The fees that Medicaid pays are so far below the usual fees that healthcare professionals receive that there is a refusal to take these patients. Practitioners will say they have no openings or are not taking on new patients. I was witness to a glaring example one day as an ENT surgeon blurted out to his colleagues why he was leaving medical practice.

In his late 60s, the surgeon said, “I get $75 for an operation on a kid where I would usually get $3K, and I’m not going to do it anymore. I’m retiring.” He had the means by virtue of many years in practice and having married a wealthy woman, so no financial loss for him, and he could play golf every day.

Where would those children who need an ENT’s expertise receive needed healthcare? It might fall to the charity sections of local hospitals and health clinics. There was no concern for them as he packed up and drove off to his beachfront home, one of two he owned.

The wealthy need not worry about the absence of healthcare, especially if they have contracted to receive concierge medical care. Paying a monthly fee or up to $10K/year, no waiting for an appointment and care is a phone call away.

The situation for those who are struggling financially and who have medical disorders as well, however, is dire. Even those who serve the greater community find they’re unable to find the help they need. I recall receiving several emails from an EMT worker who was active on 9/11 after the attacks and, as a result, developed hypertension and had two strokes.

We discussed what he needed because he was being denied Social Security disability benefits that would also provide Medicare, and he couldn’t work. Fortunately, I had been a consultant for that service, had written a book on it, and noted what he needed to do. Weeks later, I got an email telling me he received benefits.

Today, I received yet another note from an EMT worker who is suffering from PTSD as a result of pandemic work, can’t work because of panic disorder, and no therapist will accept her Medicaid. I couldn’t recommend a therapist, but I know that every profession has an ethical responsibility to take some pro bono cases.

Gauging How We Value Life

All life is precious, and there is no difference between a poor mother and her children or a yuppie gamboling in the Hamptons for the summer. Do all the therapists still take August off and attend Cape Cod seminars? The NYT thinks that’s where all the wealthy go to escape the summer heat. But that mother and her kids have no choices like that, and she has to pray they don’t get sick and need medical or psychological care. Who’s taking their Medicaid?

Can medical professionals refuse Medicaid patients? They always do it, but what consequences are there for them? One physician wrote eloquently on this dismal situation:

An oft-cited study showed that 31 percent of physicians nationwide were not willing to accept new Medicaid patients. The rate was even higher for orthopedic surgeons and dermatologists, two of the highest-paying specialties in medicine. The Affordable Care Act led to some modest improvements, particularly in access to primary care, but the acceptance rate of patients covered by Medicaid remains dismally low.

Should a retiree with a serious medical condition who lives with his wife on a fixed, marginal income have to drive 50 miles to see a physician who takes Medicaid? The answer is obvious, but no one in his area will accept his insurance.

Charity care is something hospitals do provide, and some states require them to do so. But the care may be at a high cost to hospitals. The patient load can be unusually large, staff suffer burnout, and wait times are long. For these reasons, many people delay going for care or are on waiting lists for care. Being on one of these lists isn’t unusual in mental health. But there can be a price to be paid by potential patients as they wait.

We find that longer waiting time is significantly associated with a deterioration in patient outcomes 12 months after acceptance for treatment for patients…Mental health clinics will open “wait list” groups to provide relief for patients in need until they receive an appointment with a therapist. Does that handle the deterioration? I guess we need another study.

What is the solution? There is no easy solution except to work within a more giving philosophy for those in need and an expansion of services. Creative solutions are required when funds are scarce because lives are on the line, and there is no value you can place on a life.

The post The Poor May Die While the Rich Will Play appeared first on Medika Life.

Brad has served in leadership roles at EvergreenHealth, Cue Health and Shift Labs. His 20 years of experience as a doctor, ongoing work as an emergency physician and medical director of emergency preparedness, trauma and urgent care make him uniquely qualified to envision the quality of service for those seeking immediate care need.

Saving lives is a survival instinct for Brad. He earned a Bronze Star and Combat Medic Badge for his service in Iraq as a United States Army physician, and those experiences have enabled him to think about healing a fragmented system of care to make it far more responsive to patient needs.

