School on Valentine’s Day. There were 14 wounded. The gunman was mentioned only in passing yesterday during the March For Our Lives rally, only in a word like horrible, but also as a pathetic reason why, why, why laws must be changed, gun laws, mental health laws, funding, you name it. All our hearts are broken, and we’ve had enough was the refrain, constant and true.

Parkland was center stage as a place, but its students were also taking the center stage  in  a rally in Washington D.C. Parkland is one piece of the gun-control puzzle. So is Chicago. So is New York. So is Miami. So is Los Angeles and everywhere where marches were held.  One bullet that fells any kid in a school, on a street. That’s what they fought against yesterday, mostly these kids, but there was plenty of support, no doubt about it, from parents, teachers, friends, the elderly.  Stop the gun violence. Stop people from having assault weapons.  Down with NRA. Thump the Trump. (ok, my term). Placard after placard. Sign after sign. The message was clear: Lawmakers and the President, if you don’t do enough you will be voted out by their supporters, damn it, when they are old enough to vote.  One student from Parkland told how she thought the privilege of the town helped draw it attention, but the fight  represents all races, all genders, all lifestyles. Those  voices at rallies across the country related personal experiences of friends, relatives, loved-ones cut down in senseless violence, in emotional, drive you to tears speeches. Eyes welling up all over.  Let’s hold those thoughts.

“We are survivors of a cruel and silent nation,” said D’Angelo McDade, 18, of Chicago at the Washington D.C. rally.  “I too, am a victim, a survivor and a victor of gun violence,” McDade said. “We are survivors not only of gun violence but of silence. I come from a place where minorities are controlled by both violence and poverty, leading us to be deterred by success. But today we say, ‘No More.’

No more, he said: violence, no more poverty, no more unjust policies and lack of resources. “You must be the change,” he told the crowd.

In 1970, after National Guard troops shot students at Kent State, we were young and demonstrated with passion and fury. We were convinced the wrongs of America would turn to rights.

We didn’t have social media. We had bull horns.

There’s something magical going  on now amidst the sadness.

These kids are articulate and their speeches are raw and practical. Blunt.  No more BS!

There are still huge bureaucratic mountains to climb, but as the protestors insisted yesterday, this is just the beginning. We’ll be hearing more of the words Ballet Box. — Joe Cantlupe

 

 

 

Did FBI drop the ball? Yes. Florida Gov. Wants FBI Director to Resign

The FBI conceded today that the agency did not follow proper protocols to pursue information on a tipline Jan. 5 about Nikolas Cruz, the self-confessed gunman in the Parkland high school massacre on Valentine’s Day and his “desire to kill people.”

Stunned by the admission, Republican Florida Gov. Rick Scott called for the FBI director to resign, saying: “The FBI’s failure to take action against this killer is unacceptable.

In an extraordinary  statement, the FBI said they did not followup on a call to the FBI’s Public AccessLine (PAL) tipline that reported concerns about Cruz, and his  “gun ownership, desire to kill people, erratic behavior and disturbing social media posts, as well as the potential of him conducting a school shooting.”

“Under established protocols, the information provided by the caller should have been assessed as a potential threat to life. The information then should have been forwarded to the FBI Miami Field Office, where appropriate investigative steps would have been taken,” the FBI said. “We have determined that these protocols were not followed for the information received by the PAL on Jan. 5. The information was not provide to the Miami Field Office an no further investigation was conducted at that time.”

The apparent mishandling of the information only adds to the tragedy in which 17 people were killed by the former student at Marjory Stoneman Douglas High in Florida. The defendant’s lawyer and President Donald Trump has said the 19-year-old Cruz, who had been expelled from the high school, had mental health problems.

News reports today said earlier that a tipster had alerted the FBI in September about a comment Cruz , who allegedly said he was going to be a “professional school shooter.” At the time the bureau checked databases but could not identify it as Cruz, or anyone else, according to the reports.

As a city and a country reels, the FBI is doing some soul-searching.

“We are still investigating the facts. I am committed to getting to the bottom of what happened in this particular matter, as well as reviewing our processes for responding to information that we receive from the public,” FBI Director Christopher Wray said. “It’s up to all Americans to be vigilant, and when members of the public contact us with concerns, we must act properly and quickly.

“We have spoken with victims and families, and deeply regret the additional pain this causes all those affected by this horrific tragedy,” Wray said. “All of the men and women of the FBI are dedicated to keeping the American people safe, and are relentlessly committed to improving all that we do and how we do it.” – Joe Cantlupe

To Tell the Truth: Will the Real Donald Trump Stand Up?

For once, he wasn’t the trash-talking, excitable President and he was down-to-earth. Does Donald Trump mean business and does he seek the “unity we need to deliver for the people” or is he simply a chameleon?

In his 80-minute State of the Union address last night, Trump touched fairly briefly on some healthcare issues, but they were the most volatile impacting the nation — drug abuse and healthcare reform.  And he did so in a presidential manner, not as a street tough.

