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


Another Reason To Stop At CVS?….Or Is Merger Medicine A Tough Pill to Swallow?

As CVS and Aetna see it, the multi-billion dollar companies are getting together to tap into data and the “human touch” to transform and “redefine access” to health care.

How? By reducing costs,  help fight chronic conditions and lower readmission rates through an “effective integrated community-based health care delivery system,” the companies predict.

Today, CVS, the giant pharmacy,  announced it is buying Aetna, the giant insurer, for $69 billion — $77 billion including debt – that could have a significant impact on healthcare. The plan, if approved, would result in a company with an annual revenue of $240 billion – second only to Walmart in the U.S, according to news reports.

Ironically, as Congress seems confused about health care, the private sector is moving forward, with these major players aligning its futures into a growing force: personalized medicine. But the overall impact of the deal remains to be seen, and whether the proposed merger will even fly —  with regulators surely ready to raise questions about this huge health insurance deal

And there’s another question. Is this good for consumers?  The Coalition To Protect Patient Choice, said of the $200 per share offer: “This massive merger would greatly harm consumers, leading to less consumer choice and more exclusionary conduct, and (the) promised savings will not materialize.”

The move is considered by the companies as a “natural evolution as they seek to put the consumer at the of heath care delivery.” They said: “CVS Health has steadily become an integrated health care company, and Aetna has moved beyond being a traditional insurer to focus more on consumer well-being.”

CVS said the “transaction fills an unmet need in the current health system and presents a unique opportunity to redefine access to high-quality care in lower cost, local settings whether in the community, at home, or through digital tools.”

There are more than 9,700 CVS pharmacy locations and 1,100 walk-in clinics and other programs including 4,000 CVS Health nurses who provide  in-clinic and home-based care, the company says. By connecting with Aetna, which serves more than 44 million people and its  network of providers, CVS believes  “there will be a better opportunity to utilize local care solutions in a more integrated fashion with the goal of improving patient outcomes.”

“This combination brings together the expertise of two great companies to remake the consumer health care experience,” said CVS Health President and CEO Larry J. Merlo. “With the analytics of Aetna and CVS Health’s human touch, we will create a health care platform built around individuals.”

Said Mark T. Bertolini, the Aetna chairman and CEO: “Together with CVS Health, we will better understand our members’ health goals, guide them through the health care system and help them achieve their best health.”

As a “benefit to consumers,” CVS says its pharmacies will include “space for wellness, clinical and pharmacy services, vision, hearing, nutrition, beauty and medical equipment, in addition to the products and services our customers currently enjoy.”

“An entirely new health services offering available in many locations will function as a community-based health hub dedicated to connecting the pathways needed to improve health and prescription drugs and health coverage.”

No doubt, a hub of controversy, too.

— Joe Cantlupe





Healthcare, American style: Too many administrators? Too many regs? Doctors forced to look at their computers instead of having more time with patients? What’s the Rx?

Are there too many administrators in healthcare, compared to the number of clinicians? Have the technology and regulatory changes forced physicians to spend too much time at their computers, and not enough with patients, or undermined the relationship between physicians and administrators?

I explore some of these issues and more in a Q and A with top health officials in  athenaInsight that says:

“Here’s some food for thought: The number of physicians in the United States grew 150 percent between 1975 and 2010, roughly in keeping with population growth, while the number of healthcare administrators increased 3,200 percent for the same time period.”

“Yes, that’s 3,200 percent in 35 years, a statistic derived by Physicians for a National Health Program using data from the Bureau of Labor Statistics, the National Center for Health Statistics, and the United States Census Bureau’s Current Population Survey. Physicians for a National Health Program.

Healthcare Is So Much More Complex – More Administrators Needed?

Decades ago, “the hospital was seen as an open workshop where doctors brought their patients and worked largely independent of the hospital,” says Ben Bache-Wiig, MD, executive vice president and clinic clinical officer at Allina Health Group in Minneapolis, Minn. “Now, more than 50 percent of physicians are employed by hospitals and work in largely speciality groups. They’re being asked to follow protocols within a hospital system and report to administrators.”

The level of complexity has “grown exponentially and the degree of complexity has grown exponentially and the degree of external requirements has also skyrocketed,” says Marilu Bintz, MD, a senior vice president of population health and strategy at Gundersen Health System in La Crosse, Wis. “Since the early 1980s, there has been a consolidation and aggregation of larger and larger physician groups in our health system, some affiliated with one or more hospitals. Then there’s the trend of hospitals merging into larger networks. If we’re saying the sheer number of administrators is compromising relations between physicians and patients, I disagree. I don’t believe the number itself is a key factor. The key is for (physicians and administrators) to come together and deal with that complexity.”