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Gil Bashe: You and I both served in an army medical corps, you as a surgeon with the US Army, and I as a frontline paratrooper combat medic. We both had dramatic experiences in providing care. I went out with our soldiers to treat them where and when they were wounded. Fast forward, you served during the Iraqi War, when great technological advances in medical care were available. You saw that medical personnel were deployed piecemeal, and care was fragmented and provided by scrambling to get to patients. Tell us a little bit more about how those experiences framed your vision for patient care?

Brad Younggren: I completed my residency after September 11 (2001) and then joined the US military. Suddenly, I found myself transported to the middle of a major conflict as a squadron surgeon for a reconnaissance unit along the Syrian border.

When I arrived, the doctors and physician assistants were stationed in different places along the front. I couldn’t understand why. I thought: “We have helicopters, portable ultrasound machines, and video calling capabilities. Wouldn’t it be more strategic to position ourselves in Tal Afar, which would allow us to get to soldiers more quickly?”

Bashe: So, you saw the capability to use resources more effectively to treat patients faster to save lives. You recognized that you also had the technology to connect to the front-line instantly. What did that realization inspire you to do?

Younggren: When I saw critical time wasted and providers pushed to the point of injury, that launched this notion to use technology to save soldiers’ lives. When I returned stateside, I dived into technology visualization procurement for the Army. If we have devices that are durable enough for deployment that can extend our reach, we shouldn’t need to risk doctors’ lives by stationing them in Baghdad. Why not place them strategically in locations where they can sustain and save lives using technology at major medical centers such as Walter Reed Medical Center?

In 2010, I got out of the military and went to work for a company that developed the first Food and Drug Administration (FDA)-approved mobile-phone device. Now, we take for granted that a cell phone has better visualization than a hospital monitor. At that time, that wasn’t the case. That’s when I got my first taste of just how great an impact technological evolution could have on patient care.

Bashe: Can you expand on your decision to join 98point6? You saw the potential of technology to transform military medicine. Is the civilian world of urgent care very different? Why do you feel those in the healthcare profession must use technology to bring the primary care physician closer to the patient?

Younggren: As an emergency physician, I saw several failures within the healthcare system. During my time in the military, I saw how technology accelerated and could be leveraged to meet urgent medical needs. I recognized the need to build a technology platform that provides on-demand service at the point of care that also would reduce physician variability in practice.

Instead of repeatedly trying to get doctors to do something with an off-the-shelf digital plan, the only way you can impact change and care is to put technology tools and data directly into the hands of the doctor. Then they can make the best clinical decisions when they need to, in real-time.

Bashe: We both know how hard it is to change the healthcare system. You may need to push new ideas while old ones are still firmly in place. Tell us how the 98point6 platform is working to effect changes that will eventually transform the system?

Younggren: One of the primary reasons I came to 98point6 was to be the first point-of-care company in the room during every single patient visit. Almost all of our patient cases are handled via text (with support for photo/video as needed for diagnosis). We can capture all of the conversational information that occurs between doctor and patient, which informationally and procedurally, is incredibly powerful. If you want to understand how to impact the care delivery system, you need to fully understand the interaction: you need to be in those rooms.

Our Chief Product Officer Robbie Schwietzer helped build Amazon Prime. His acute understanding of consumer engagement played an integral role in the development of our platform. We are committed to providing a pleasurable experience that gets people the care they want and need.

That’s key to the transformation of care, and we have patients tell us all the time how easy-care is for them now. They’re on a bus or in a meeting when they’re engaging in care, and that’s the beauty of it. You don’t even need to be on video: you can access care from physicians in an incredibly convenient, nondisruptive way. And that’s going to change how consumers want to get care, and how they expect to access it.

Bashe: Most certainly, you are familiar with Dr. Eric Topol’s book “The Patient Will See You Now?” Is 98point6 the transformation from question mark to exclamation point to the polemic he raises?

Younggren: Yes, I’ve read the book and considering Eric’s view that the smartphone is the agent for transforming care, and digitally empowered patients can take charge of their health care, I hope that he would believe that we are the kind of “bottom-up” care that he envisioned.

Ultimately, we’re a technology-driven, care-delivery platform where every case is backed by a doctor. We’re leveraging our technology and physicians to deliver better patient outcomes because that’s truly where the magic happens.

Bashe: Tell me about the 98point6 physicians. Do they take on 98point6 work in addition to their private or group practices? Or are they dedicated to pioneering this sort of connective technology with patients?

