In modern America, “the bread” has changed. It is no longer found in a Parisian bakery but in a community health center, a pharmacy, or a hospital admissions office. It is insulin, chemotherapy, biologics and mental health care. Access to these essentials increasingly depends not only on medical need but also on administrative thresholds, shifting eligibility rules, and delay mechanisms that quietly determine who waits, who deteriorates, and who absorbs financial collapse as collateral damage.

When Illness Becomes Economic Collapse

Medical debt has become the most visible expression of this misalignment. More than 100 million Americans now carry health-related debt, much of it incurred despite having health insurance. For millions of Americans, a single diagnosis can be enough to destabilize their household finances permanently. Medical debt damages credit, constrains housing and determines employment options. It fuels chronic stress that contributes to poorer health outcomes. It punishes people not for recklessness, but for uninvited illness.

The consequences extend well beyond ledgers. Individuals carrying medical debt are significantly more likely to delay or avoid needed care, skip prescriptions or postpone follow-up visits. Families report cutting back on food, utilities or rent to manage medical bills. In this way, illness becomes an economic accelerant, pushing people already close to the edge into deeper instability. Survival may be possible, but recovery, both financially, emotionally, and psychologically, becomes elusive.

For patients with serious illnesses such as cancer, autoimmune disease, or rare conditions, the stakes are far higher. Financial toxicity has been associated with increased mortality among cancer patients, as out-of-pocket costs lead individuals to delay treatment or abandon therapy altogether. This occurs at the same time that medical innovation has never been more promising. Targeted therapies, biologics, and personalized medicine are extending life and improving quality of life. The contradiction is stark: scientific progress accelerates while access narrows.

How Administration Became a Barrier to Care

At the center of this contradiction sits prior authorization. Originally intended as a utilization management tool, it has evolved into a pervasive barrier to timely care. Physicians report that prior authorization routinely delays necessary treatment and consumes hours of clinical time, while patients wait often in pain, sometimes in medical crisis. In oncology, delays can mean missed treatment windows. In neurology, they can mean needless pain or irreversible decline. In mental health, they can mean crisis escalation and hospitalization.

Denial rarely arrives as a clear refusal. More often, whether intentional or not, care is slowed until the patient deteriorates, disengages, or pays out of pocket. The system follows the rule, but the consequence is the weight that the patient carries. What was designed as stewardship increasingly functions as deterrence, too often transferring the burden of cost control to those least equipped to carry it.

Public programs meant to stabilize access have not been immune to this dynamic. Medicaid and Medicare, established as pillars of the American safety net in 1964, now operate amid growing instability. Eligibility thresholds are a moving target. Redetermination processes remove coverage for administrative reasons, rather than due to changes in need. Patients in active treatment lose coverage mid-course, forcing physicians to scramble and patients to panic. Coverage churn disrupts care and erodes trust, encouraging people to delay engagement with a system that is no longer structured to protect them when they are most vulnerable.

Taken together, medical debt, administrative delay, and coverage instability are not isolated policy failures but a systemic pattern. The modern sick-care system excels at episodic intervention but struggles with continuity, predictability, and lived experience. It measures success in transactions rather than trajectories, focusing on efficiency rather than consequences. Innovation thrives, while access to these medicines frays.

Violence is Never Justified

Hugo warned of where this leads. When systems feel unreachable, when appeals are endless and context is stripped away, frustration hardens into despair—the search for bread. Despair does not always erupt visibly. More often, people delay care not because they are indifferent to their health, but because they are afraid of what seeking care will cost them financially and emotionally.

Violence is never justified. The murder of health insurance executive Brian Thompson must be condemned without qualification. It is a human tragedy, not a symbol, and should never be rationalized. At the same time, refusing to examine the conditions that fuel public rage that applaud the killer is a warning sign about how people experience health care as an institution that governs life-and-death decisions while feeling increasingly inaccessible and unaccountable.

In Les Misérables, bread was enough to keep Jean Valjean’s family alive, but it was the weight of rigid systems that nearly broke him. That distinction matters today. When access to health care is treated as something to be rationed through delay, instability, and administrative friction, survival may still be possible, but long-term stability is put at risk. Medical debt, coverage churn, and seemingly weaponized delays do not merely inconvenience patients; they reshape how people relate to illness, the government, and companies, and allocate care.

