State of the Union — Five Major Healthcare Initiatives

By George W. Chapman

President Trump delivered his SOTU address on Feb. 5.  Here are some of his plans. 1) Obliterate the “HIV epidemic” within 10 years by focusing on geographic hotspots; funding an HIV health force; improving access to testing and proper medication.  2) Cure childhood cancer by providing $500 million of research over the next 10 years. 3) Produce a plan for a national  paid family leave act, which has been the pet project of Ivanka Trump. 4) Pass legislation to prohibit late term abortions. 5) Continue to focus on lowering drug prices and mandating pricing transparency among drug manufacturers, hospitals and physicians. Surprisingly, there was little mention of how he would lower overall healthcare costs, making premiums more affordable. Trump also promised to protect pre-existing conditions. Ironically, he has systematically dismantled the Affordable Care Act, which protected pre-existing conditions.

Opioid epidemic

Thirty-five states are suing opioid manufactures. Recently, the state of Massachusetts attorney general filed a lawsuit against Purdue Pharmaceutical and its owner family, the Sacklers, for knowing their pain killer OxyContin was highly addictive and for deceiving physicians and consumers alike. Several incriminating internal emails and documents from Purdue have been subpoenaed. Roughly 130 people per day, or about 47,000 people per year, die from opioid addiction. The worse states for opioid-related deaths per 1,000 are: West Virginia 50; Ohio 39; District of Columbia 35; New Hampshire 34; Maryland and Oregon 32. New York ranks 24th with 16/1,000. The state with the least opioid deaths per 1,000 is Nebraska at 3.

Need a Lyft?

The ride provider Lyft (vs. Uber) sees Medicare Advantage plans as a good market for their business. Lyft’s first Advantage plan partner was Anthem insurance. Anthem includes rides as a benefit to Advantage members. Ninety percent of Anthem’s non-emergent patient transportation is booked with Lyft. As a result, Anthem’s ride costs have decreased 39 percent and wait times for a ride have decreased 40 percent. This clever benefit could benefit physicians by reducing patient no-show rates.

Fewer People Have Employer-Sponsored Insurance

Twenty years ago, 67 percent of us received health insurance through our employer —Today, the percentage has dropped to 58 percent, according to research conducted by the Kaiser Family Foundation. Some experts surmise the gradual decline over 20 years could be due to retiring baby boomers and employees of small businesses purchasing their insurance on the exchange. Recently, the Trump administration struck down the individual mandate to have insurance which may fuel the downward trend going forward. About 156 million people, or slightly less than half of the US population, were covered by employers in 2017. The other half of us were covered by Medicare, Medicaid, the VA, federal employment, co-ops, the Bureau of Indian Affairs and the exchanges.

Smaller Hospitals Seek Affiliations

In order to enhance their reputations, remain independent and provide their communities access to the best care, let alone survive, smaller community hospitals  are affiliating  (versus merger or acquisition) with larger, more prestigious hospitals. In return, the larger hospital increases its market for the specialized services that most smaller hospitals can’t provide. Most of these affiliations have eventually resulted in a complete merger or acquisition of the smaller by the larger. Because today’s consumers are far more savvy and demanding, smaller hospitals need to shed their local or “community” reputation and rebrand as part of a larger more comprehensive health system.

Drug Costs

Uncontrolled, skyrocketing and mysterious drug costs are a bipartisan issue. Trump mentioned this in his State of the Union. But few of the invited drug CEOs bothered to show up, voluntarily, at a Senate Finance Committee meeting to discuss drug costs. The CEOs who failed to show told committee chairman Chuck Grassley they would prefer to meet in private versus in public. (Talk about transparency.) The committee is threatening to force the CEOs to testify if they continue to balk. There have been several suggestions on controlling drug costs. But most are convoluted and difficult to monitor and enforce. The best solution for controlling drug costs would be to allow CMS (Medicare/Medicaid) to use its massive purchasing power to negotiate drug costs. This solution is not favored by the powerful drug lobby. Bowing to pressure from the lobby, Congress is still dancing around the real solution.

Artificial Intelligence in Healthcare

The healthcare industry is slowly incorporating artificial intelligence — AI — when it comes to assisting physicians in determining a diagnosis or treatment plan.  AI is already being used in radiology, pathology and dermatology. It assists physicians with faster and highly accurate diagnoses. Combining AI with physician experience and judgment results in higher diagnostic confidence. Telehealth continues to be perfected and more widely accepted. Robots and 3-D printers are being used in operating rooms. AI in psychotherapy is becoming more prevalent due to the limited availability of psychiatrists, the cost of treatment and the greater willingness of patients to be honest about themselves, especially when it comes to socially deviant behavior, with a computer versus a human. The integration of AI in healthcare will lessen, if not negate, the impact of the projected physician shortage.

George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at gwc@gwchapmanconsulting.com.

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