Brad Younggren: It’s the latter. I spent a lot of time looking at the market and found that physicians are on the outside looking in. To build an AI platform where the AI is learning from the behavior of the physicians, and to deliver care in 51 jurisdictions on demand, we needed a cadre of dedicated, on-staff physicians.

With these goals in mind, we couldn’t rely on locum doctors, which most of our competitors do. We needed to train our doctors to properly use technology. Originally, we started with seven and now we’re up to approximately 50 full-time, board-certified physicians. We augment the full-time physician team with part-time, directly employed board-certified physicians who meet the same hiring bar and receive the same training.

Bashe: Going back for a minute to our shared past in military triage, how do you deal with the triage of specific health needs within the 98point6 system?

Younggren: We have a whole team that’s devoted to continuously improving virtualized or AI-based triage, and one of the angles we’re taking is how to triage based on acuity and immediacy of need, which is very similar to being an aide in an emergency department. We’ve already built AI-based tools to help identify suicidal patients and pull them up to the top, so you can locate the patients that need care most immediately. Even though we’re aiming to provide on-demand care for all patients, it still requires a bit of clinical triage.

We do employ some doctors part-time who can help fill in gaps as needed from a capacity perspective. Ultimately, we want all the doctors we employ to work for us forever, so any work we can do to make their lives better from the perspective of preventing burnout is really important to us. At the heart of it, we’re a physician-forward organization. We track their satisfaction scores and constantly ask what we can do to make their experiences better.

Bashe: Describe the relationship between the primary care provider and the patient from a technological standpoint. Do you feel that 98point6 has maintained a relationship there or is it more functional than anything?

Younggren: Our theory at the beginning was based on research in computer science that shows patients can develop relationships with technology. Because we’re on-demand, it’s basic to our system that patients develop a relationship with 98point6 versus our physicians — it’s simply unrealistic for each of our doctors to work 24–7. We constantly strive to provide a peerless experience for patients that builds a level of trust with the brand, regardless of the physician on duty.

Bashe: In this country, 90 million people are pre-diabetic, but only 1 in 4 know that are trending toward diabetes. If 98point6 has a relationship with the customer, and you see that they’re pre-diabetic, do you simply say your blood glucose is a little high, you should be more mindful? Or do you preemptively engage that patient/customer?

Younggren: At the most basic level, we’re focused on invoking the standard guidelines of preventative care. So, let’s say a patient is 45 years old with a family history of colon cancer. We can catch that and recommend a colonoscopy, especially if they’ve never had one. There’s still a lot more work to be done in making preventative care more effective, as well as care navigation, chronic disease, behavioral health and we’re constantly looking to improve these areas.

Bashe: How do you feel about empowering faster engagement and the use of artificial intelligence, or even a medical chatbot to do so?

Younggren: There are a lot of symptom-based chat boxes on the market, and this technology isn’t inherently connected to a doctor. Even if a chatbot supplies the top four diagnoses to a patient, when a physician comes into the picture, they still have to backtrack to understand what has happened in that technology experience to build trust, provide an accurate diagnosis, and determine the next steps. That takes additional time and effort, and patients feel that.

I believe you need physicians trained to use technology that is fundamentally connected to the practice of medicine. In that case, technology is extending the reach of a physician’s hands and it’s a pretty cool, proven approach.

Bashe: I noticed that you’ve been tapped by major corporations as their medical service partner of choice. What’s the driving force behind these partnerships?

Younggren: One of the great things about working with employers is that we make a real concerted effort to understand their challenges and the problems their employees face. For instance, when the pandemic hit, we had to figure out a way to support employers with COVID testing in several different contexts.

Large employers trust us to give them high-quality care, but it goes beyond that. We’re having meetings regularly to better understand what their pain points are and where we can use technology to make the greatest impact. Many times, patients don’t know the extent of their medical benefits, but we know exactly what their plans are, and can recommend other services they might need, whether it be substance abuse support or behavioral coaching, that they’re not even aware they can access.

That additional ability to increase the utilization of other services these employers are paying for is a win-win for employers and their employees, who can further improve their health and enhance their quality of life.