The path forward does not begin with sanctifying health care, nor with vilifying those who work within it. It starts with recalibration. Administrative tools must serve care rather than obstruct it. Eligibility for public programs must offer predictability, not whiplash. Access must be treated as infrastructure, something that must function under stress, not a privilege rationed through complexity. America’s health-care story is still being written. Its outcome will not be determined solely by innovation or cost control, but by whether systems are designed to work when people are most vuln

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TUSTIN, Calif. — Cynthia Williams is furious with U.S. House Republicans willing to slash Medicaid, the government-run insurance program for people with low incomes or disabilities.

The 61-year-old Anaheim resident cares for her adult daughter, who is blind, and for her sister, a military veteran with severe post-traumatic stress disorder and other mental health conditions. Medi-Cal, the state’s version of Medicaid, pays Williams to care for them, and she relies on that income, just as her sister and daughter depend on her.

“Let’s be real. We shouldn’t have to be here tonight,” Williams told a raucous standing-room crowd of over 200 people at a recent town hall. “We should be home, spending time with our loved ones and our families, but we’re here. And we’re here to fight, because when politicians try to take away our health care, we don’t have the option to sit back and let it happen.”

The House last week approved a Republican budget plan that could shrink Medicaid spending by $880 billion over 10 years, only partially paying for an extension of expiring tax cuts from President Donald Trump’s first term, plus some new ones he has promised, totaling as much as $4.5 trillion.

A spending cut of that magnitude would have a huge impact in California, with nearly 15 million people — more than a third of the population — on Medi-Cal. Over 60% of Medi-Cal’s $161 billion budget comes from Washington.

Williams was among about a dozen providers, patient advocates, disabled people, and family members who stood up one after the other to tell their stories. Rep. Young Kim, a Republican whose district includes this relatively affluent Orange County city, declined an invitation for her or a staff member to attend. But her constituents delivered their message loud and clear to her and the other Republicans in Congress: Hands off Medicaid.

Josephine Rios, a certified nursing assistant at a Kaiser Permanente surgical center in Irvine, said her 7-year-old grandson, Elijah, has received indispensable treatments through Medi-Cal, including a $5,000-a-month medication that controls his seizures, which can be life-threatening. Elijah, who has cerebral palsy, is among the more than 50% of California children covered by Medi-Cal.

“To cut Medicaid, Medi-Cal, that’s like saying he can’t live. He can’t thrive. He’s going to lie in bed and do nothing,” Rios said. “Who are they to judge who lives and who doesn’t?”

Two thirds of Californians across party lines oppose cuts to Medi-Cal, according to a new survey by the California Health Care Foundation and NORC at the University of Chicago.

The town hall here was one of three organized late last month by “Fight for Our Health,” a coalition of health advocacy groups and unions, to target Republican House members whose California districts are considered politically competitive. The other two were in Bakersfield, part of which is represented by Rep. David Valadao, and Corona, home to Rep. Ken Calvert. Multiple other town halls and protests have sprung up across the country in recent weeks.

The coalition has reprised a campaign — part of a broader national movement — that fought against the GOP’s unsuccessful 2017 effort to repeal the Affordable Care Act.

The Republicans’ loss of House control in the 2018 midterm elections has been widely attributed to their stance on health care. Valadao was among the GOP members who lost their seats in 2018, though he took his back two years later.

Still, he voted for the House budget proposal last week, despite the fact that about two-thirds of the population in his district is on Medicaid — the highest in the state — and even though he is one of eight GOP House members who sent a letter to Speaker Mike Johnson warning about the “serious consequences” of deep cuts to Medicaid. Valadao’s office did not respond to requests for comment.

Calvert, who’s been in the House for 32 years and eked out reelection last November, also voted for the budget, as did Kim. All nine GOP members of California’s congressional delegation supported it, as did all House Republicans except one.

Critics of the budget plan say it helps the rich at the expense of society’s most vulnerable — an argument that was vigorously repeated at the Tustin town hall. But supporters of the plan say that extending the tax cuts, key provisions of which are set to expire at the end of this year, would avoid a large tax hike for average Americans and benefit low-income families the most.