“The challenge,” she adds, “is for physician leaders and non-physician administrators to find the common ground that, if approached with the best interests of patients and community in mind, leads to the success of the health system and physicians. That starts with an understanding of one another’s role.”

All those technological changes – impact on doctors. No time for patient care!

“When we talk about the practicing physician, the way the system is structured, there is a shorter and shorter window of time when a patient sees a doctor,” says Louis J. Goodman,PhD, executive vice president and CEO of the Texas Medical Association and board member of The Physicians Foundation, where he previously served as president. “Based on Physician Foundation surveys we have conducted over the past six years, that’s the No. 1 reason why doctors enjoy medicine and their practice, and that is the time with patients. Yet we see that time is diminished when they have to consider unnecessary box checking on electronic record forms to meet regulatory requirements.:

“Our 2016 Physicians Foundation survey shows that physicians spend 21 percent of their time on non-clinical paperwork. There is a significant increase in the number of administrators, at a much more rapid rate than we are producing physicians,” says Goodman. “With the growth of administrators, we naturally are going to see an increase in rules, regulations and management procedures to that ‘triple aim’ that hospitals like to talk about (improved patient experience, overall population health and reduced cost in healthcare).”

Physicians becoming administrators.

“More and more we’re seeing an enhanced push toward physician-administrators, with more physicians going into administration through MHA and other degrees. Doctors have a greater sense that an administrator understands their concerns and is focused on the clinical side of patient care than if that person is a physician-administrator rather than a lay administrator,” Goodman says.

“There’s been a conscious effort in our health system to encourage physicians to take a leading role in the organization,” says Bache-Wiig. “ I myself am a physician who had the opportunity to cross over and become successful as an administrator with excellent professional support throughout the system. That formula has been pretty successful for our four healthcare systems.”

“We have an open dialogue and have helped physicians maintain autonomy and innovative spirit,” Bache-Wiig says. “There is the challenge of standardization versus individualization, which can lead to physician burnout and disengagement, and we are not immune to that.” “

Hospitals Should Open-the-Door For Physicians To Become Administrators

“Health systems have to be more welcoming to physicians who want to be involved in administrative medicine,” says Bintz. “There needs to be a common understanding that the term physician-administrator does not require that a physician stop caring for patients. Physicians have to have the opportunity to be involved in caring for patients. Physicians (also) have to have the opportunity to be involved in administrative roles and continue to practice if that is their desire.”

Bintz adds: “Here at Gundersen Health System we have spent 125 years fostering a culture where we attract both administrators and physicians who believe the patient comes first, that we exist to serve our communities, and that it’s important for physicians and administrators to work together to demonstrate how we do those things.”

Training Physicians to Be Administrators

Goodman: The Physicians Foundation has sponsored the Physicians Leadership Academy since 2010 and what we’ve tried to play a role in helping physicians undertake leadership roles. We have partnered with different, highly seemed university and medical programs, such as Northwestern and Duke. And we use seminar and small group formats focused on areas such as leading organizational transformation, executive decision-making and negotiating productive agreements. Physicians can take back to their hospital or practice and give them the tools administrators need. Without understanding the technical or financials, that puts physicians at a disadvantage to being administrators. We are giving them the tools at the baseline for a practice so they can do the best they can, going forward for their patients.

Nick A. Fabrizio, PHD, FACMPE, FACHE, a principal consultant with the MGMA Health Care Consulting Group in Washington DC, observes:

“There are definitely gaps with lack of business training (for physicians). That’s where the MGMA and other groups, graduate programs and trade associations provide needed additional training. Working in a health system is difficult and very different from a physician group practice. There are multiple stakeholders. And behind every physician leader, there is always a great non-physician administrator, whether a CFO or a CEO, someone with the knowledge of running a hospital for 20 years or more, having that knowledge especially being able to survive politically in this climate, is invaluable.

Docs: Don’t Be Loners — Be Part of a Team

The need for teamwork: “If we’re saying the sheer number of administrators is compromising relations between physicians and patients, I disagree. I don’t believe the number itself is a key factor. The key is for (physicians and administrators) to come together and deal with that complexity.” Says Bintz: “Beyond that, the best way to improve the quality of care that patients receive is to have a strong partnership between physicians and administrators so that both understand the complexity of how ‘quality is defined and reported, and both understand the real-life details of high-quality care at the bedside. The relationship is far more important than the numbers.”

Bache-Wiig: “In many ways we across the country have trained physicians to come out and think of themselves as individual businesses. There will be an increasing need for physicians to function within complex systems, and understanding that role in complex systems.”

What’s the shouting about?