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As an experienced combat physician and trauma care specialist, Dr. Brad Younggren — applying technology to accelerate access to care — demonstrates the digital transformation occurring in the health ecosystem. He is centering medicine around the patient and selecting to reinvent care, not by planting technology into a system seeking to keep it away at arm’s length, but rather by inviting physicians who select to be on the frontlines of care to use innovation to improve people’s wellbeing.

The post People Needing Access to Care Shouldn’t Have to Do Battle to Get It appeared first on Medika Life.

Research Underscores Absence of Paid Sick Leave at Nation’s Largest Employer Poses a Public Health Risk

Date of Release: April 28, 2021

NATIONWIDE — A new study out today quantifies the public health impacts of Walmart’s failure to have a paid sick leave policy that met the needs of associates and their families during the COVID-19 pandemic. Human Impact Partners found that had Walmart established an adequate paid sick leave policy before the COVID-19 pandemic struck, at least 7,618 employee cases of COVID-19 and 133 deaths from COVID-19 could have been prevented. 

Walmart is the nation’s largest private employer in the United States and has a long history of resisting adequate paid sick leave for employees. Early on in the pandemic, Walmart refused a request made by shareholders to study the feasibility of a 14 day paid sick time benefit – even as reports were emerging of employees contracting the virus at work. Meanwhile, Walmart — like all private employers with more than 500 employers — was exempt from the Families First Coronavirus Response Act’s mandate to establish paid sick leave policy.  

“Without sufficient paid sick leave, Walmart workers face an impossible choice between staying home to stay healthy but risking wage loss and retaliation, or coming into work symptomatic despite the public health danger this poses to customers and communities,” said Sukhdip Purewal Boparai, Research Project Director at Human Impact Partners. “Employers and elected officials need to understand that paid sick leave is a non-negotiable policy that all Americans need, and an essential key to recovery from this pandemic. Walmart should be leading the way for employers across the country by implementing a universal paid sick leave policy that supports workers and the public to get through the current crisis safely.” 

Human Impact Partners is a national nonprofit organization based in Oakland, California which seeks to transform the field of public health to center equity and builds collective power with social justice movements. Researchers at Human Impact Partners calculated the national numbers of preventable COVID-19 cases and deaths among Walmart workers using methodology from researchers at University of Wisconsin, who estimated the number of COVID-19 cases and deaths among workers in Wisconsin using epidemiological surveillance data from the Institute for Health Metrics and Evaluation. HIP researchers then applied an estimate from the sick pay literature that attributes a 6% reduction in death and caseload of influenza-like disease to paid sick time policies, replicating a methodology that University of Wisconsin researchers used as well. This methodology is a powerful tool to quantify the benefits of paid sick time as an effective public health measure. 

Where Walmart’s Paid Sick Leave and COVID-19 Pandemic Policies Went Wrong 

Walmart currently provides 48 hours of “protected paid time off”, but workers have reported barriers like retaliation and lack of communication around the policy in accessing even this meager amount of leave. 

According to a 2020 survey, 45% of Walmart associates reported they were still likely to come into work if they were sick. Employees reported fear of disciplinary action, loss of wages, and no knowledge of the 48 hour policy as reasons they would choose not to stay home while ill. 

Walmart associates were also not informed when co-workers tested positive for the virus.  In collaboration with United for Respect, Walmart employees created a COVID-19 tracker to keep each other informed and safe. Currently, they are tracking 1,862 cases across the country.

“The failures in Walmart’s coronavirus response are not new,” said Cynthia Murray, a Walmart associate and leader with United for Respect, who has also introduced a shareholder resolution calling on the creation of a pandemic task force at Walmart to address policies like paid sick leave. “Workers have been telling Walmart management for years that we need paid sick leave so we’re not forced to come to work sick. This pandemic is not over yet, and Walmart’s paid leave policy gap is a life or death issue for workers and customers and a huge risk to the company. That’s why I’m calling on Walmart to create a pandemic task force. If workers’ voices were included in decision-making, we could have had paid sick leave already, and countless lives could have been saved at Walmart and beyond. It is time our employers and our elected leaders start listening.” 

