Uno Health’s Post

“The Commonwealth Fund, a private U.S. foundation which supports independent research on health care issues, released the 2024 State Health Disparities Report. It compares medical outcomes for people of different races and ethnicities in each state, and ranks how well each state’s health system addresses medical conditions for each racial and ethnic group.” The latest report “shows racial and ethnic disparities persist in health care access, quality, and outcomes across the nation.” https://lnkd.in/eSSSTmZh

Primary Care should be Funded as a Common Good The recent publication in the NEJM by Dr Mandy Cohen, Director of the CDC, describes the underused and much needed synergistic power of integrating Primary healthcare and Public Health. This synergy is underpinned by the reality that Primary Care and Public Health are the “Twins Separated at Birth” with both having the common DNA that allows them to be recognized as “Common Goods”, that both benefit society as a whole.  Public Health has long been accepted and funded as a Common Good but Primary Care recognition has lagged behind until recently.  The CDC Director makes the important point that both Public Health and Primary Care need to be sufficiently funded if they are to serve the “Common Good” adequately.  Public Health has been underfunded by states and the federal government. Primary Care has been underfunded by insurers (Commercial and Federal). The clear path to increasing Public Health funding is through government budgeting. The path to increasing Primary Care funding is more complicated and must pass through the hands of many insurers and intermediaries with diverse priorities (including profit and power) that may or may not be directed at using Primary Care to bring better health to people and communities. The 2021 NASEM report “Implementing High Quality Primary Care” suggests that Primary Care is a common good and should be provided with government funding in the same manner as public health. The report offers a governmental policy framework to support, fund, define required elements and hold primary care accountable. As we navigate this framework there are a number of important issues to address, including but not limited to: What does funding primary care as a common good mean? How should the “common good” be funded; capitation, or an enhancement to current funding models? Is moving forward to fund PC as a public good a state-by-state decision process, federal decision or hybrid? Must states and/or the federal government establish non-exhausting funding mechanisms? Must funding be linked to new or existing tax revenues and how will sufficiency of current and future funding be established? Will the current insurance providers remain as intermediaries and how will the Public Good funds be paid? How will primary care accountability be established and enforced? How will PH/PC integration be assured? What definition of primary care will be used to the inclusion or exclusion of OB/GYN and Behavioral Health? https://lnkd.in/eFAazCx9 Yours in Common Goods Howard

Here is a terrific take from Joseph Betancourt on the trends in health care and how The Commonwealth Fund is bringing data and expertise to understand the impacts--good and not so good. In the midst of all this change, the PCC strives to ensure the voices of people--patients, clinicians, community leaders--are heard and able to shape they system to produce better health outcomes for all of us. https://lnkd.in/e9UxeXtZ

This Sunday, it will be two years (4/7/22) since the Centers for Medicare & Medicaid Services (CMS) pummeled Medicare beneficiaries living with early Alzheimer's with its "coverage with evidence development" (CED) health rationing policy for the entire class of FDA-approved, disease-modifying monoclonal antibody therapies.   Under a CED rationing policy, Medicare denies coverage for an FDA-approved item or service, except through one or more very limited clinical studies. That means only a fraction of estimated eligible Medicare beneficiaries get access to the FDA-approved treatments included.   The proof lies in the small number of Medicare-related claims paid for Leqembi - the second FDA-approved therapy in the class and the first to receive traditional approval. As of early February 2024, data show that only a scant 635 Medicare fee-for-service claims and 337 Medicare Advantage claims have been paid for Leqembi over nine months.   According to estimates from the Alzheimer's Association®, each day more than 2,000 older adults transition from mild to moderate Alzheimer's. At that stage, they become ineligible for Leqembi. Essentially, countless beneficiaries have already missed out.   Private payers in the commercial market often follow CMS' restrictive policy, and they are doing so for the early Alzheimer's drugs (only 144 claims paid so far). In the coming days, the Alliance for Aging Research will name the commercial insurers that either do not cover Leqembi or have complex prior authorization (PA) requirements.   The New York Times recently investigated the wider use of PA by insurers, and their video Editorial is worth the watch. In it, they share horror stories about "a seemingly trivial process that inflicts enormous pain, daily": https://lnkd.in/esxEEtMt   The FDA will soon consider approval of a third Alzheimer's therapy in the class. Meanwhile, CMS’ CED policy is actively undermining public trust in the FDA and more broadly in biomedical science itself.   And, it's not just about Alzheimer's. More restricted coverage policies are on the way: 🤔 Last week, CMS inserted CED into The White House's "Executive Order on Advancing Women’s Health Research and Innovation," giving the false impression that the agency supports women's health by promoting a policy that denies their access to care: https://bit.ly/4aJ5I1a. 🤔 On May 21, CMS' federal advisory committee will meet to discuss the safety and efficacy of FDA-approved continuous glucose monitoring (CGM) devices used in the self-management of type 1 and insulin-dependent type 2 diabetes in older adults: go.cms.gov/4aoUEX3.   CMS is a payer; it is not a biomedical agency like the FDA or anyone’s family doctor. CMS is overreaching in its authority and--absent a pullback--Congress or the President needs to step in.   More on this to come. #CMS #Medicare #Insurance #Alzheimers #WomensHealth #diabetes #PriorAuthorization