Among the issues, in order of his presentation:

Obamacare. Trump praised elimination of the “core of disasterous Obamacare – the individual mandate is now gone.”

FDA approvals. He noted the “FDA approved more new and generic drugs and medical devices than ever before in our history,” to speed access to “breakthrough cures an affordable generic drugs.”

Terminal conditions. He said he believes that “patients with terminal conditions should have access to experimental  treatments that could potentially save their lives.”

“People who are terminally ill should not have to go from country to country to seek a cure — I want to give them a chance right here at home,” Trump said. “It is time for the Congress to give these wonderful Americans the “right to try.”

Prescription Drug Prices. “One of my greatest priorities,” Trump said, is to reduce  prescription drug prices. “In many other countries, these drugs cost far less than what we pay in the United States. That is why I have directed my Administration to make fixing the injustice of high drug prices one of our top priorities. Prices will come down,” he said.

Opioid and other drug overdoses. Trump, referring to the “terrible crisis of opioid and drug addiction,” said his administration is “committed to fighting the drug epidemic and helping get treatment for those in need. The struggle will be long and difficult – but, as Americans always do, we will prevail.”

Trump said 64,000 Americans died as a result of drug overdoses in 2016: 174 deaths per day, seven per hour. “We must get much tougher on drug dealers and pushers if we are going to succeed in stopping this scourge,” he said.

Among Trump’s invited guests were Albuquerque Police Officer Ryan Holet, 27, an his wife Rebecca.

Trump said:  “Last year, Ryan was on duty when he saw a pregnant, homeless woman preparing to inject heroin. When Ryan told her she was going to harm her unborn child, she began to weep. She told him she did not know where to turn, but badly wanted a safe home for her baby.

“In that moment, Ryan said he felt God speak to him: ‘You will do it — because you can.’ He took out a picture of his wife and their four kids. Then, he went home to tell his wife Rebecca. In an instant, she agreed to adopt. The Holets named their new daughter Hope.”

About the battle against drug abuse, Trump said: “We will succeed; we will prevail.” – Joe Cantlupe

 

 

 

 

CVS-Aetna Deal Faces Huge IT, Data Challenges

There’s that huge pharmacy chain and the behemoth insurance company, inching toward a partnership that they say will change how we get our drugs and are covered for our care.

Many of the headlines are gone – for now – but it is only the iceberg that we cannot see, of the proposal by CVS, the giant pharmacy, to buy Aetna, one of the nation’s largest insurers, for $69 billion that many say will drastically reshape healthcare, if approved. The proposed merger is designed, the companies say, to “redefine access” to healthcare, provide lower costs to consumers, with a “human touch.” It would combine CVS retail pharmacy services with Aetna’s health insurance business, resulting in a company with an annual revenue of $240 billion – second only to Wal-Mart in the U.S, according to news reports.

Much of the talk, and rightfully so, focuses on the pros and cons related to cost savings to consumers, (still unknown) but below the surface there’s this digital transformation proposed that may touch consumers in a big way: And with plenty of questions expected from regulators that will make change – if it happens at all– come very slowly.

Ankur Laroia, solutions strategy leader at Alfresco Software, says the CVS-Aetna plan has a long journey ahead, but portends potentially exciting but also intriguing and unknown possibilities, fraught with roadblocks. Alfresco is an enterprise open-source software company that focuses on digital transformation.

At the outset, the proposal involves “creation of new computer solutions that leverage big data around the patient/consumer concept and apply AI/ML (artificial intelligence/machine learning) to provide both better quality of life and quality of care,” Laroia says.

ankur_laroia-1.jpg (1).jpeg

Ankur Laroia of Alfresco Software

Such a merger could open up “a whole new segment that can be marketed to try by both technology and services providers,” Laroia adds.

In the meantime, there is the nitty-gritty of working out the details, and some confusion from the consumer perspective, and even among the parties themselves, with the prospect for better consumer quality uncertain at best. The process has to be “well-thought-out and well-orchestrated,” Laroia says. “ “This deal is unprecedented,” Laroia says. “We’ve never had retail and insurance come together. The digital transformation journey for both companies, even if they are under one umbrella, will likely still look very different. You are talking about remapping healthcare.”

Many, Many Questions

There are so many questions within questions, says Laroia, that it may take five to seven years to iron it all out, in his view, and for any final approvals even if it is given the preliminary OK by the Trump administration, which isn’t crazy about tightened regulations.

“A snail’s pace,” he says.

“In the case of CVS and Aetna, they both have digital transformation initiatives underway, with end goals that are very different,” Laroia says. “Aetna is all about the traditional homegrown IT shop. They are very big on IBM, which most insurance companies are. Contrast that with CVS, which has a knockdown drag-out with Walgreens. It’s all about the customer and effective marketing up-selling. They are both leveraging their IT computer frameworks and go about reinventing themselves but for different reasons.”

Not only are they obviously different organizations with a differing customer base, but HIPAA and privacy laws are tough hurdles to overcome for complete integration, never mind what Laroia calls “back office functions” such as HR, finance, and procurement issues.