Key Takeaways

HIP’s report underscored the scale and urgency of implementing adequate paid sick leave policies at Walmart and across the country:

• Access to paid sick time saves lives:  HIP’s original research found that if Walmart had an established paid sick leave policy in place before the pandemic, research indicates that 133 employee lives could have been saved, and 7,618 COVID-19 cases prevented. Without universal paid sick time, thirteen additional Walmart employees will be at risk of COVID-19 death between April and July 2021 — unless the company takes immediate action.
• Lack of paid sick leave exacerbates pandemics: Without paid sick leave, workers may not have the option to miss out on a paycheck. A study last year revealed that 94% of workers surveyed would comply with self-quarantine during COVID-19 when they were compensated for loss of income, whereas only 57% of employees would comply with the guidance if they weren’t compensated. 
• Paid sick time is beneficial for childrens’ health: Children whose parents have paid sick time are more likely to be current on their healthcare needs, like receiving their annual check-up and flu vaccine. Considering nearly half of Latinx employees and over a third of Black employees do not receive paid sick time, this undoubtedly perpetuates inequality and keeps Black and brown children from thriving.
• Employers benefit from paid sick time policies: Having established paid leave in place has been found to increase loyalty and morale amongst employees, and decrease turnover – all goals Walmart has alluded to, even in their recent decision to grant more employees full-time status. 
• Paid sick time is critical for racial, gender, and economic equity: Because Walmart employs more women and Black and Latinx workers than any other US corporation, the positive outcomes associated with paid sick time would be far-reaching — to families and communities across the country, with benefits for gender, economic, and racial equity.

Full report here >> Walmart’s role in the COVID-19 pandemic: How lack of paid sick time prolongs the pandemic and increases mortality

About HIP:

Human Impact Partners transforms the field of public health to center equity and builds collective power with social justice movements.

The post Lives Cost from Meager Paid Sick Leave at Walmart appeared first on Medika Life.

Just imagine if we could cure everything. We could all pack our bags and go home.

You assume you have a right to be healthy, or at the very least, expect health as a prerequisite for a good life. We are all born with this assumption programmed into us and if you don’t believe me, ask yourself this question. When you are sick or unhealthy, what tends to be the first thought that crosses your mind? Why me? It is as though the gods of ill intent have personally singled you out for a dose of pain and misery.

We use the term ‘health’ freely to describe, well, pretty much anything related to our ‘health’, but what do we actually understand of the word, in terms of definition. What does your ‘right to health’ actually entitle you to? Does it relate just to your physical state and being free of disease or does it encompass more? Should you be considering your social and economic conditions when you pose the “why me’ question and are they a part of your ‘health’?

How does the ‘healthcare’ industry interpret this term? It’s an important question as this directly impacts the treatments and outcomes you can expect from your health providers. Are doctors, for instance, tasked simply with your physical wellbeing (illness and disease), or do their duties extend beyond that. 

Let’s turn to the organization that is arguably seen as our global gatekeeper for health, the World Health Organization (WHO) to explore the answer. How do they define their very reason for existence? How do they define ‘health’? 

“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” 

World Health Organization

That’s a pretty tall order and a seriously extensive scope of responsibility for one single term and to bring home the further complexities of modern healthcare, this diagram from America’s Health Rankings (AHR)shows the overlaps of various disciplines considered in the field of health when they compile their data

What’s important about the little diagram above is the center, entitled health outcomes. It’s become a watchword for American healthcare. Successful outcomes are how we now gauge healthcare in America. The factors listed in the diagram, Behaviours, Physical Environment and Social Factors shouldn’t be confused with your understanding of health or the WHO definition. These environmental, social, and geographic factors are however crucial in developing healthcare’s responses and planning with regards to the care they provide you. So indirectly, they do affect your ‘health’.

Let’s explain this through the use of an example. America, in global terms, ranks terribly for infant mortality at birth. In fact, out of the 36 OECD countries measured, America comes third from last. Let’s use the 2020 data provided by AHR to support this statement. 

As an aside, if you’re wondering which state is best for pregnancy care, Vermont scores the highest, and statistically, your birth is safest in Massachusetts (3.8 deaths per 1000) and most at risk in Mississippi (8.7 deaths per 1000). According to the AHR 2020 report;

In 2018, over 21,000 infants died in the United States. According to the Centers for Disease Control and Prevention (CDC), the leading causes were birth defects, low birthweight and preterm birth, maternal pregnancy complications, sudden infant death syndrome (SIDS) and unintentional injuries.