“American families are facing a massive tax increase unless Congress acts by the end of the year,” Calvert said in a statement to KFF Health News before the vote. He vowed the GOP would not touch Social Security or Medicare. He did not offer similar assurances on Medicaid, but said, “We are not interested in cutting the social and healthcare safety net for children, disabled, and low-income Americans. We are focused on eliminating waste, fraud, and abuse.”

The document greenlit last Tuesday does not specify spending cut details, though it instructs the Energy and Commerce Committee, which oversees Medicaid and Medicare spending, to cut $880 billion — a large chunk of the up to $2 trillion in total cuts. The GOP’s razor-thin majority means Johnson will have a narrow path to get a more detailed budget passed. Republican support, whether from fiscal hawks who want deeper spending cuts or House members worried about slashing Medicaid, could ebb and flow as the details are hashed out.

Moreover, the House must reach a compromise with the Senate, which has passed a much narrower budget resolution that leaves the big tax cuts out for now.

Like Kim, Valadao and Calvert declined invitations to attend or send staffers to the town hall meetings in their regions. At the Tustin meeting, multiple speakers chided Kim for her absence. At one point, the large screen behind the podium flashed a picture of an empty chair with the words, in large block letters, “Congresswoman Kim, we saved you a seat.”

Kim spokesperson Callie Strock said in an email that Kim and her local staff had preexisting commitments that night. She added that Kim is “committed to protecting and strengthening our health care system.”

But those in attendance were clearly worried.

“It’s a moral obligation for all of us to look at the most disadvantaged people in our country and take good care of them,” said Beth Martinko, whose 33-year-old son, Josh, has autism and relies on Medi-Cal for his care. “This has no place in politics.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

Bernard J. Wolfson: bwolfson@kff.org, @bjwolfson

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Nearly 1.7 million Texans have lost their health insurance — the largest number of people any state has removed — in the months since Texas began peeling people from Medicaid as part of the post-pandemic “unwinding.” Around 65% of these removals occurred because of procedural reasons, according to the state.

Texas’ Health and Human Services Commission has neared the end of a chaotic and overburdened process to remove people from state Medicaid insurance who became ineligible during the coronavirus pandemic. The state had not unenrolled people before this year because of federal pandemic rules, which forbid states from cutting coverage.

As a result, more than 5 million Texans had continuous access to health care throughout the pandemic through Medicaid, the joint federal-and-state-funded insurance program for low-income individuals. In Texas, the program’s eligibility criteria is so restrictive, it mainly covers poor children, their mothers, and disabled and senior adults.

But the effects of speed running this process have reverberated: still-eligible Texans were kicked off both in error and for procedural reasons, adding to backlogs of hundreds of thousands of Medicaid applications and pushing wait times back several months. Backlogs for SNAP food benefits applications, which the same state agency also manages, also skyrocketed because of the burden.

“The state handled this with an incredible amount of incompetence and indifference to poor people,” U.S. Rep. Lloyd Doggett, D-Austin, told the Texas Tribune. “It’s really appalling.”

Doggett has repeatedly demanded for changes in the process, most recently sending a letter to the U.S. Centers for Medicare and Medicaid Services calling their scrutiny of the state “woefully inadequate.”

He said he also contacted the agency overseeing the nation’s Supplemental Nutrition Assistance Program program, the U.S. Department of Agriculture, about improving the state’s food benefit access during this time. He suggested pausing upcoming SNAP renewals so Texas staffers could focus on working through backlogs first.

Neither federal agency had responded to him as of Thursday morning, he said.

As of Dec. 8, there were 207,465 SNAP applications and 288,939 Medicaid applications waiting to be processed, according to HHSC spokesperson Tiffany Young.

“Nobody who watched this is surprised about the backlog. We had delays before the unwinding, and then we put a gigantic amount of work on the system that wasn’t spaced in any sort of even, realistic way, that was totally front-loaded,” said Stacey Pogue, a senior policy analyst at Every Texan.

“The way the state’s choosing to do this is one gigantic, long backlog. That’s a choice, and it hurts people in need,” she added. “But they had other choices to take workload off the system without asking people to wait and wait and wait and wait.”