“I don’t’ see what the data sees – big discrepancies in the numbers of administrators to physicians,” Fabrizio says. “ In fact I have seen hospitals taking away administrative operations people through mergers and combined joint ventures. I see that happening as positions are absorbed into the larger structures.” – Joe Cantlupe, HealthDataBuzz

Trump Does Health Care ‘End Run’ Around Congress – Critics Call Executive Order ‘Callous Sabotage’

Interestingly in a country where many debate the psychological state of this president, the American Psychological Association says Donald Trump is taking us backward in healthcare. Other critics are much, much harsher.

For much of the year, Trump has been upset that one of his signature campaign themes was not realized, the overturning of Obamacare. After all, for his base, his hard-core supporters, what had he done, beyond the mood swings? Every once in a while, in between tweets denouncing “false media” or criticizing the NFL, he took stabs at Congress for not passing a bill to rid the Affordable Care Act.

He wanted the wrecking ball and the GOP leadership didn’t come through.

Yesterday, he went off the legislative track and stayed on the executive: Trump signed an executive order to take steps that he says were designed to expand choices and alternatives to Obamacare, while increasing competition to reduce costs. Not so fast, critics say.  Trump also is moving to end billions of dollars of key so-called “cost-sharing” payments by insurers that help lower-income people pay for insurance, opponents say. The actions could undermine the entire Obamacare marketplace, and result in insurance policies with reduced benefits.

Many groups are concerned that the Trump action targets the most vulnerable: those people who need services the most may be left out in the cold. Some say that they are concerned that health plans ultimately would not provide the essential health services such as maternity care and services for children, and cheap and narrow plans would be structured outside of the Affordable Care Act  that might draw healthy people, but leave sicker people or those with pre-existing conditions facing what some term as “impossibly higher premiums.”

In a tweet this morning, Trump suggested he wants to work with Democrats on Obamacare. “The Democrats ObamaCare is imploding,” he wrote. “Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!.”

“The time has come to give Americans the freedom to purchase health insurance across state lines, which will create a truly competitive national marketplace that will bring costs way down and provide for better care,” Trump said in an earlier statement.

Trump poked at the flaws of Obamacare: the percentage of workers at small firms receiving coverage through their employer had declined from nearly half in 2010 to about one-third in 2017, according to the White House.

The subsidies that Trump seeks to get rid of impact about 6 million people, the Department of Health and Human Services says, costing about $7 billion in 2017, according to CNN.

Once again, instead of trying to rebuild flaws in the current system, Trump seems intent on undoing it. He’s an interesting kind of developer. He destroys and then….His critics say with the executive action and others, healthcare in the country is becoming Trumpcare and the problems are his, at least politically.

“The executive order begins by reciting perceived failures of the Affordable Care Act; rising premiums for ACA coverage, reduced insurer participation in exchanges and reduced exchange enrollment,” Timothy Jost, a contributing editor at Health Affairs and emeritus professor at the Washington and Lee University School of Law, wrote in a Health Affairs blog. “However, many of the problems the individual market is experiencing are certainly due to actions the Trump administration has taken to undermine ACA coverage, and there is good evidence that the ACA market could have stabilized absent those actions,” Jost added.

The order essentially encourages health plans “to pick and choose” services they cover and won’t help those who desperately need mental health, substance use, and other critical services,” Antonio Punte, PhD, president of the American Psychological Association said in a statement. “Before the Affordable Care Act, more than one-third of individual market plan plans chose not to cover mental health services and nearly half chose not to cover substance abuse.”

Punte noted these are especially tough times: 91 Americans a day, for instance, are dying from opioid overdoses.

“Today health plans are competing on how efficiently and effectively they provide care, but the president’s executive order, if carried out, would take us backward by letting plans once again compete on how fewer services they cover and ignore state health insurance protections,” Punte said. “We are deeply disappointed that the administration continues to try to dismantle our health care system, instead of trying to increase enrollment and stabilize insurance markets.”

“Now that President Trump and the Republican Congress failed to end the Affordable Care Act by legislation, the president is sabotaging the law by executive action,” said Vanita Gupta, president and CEO of The Leadership Conference on Civil & Human Rights. “Today’s move is their effort to put another nail in the coffin. This order will only drive up costs for the sick and put the health of millions at risk.”

Trump’s executive order “will result in fewer protections for the most vulnerable Americans, such as those with pre-existing conditions, and will encourage sham, loosely regulated health insurance plans that won’t provide adequate benefits,” said Randi Weingarten, head of the American Federation of Teachers in a statement. “Ultimately, this could lead to the collapse of individual health insurance markets through which millions of Americans obtain coverage.”

“Donald Trump owns the unwinding of the Affordable Care Act,” Weingarten said. “He is ignoring the rule of law, refusing to compromise, and doing an end-run around Congress in order to strip people of their healthcare. Millions of Americans will be worse off because of his actions. There is an ongoing pattern of the Trump administration’s callous sabotage of Obamacare, and it will cause real harm to American families.” – Joe Cantlupe