The data stream possibilities – and question marks – are huge, Laroia says.

“You can’t just take somebody’s retail data and just share it with an insurance company,” Laroia says of the possible roadblocks. “They aren’t insurmountable, but there are also a lot of cultural issues to overcome. And these guys are attached to their own data. Who owns the data, and how is it going to be secure and protected? Aside from the federal requirements, there are stringent state regulations.”

Also, the parties have to be sure of “no leakage of information” – when a consumer goes to CVS and has Cigna or Blue Cross Blue Shield as their insurance providers, for instance, not Aetna, Laroia says.

Once the glitches are – if they can be – worked out, Laroia says, there might be “new, novel ways in which digital transformation concepts and techniques will be applied to create (a) better picture of consumer habits.”

And the floodgates may open about other possible mergers like the one CVS and Aetna want to have – but don’t hold your breath for it happening anytime soon. – Joe Cantlupe

Happy Holidays !!!!!!!! (Let’s Change Things…)

Health Data Buzz has been thinking, working, resting, rejuvenating — but most of all wishing you the very best of holiday seasons, and looking toward a great 2018.  Thank you terrific readers!

Great, I know, I know. It sounds like some people talking that aren’t so great.

Let’s work together and do the best we can — and then some.

There haven’t been many stories lately in Health Data Buzz — but, oh, we are working on them — more in-depth, giving readers more of a reason to —- read them.

We can change things for the better. Beyond this blog. Beyond ourselves. Let’s be healthy together.

If you don’t like something, change it. If you can’t change it, change your attitude.”Maya Angelou.

And with that attitude readjustment, change inevitably comes on the inside – and outside. — Joe Cantlupe

 

The CVS-Aetna Merger: Now Comes The Fine Print for Consumers. Is It A Match?

Amid the hoopla echoed by CVS and Aetna over their proposed merger, cost savings for consumers are what the duo talks about very much. But some worry that other mergers didn’t work out that way, history has this nasty habit of repeating itself, and the greatest benefit may be to the corporation rather than the average buyer of drugs and other pharmaceutical products and wellness services.

The proposed $69 billion merger “set off a wave of speculation “and “few expect drug costs, which have been rising, to decline under this arrangement,” said The New York Times.

At the outset, what does CVS, the large pharmacy, gain from the merger with the giant insurer? With the deal, CVS “would gain instant access to Aetna’s 23.1 million medical members and 15.2 million PBM (pharmacy benefit manager) customers,” the Employee Benefit Advisor said.

It noted that CVS already has tied the knot in different ways with Aetna. “CVS inked a 12-year contract with Aetna in 2010 to service about 9.7 million of the insurer’s PBM  members,” the EBA said. If the deal is approved by regulators, “what can brokers, advisors and their employer customers expect to see happen with drug prices?” EBA asked.

Answering that question is, well, pretty uncertain.

The Employee Benefit Advisor said that one of the CVS divisions has improved “patient engagement and medication adherence” through “personalized medicine” that many in healthcare are aiming for – but the EBA notes “some brokers worry that a CVS-Aetna pairing could corner the market on certain high-cost drugs.”

IMG_1493One of the top voices of concern is National Community Pharmacists Association CEO B. Douglas Hoey, who said in a statement he fears the proposed merger would not only generate cost savings for the corporation, but “there may be detrimental effects on consumers and community pharmacy providers.” The National Community Pharmacists Association represents the interests of America’s community pharmacists, including the owners of more than 22,000 independent community pharmacies.

“For all of the talk about cost savings, prescription drug costs have clearly continued to rise despite previous vertical mergers like UnitedHealth’s 2015 acquisition of Catamaran,” a pharmacy benefits manager, he said. “Moreover, the anticipated efficiencies CVS and Aetna tout may benefit the merged company more than the consumer, who is likelier to be driven to use health care resources chosen by the health plan rather than those of his or her own choosing.”

As regulators evaluate the plans for the potential impacts, the companies’ “previous and current behavior” should be considered, Hoey said. He emphasized two points:

  • “In 2015, Aetna was assessed a $1 million civil monetary penalty by the Centers for Medicare & Medicaid Services for significant disruption to patients and community pharmacists that occurred as a result of the company’s inaccurate representation of ‘in-network’ pharmacies in some plans.”
  • “CVS/Caremark is already the pharmacy benefits manager for Aetna, and independent pharmacies have been foreclosed from Aetna’s Part D preferred networks for the last two years. Consolidation of the two companies will only strengthen their ability to steer patients to CVS/Aetna-owned retail or mail order pharmacies.”

“Consumers should have the freedom to choose the providers that produce the highest quality health outcomes and cost-effectiveness, rather than being coerced into using certain physicians or pharmacies,”  Hoey said. “In short, bigger is not always better. A close examination of whether this acquisition will lead to higher drug prices and fewer quality and convenience options for consumers is warranted.”  – Joe Cantlupe

 

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