The wait time for Texans who now apply for both SNAP and Medicaid has decreased to a little over a month, as they have to wait for their Medicaid application to go through first. This is a reduction from a five-month waiting period in place at the beginning of December, Young said.

As of October 2023, some previously submitted applications in the queue had been sitting there for as long as four months, HHSC spokesperson Jennifer Ruffcorn said.

“HHSC is moving 250 eligibility staff from other priority projects to focus on processing applications that request SNAP and another benefit,” Ruffcorn said in a statement. “Additionally, within the next five months, HHSC will be sending 600 of our newer staff to Medicaid training. This will also increase our capacity to process more SNAP and Medicaid combined applications.”

For those without food, even a month is a long time. Food banks had already felt a strain before the holidays approached.

“It’s just a difficult time, it’s sort of a perfect storm,” said Celia Cole, CEO of the nonprofit Feeding Texas, earlier this fall. “Food banks are seeing higher demand. They’re struggling to get food in and out the door, and it’s costing more to do that.”

And for those without health insurance coverage, options remain limited, often to either stomach thousands of dollars in medical debt or turning to federally qualified health centers, which are required to provide medical care regardless of insurance.

“It’s tragic to think that children are missing their check ups or medications because their Medicaid application is collecting dust in a state office,” said Diana Forester, Director of Health Policy at Texans Care for Children, in a Thursday news release.

Some of the solutions the state has offered have been bleak. In a cheerfully-toned email from HHSC to its staffers obtained by Doggett’s office, leaders suggested employees participate in a “6 Days of Merry Service Challenge” where they would work overtime every day through either extending hours or coming in on a Saturday.

“There’s other pathways besides asking an overworked staff to work more,” Pogue said of the email. “Of all the solutions to pick, that’s just the last one on the list.”

Texas also has made limited use of an automated eligibility checking system, which uses previously submitted data like pay stubs as well as federally provided data about people’s work. Only 6% of Medicaid renewals came through the automated system, according to state numbers.

Throughout the process, advocates like Pogue made unheeded calls for a pause so HHSC staffers could catch up on backlogs before sending more eligible people to the back of the line.

Now that the state has gotten through most of its “cohorts” of trying to renew people — one million people’s coverage has renewed — advocates say the state has an opportunity to fix the system.

“Texas lawmakers can look forward to like, ‘What kind of system do we want? How hard should it be to get through the Medicaid renewal process? How do we staff our system to process paperwork?’ ” Pogue said. “It’s no longer about how we’re going to do unwinding. It’s: ‘How are we going to run the Medicaid program?’ ”

Karen Brooks Harper contributed to this report.

Neelam Bohra is a 2023-24 New York Times disability reporting fellow, based at The Texas Tribune through a partnership with The New York Times and the National Center on Disability and Journalism, which is based at the Walter Cronkite School of Journalism and Mass Communication at Arizona State University.

Disclosure: Every Texan, Feeding Texas, Texans Care for Children and New York Times have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.

Information about the authors

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FALLON, Nev. — Linda Noneo turned up the heat in her van to ward off the early-morning chill that persists in northern Nevada’s high desert even in late June. As the first rays of daylight broke over a Christian cross on the top of a hill near the Fallon Paiute-Shoshone colony, she drove toward her first stop to pick up fellow tribal members waiting for transportation to their medical appointments.

Noneo is one of four community health representatives for the Fallon Paiute-Shoshone, which the tribe said includes about 1,160 enrolled members. The role primarily involves driving tribal members to their health appointments, whether in Fallon, a city of just under 10,000, or Reno, more than 60 miles west. Noneo said she and her colleagues have also taken patients as far away as Sacramento, California, and Salt Lake City, round trips of nearly 400 and 1,000 miles, respectively.

Public health experts contend the role Noneo and others like her fill is an integral part of ensuring people receive the care they need, especially for chronic illnesses, by helping close gaps in areas with medical provider shortages. Besides transporting patients to their appointments, community health representatives provide health education, patient advocacy, and more. Noneo said she and her colleagues spend a lot of time helping young mothers and elders, checking on the latter, taking them to get groceries, or delivering their medication.

