What's New in Health Care Reform provides an overview of the past week’s news, updates, and commentary in health care reform and utilization management.
The Vaccines for Children (VFC) program, which offers these drugs at no cost for kids from low-income families, requires clinics, doctors and other providers to undergo annual audits and use top-grade equipment, such as continuous temperature-monitoring devices. It also requires that problems be reported to federal authorities. More than 44,000 doctors participate in the program and provide vaccines to 90 percent of the children in the country, according to the Centers for Disease Control and Prevention. But medical facilities outside of the program — like many pharmacies and internists with private practices who are treating adults or children not in the VFC program — have no comparable federal oversight. Via Kaiser Health News.
The U.S. government estimates that close to 1 million people in California alone cross to Mexico annually for health care, including to buy prescription drugs. And between 150,000 and 320,000 Americans list health care as a reason for traveling abroad each year. Cost savings is the most commonly cited reason. Via NPR.
Lawmakers in Washington State are proposing a bill that would no longer allow parents to cite philosophical or personal reasons for not vaccinating their child as the region battles a growing measles outbreak. Currently, 18 states allow those exemptions. The 56 confirmed cases in the Pacific Northwest have prompted the governor of Washington to declare a state of emergency. Monica Stonier is the state representative for Clark County, Washington, the area hit hardest by the outbreak. In her county alone, there is currently 51 confirmed cases of the measles, and another 13 suspected. "Right now, my city is the hotbed for this outbreak," Stonier said. "It certainly has reached a critical state in my county." Stonier is now co-sponsoring a bipartisan House bill that would require "every child at every public and private school in the state and licensed day care center" to be vaccinated for "measles, mumps and rubella" unless they have a legitimate medical or religious exemption. Via CBS News.
The second-largest, second-deadliest Ebola outbreak in history has claimed the lives of nearly 100 children. At least 97 children, 65 of whom were younger than 5 years old, have died from Ebola virus disease in the eastern Democratic Republic of the Congo since the outbreak was declared there Aug. 1, according to a press release from Save the Children, a charity supporting the fight against the current epidemic. "We are at a crossroads," Heather Kerr, Save the Children's country director in the Democratic Republic of the Congo, said in a statement Sunday. "If we don't take urgent steps to contain this, the outbreak might last another six months, if not the whole year." Via ABC News.
The thinking behind higher education being one such factor affecting or protecting cognition, says Prashanthi Vemuri, a Mayo Clinic neuroscientist who studies cognitive reserve, was that “those with higher ed can withstand more pathologies because their brains are more efficient and more flexible.” (The relatively high level of education of participants is recognized as a potential limitation by the study authors and others, who say that the study didn't compare those with very little education to those with much more schooling. Wilson notes that is possible that effects previously seen on cognitive reserve due to education may have been primarily driven by variations at the lower end of the education-level spectrum.) Both Vemuri and Wilson said that a good explanation for why higher education may not, in fact, impact cognitive reserve as much as once believed is that the schooling occurs decades before the slow creep of dementia begins. "One of the reasons we think education doesn’t seem to impact cognitive reserve very much is that it's so remote in time,” Wilson says. However, he says, things related to education, such as how much you read, or personality traits like conscientiousness, “seem to both have to do with rates of cognitive decline in old age as well as cognitive function.” As a result, he says those areas may be “more fruitful possibilities” for how cognitive reserve works to fend off dementia. Via AARP.
Each year, millions of Americans walk out of a doctor’s office with a misdiagnosis. Physicians try to be systematic when identifying illness and disease, but bias creeps in. Alternatives are overlooked. Now a group of researchers in the United States and China has tested a potential remedy for all-too-human frailties: artificial intelligence. In a paper published on Monday in Nature Medicine, the scientists reported that they had built a system that automatically diagnoses common childhood conditions — from influenza to meningitis — after processing the patient’s symptoms, history, lab results and other clinical data. The system was highly accurate, the researchers said, and one day may assist doctors in diagnosing complex or rare conditions. Via NY Times.
AI-based precision medicine combines medicine, biology, statistics, and computing. The most promising research in the field is characterized by sustained collaboration across disciplines and institutions. “You do need to work across disciplines now,” says Dr. Liewei Wang of the Mayo Clinic. “It’s not so simple that any individual could do these studies themselves.” As detailed in a 2017 paper, Wang and far-flung colleagues developed a machine-learning algorithm to predict whether a psychiatrist should prescribe a certain drug to a depression patient based on that patient’s unique medical record. The model learned from the genetic data and medical records of more than 800 Mayo Clinic patients over a 10-year period, and could predict with 85–90% accuracy whether the drug would ease depressive symptoms. That’s compared to the 50–55% accuracy of a psychiatrist, says Wang, whose drug selection for their exhausted patients often devolves into a game of pill roulette. Via Forbes.
Someday soon you may walk into your local CVS Pharmacy with your prescription in one hand and your yoga mat in the other. That's because CVS Health is testing a new concept store format as the company plans to shift more of its floor space to health care services. The drug store chain, one of America's largest retailers, is debuting three HealthHUB locations in Houston as it heads toward a future with less space devoted to retail goods like seasonal items. Via USA Today.
Private equity firms and venture capitalists are piling in to the sector, investing billions, as health care providers respond to the app-savvy, more consumer-focused generations. Nearly two-fifths of Americans aged 22-38 now seek routine medical services virtually these days, says a digital health survey from consultancy firm Accenture. And this generation demands more convenient appointment times and a better service than that enjoyed by their elders. "People are wanting to receive healthcare with the simplicity and convenience they receive in other services in their life," says Brian Kalis, Accenture's head of digital health services. The number of virtual visits to the doctor in the US will reach 105 million by 2022, up from 23 million in 2017, says IHS Markit. Via BBC.
Some dieters struggle more than others to lose weight, despite following sensible advice, and this may come down to the bacteria in our guts. Specifically, the enzymes carried within it. “What we eat is available to us, and to the bacteria inside our guts, which digest parts of food we lack the enzymes to do,” says Purna Kashyap, associate professor at the Mayo Clinic and head of its Gut Microbiome Laboratory. “This process generates additional calories that the gut microbiota can give back to us, so it’s a mutually beneficial relationship where bacteria give us more bang for our buck from what we eat,” he says. Kashyap tested to see if, when switching to a lower-calorie diet, gut bacteria can be more efficient in deriving calories from food, which would be helpful when food isn’t plentiful, but could also hinder weight loss. Via BBC.