At Alliance for Aging Research, we are dedicated to changing the narrative to achieve healthy aging and equitable access to care. Read this post from President & CEO Sue Peschin on two bureaucratic practices that limit access to breakthroughs in treatment: coverage with evidence development (CED) and prior authorization:

It's a bold statement, indeed! I share this as something for us all to consider. Health is perhaps the most precious thing we possess, yet we often forget this amidst seeking and delivering care. Unfortunately, "health care" has shifted towards a business focus rather than a consumer focus which has made us somewhat indifferent towards our health, given the challenges on all fronts. In my opinion, female doctors, and women in general, often exhibit a nurturing instinct that is not as common in men. While there are certainly men who possess this instinct, it is more prevalent among women. Men tend to be more task-oriented, while women are often more patient, although these are generalizations. From my extensive experience with doctors and hospitals, I can attest that regardless of gender, those who take the time to listen and genuinely care have a more significant impact, leading to better outcomes and a more positive experience for the family. We all need to make an effort to listen and improve our approach to enhancing the care provided. Join the conversation. - To good health - Jason

Sometimes it's OK to make a decision based on emotion. Selecting a Medicare plan is not one of those times. Mitch Anderson of Prime Time Health Advisors explains in this KTTC Midwest Access segment. https://www.pthealth.com/ #medicare #medicareaep #medicareannualenrollment #medicarecoverage #medicareinsurance #medicarerochester #minnesotamedicare #medicarespecialist https://lnkd.in/gBY_5aW4

In recognition of #MaternalHealthAwarenessDay, learn more about community health centers and the vital work they do in bringing maternal health resources to under served communities. https://lnkd.in/gnXkhmAW

This is welcome news and a step in the right direction. But we should be cautious and remember that we have been down this road before with marginal results and no systemic disparity gap closure since the Institute of Medicine report and recommendations in 2002. What is promising with this timely recommendation, is a renewed call to action to move upstream ownership to the US Congress and the Office of Management and Budget, so as to be able to drive accountability downstream.   It is indeed long overdue that we intentionally address the upstream drivers of health inequity. Downstream health disparity gap closure programs and initiatives have existed for decades, but have yielded zero closure in health disparities in over 20 years since the IOM report despite almost $200B of Federal and state governmental, philanthropic and corporate funding. We must avoid the complacency trap of perpetuating past and marginally effective strategies over the next 20 years. Organizations must stop conflating activity with achievement. Activity in and of itself is not a metric for success. Executing sustainable health equity strategies requires a deeper understanding and acknowledgment of the political and structural drivers of #health that perpetuate health inequity and a willingness to squarely address them head-on. And it starts upstream. https://lnkd.in/gYixCR2R #EYCenterForHealthEquity

Available for submission until January 25, 2024 The National Healthcare Quality and Disparities Report (NHQDR) assesses the performance of the U.S. healthcare system and identifies areas of strengths and weaknesses using measures related to priority areas of healthcare quality that include access to care, affordable care, care coordination, effective treatment, healthy living, patient safety, and person-centered care. The report presents the latest available data on care quality and access to healthcare stratified by diseases and conditions, as well as disparities related to factors such as race and ethnicity or health insurance status. The objective of this technical brief is to support an update of the criteria and process for selecting measures to align with these priority areas as well as focus areas of equity and social determinant of health. (Section 944 (c) of the Public Health Service Act [42 U.S.C. 299c 3(c)] requires that information collected for research conducted or supported by AHRQ that identifies individuals or establishments be used only for the purpose for which it was supplied unless they consent to the use of the information for another purpose.) https://lnkd.in/eaDJGDnd