The U.S. infant mortality rate has been consistently higher than other developed countries, and 1.5 times higher than the average (3.8 deaths per 1,000 live births) among Organization for Economic Co-operation and Development countries. Research indicates socioeconomic inequality in the United States is likely a primary contributor to its higher infant mortality rate.

According to the CDC report referenced above, race affects these figures in the following way. Sections in bold added by way of explanation.

Black women had the highest mortality rate (10.75), followed by infants of non-Hispanic NHOPI (Native Hawaiian or Other Pacific Islander: 9.39), non-Hispanic AIAN (American Indian or Alaska Native: 8.15), Hispanic (4.86), non-Hispanic white (4.63), and non-Hispanic Asian (3.63) women.

So that part of our diagram above, entitled Social and Economic, is actually the driving factor that increases the risk of your baby dying at birth. Does this have anything to do with your health and your child’s health, other than implying you move to Vermont for your pregnancy and deliver the baby in Massachusets? What if you’re black? Will moving help or is your race a fixed determinant in your child’s chances at birth? 

This where it gets complicated and where healthcare treads on quicksand. Your race, from a genetic point of view, does not affect your risk of infant death at birth and that is what makes the figures above so damning. These figures have nothing to with genetics or you but are rather an indictment of how the color of your skin, your sex, and your economic and social situation determine your access to healthcare and a healthy lifestyle. In effect, your right to ‘health’.

Racism, it turns out, kills babies, not race. Being socially disadvantaged kills babies. Being financially impoverished kills babies. 

In terms of health, the above are all classic WHO indicators of physically healthy people living in an unhealthy society. If we are to judge by the WHO definition, then American healthcare, in its current state, fails to live up to the lofty goals set, and it isn’t just in the field of infant mortality that it falls short. 

The question is, can we blame the American healthcare system for social and racial disparities? How can you hold doctors responsible for generations of institutionalized racism, sexism, and social inequality? No fair.

There is a quandy at the heart of modern healthcare. Is your provider merely required to treat your symptoms or do they have a moral and ethical responsibility to look beyond the diseases, to identify the causes and address these, to seek cures, rather than treatments? Where does their remit begin and where does it end?

The dangers of mixing the fields of medicine and health with finance, economics, societal politics, and race are that the lines begin to blur. Boundaries are necessary for the effective functioning of any system. Act beyond the scope of your boundaries (profession) and you dilute both your efficacy and your impact.

While we cannot hold Healthcare accountable for societal racism, sexism, and general inequality, we most certainly can expect the industry not to engage in any of these practices. That is sadly not always the case, but the industry is beginning to assess itself more introspectively with a view to rooting out these practices. Empowering and recognizing the voices of women within Healthcare is a massive step in the right direction.

Patients can also, and rightly so, expect health care providers to address the imbalances in their communities that lead to the racial disparities so clearly underlined by infant mortality in America. 

Let’s clarify that statement as it’s a weighty one. This expectation does not involve doctors and nurses dropping their stethoscopes and picking up banners for the next BLM protest. It refers to them addressing these imbalances from within the scope of their professional abilities. A clear set of “non-medical symptoms” or parameters exist to identify the at-risk and healthcare needs to respond accordingly by pre-empting the 8.7 dead babies for every 1000 born in Mississippi.

The healthcare profession is about exactly that, health. It isn’t about creating a revolving door of repeat business, but rather seeking out the lofty aspirations of the WHO. To treat a ‘sick’ society as their primary patient, particularly if that patient lies at the heart of burgeoning illness and disease. 

Providers need to encourage free weekly clinics in marginalized communities, governors need to increase budget allocations for communities that are in dire need of healthcare, free medication needs to be made available for those unable to provide for themselves., courtesy of a cash-rich Pharmaceutical industry. All of these things and more need to be put into action. Not to act is to be aware of the growing tumor and refusing to treat it. 

It leaves the industry with blood on their hands.

By now, I hope you understand that your ‘health’ means far more than simply waking up in the morning with all your fingers and toes accounted for. To be truly healthy, you need to strive for a stable social and economic environment, for you and your family. Achieving this is within everyone’s reach and when we encounter obstacles intentionally placed in the way of people achieving their true health, it falls on everyone’s shoulder to speak out and speak up.

Not just healthcare.

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