Yet, most state Medicaid programs don’t recognize or pay for services offered by health workers, such as Noneo, who work on tribal lands. That’s despite their work being essentially the same as that of “community health workers” in nontribal communities, a classification many state Medicaid programs cover.

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In Nevada, that disparity recently changed when the state began allowing workers on tribal lands to qualify for Medicaid reimbursement as community health workers. Tribal leaders say the Medicaid payments supplement existing personnel funding by covering the individual services the workers provide. That in turn should allow tribes to train and hire more community health representatives, which could expand health and support services for tribal members.

Only two other states, South Dakota and Arizona, treat community health representatives serving Native American populations as eligible for the same Medicaid reimbursement as their similarly named counterparts in nontribal areas, according to Michelle Archuleta, a community health representative program consultant for the federal Indian Health Service. However, she said, the tribes the CHRs work for have not begun billing the states’ Medicaid programs.

The Community Health Representative program, established by Congress in 1968, is among the nation’s oldest community health workforces. It’s jointly funded by each tribe and the IHS, an agency within the Department of Health and Human Services responsible for providing health care to members of federally recognized tribes. As of 2019, more than 1,600 of these tribal linchpins worked in the United States, according to the IHS.

Last year, the Centers for Medicare & Medicaid Services approved Nevada’s plan to make community health workers who complete training and certification requirements eligible for Medicaid reimbursement when they assist with chronic disease management and prevention.

And in December, leaders with the Nevada Community Health Worker Association helped tribes make sure their community health representatives would receive the necessary training for certification. The association would “fully support” tribal clinics submitting their community health representative training for recognition in the state and it would not require a change to state law, said Jay Kolbet-Clausell, program director for the group. For now, community health representatives are receiving double training to be able to file for Medicaid reimbursement.

Training and certification requirements for community health workers vary widely by state and employer, as workers are often hired by hospitals, local organizations, health departments, or federally qualified health centers. But a movement has been emerging across the country to bring more uniformity to those requirements and formalize the roles, said Sweta Haldar, a policy analyst with the Racial Equity and Health Policy program at KFF.

As part of this process, states are expanding coverage for community health workers under Medicaid. According to a brief Haldar co-authored, 28 of 47 states, and Washington, D.C., reported having policies that allow Medicaid reimbursement for services provided by community health workers. Arkansas, Georgia, and Hawaii did not respond to KFF’s survey.

“There’s a really robust evidence base that is growing every day that community health worker interventions can be effective in reducing health disparities, particularly in communities of color,” Haldar said.

Studies have also shown that community health worker programs are effective in improving health outcomes for people with chronic conditions and that they reduce health care costs.

Soon after Nevada implemented its program, about 50 community health representatives completed the requirements. Another cohort of 20 finished the curriculum later, said Kolbet-Clausell. The goal is for those who have completed the recent training to help their peers through it, they said.

Even before the tribal workers were included in the community health workforce, one of its greatest strengths was its diversity, Kolbet-Clausell said. In Nevada, the 2022 student group was made up of greater shares of people who are American Indian or Alaska Native, Hawaiian or Pacific Islander, Black, Hispanic, or from rural areas than the state’s general population. They said it’s likely one of the most diverse health programs in the state.

Community health representatives such as Noneo are typically tribal or community members themselves, which, public health experts say, allows them to connect more easily with the patients they serve and better connect them to health care.

For example, the first person she picked up that June morning was her cousin, who had a 6 a.m. dialysis appointment.

Kolbet-Clausell said they’re optimistic about the growing workforce and the support it’s getting from state leaders.

“Five, six years ago, there was a lot more resistance,” they said, because lawmakers saw the efforts to expand the community health workforce as simply spending more money. “But this actually just benefits rural communities as much as it benefits underserved urban communities. It serves everyone.”

Back in Fallon, Noneo reflected on her 27 years as a community health representative for her tribe as she prepares to retire in September. She has been there with her fellow tribal members through important and hard times in their lives — like driving an expectant mother to Reno to deliver a baby, taking people to receive treatment for mental health crises and addiction, and bringing patients to their dialysis treatments on her week off around Christmas so they wouldn’t miss their appointments.

The most challenging part of the job, she said, is experiencing the loss of someone she has regularly seen and provided years of services for.

“We all have compassion,” she said. “In this kind of job, you have to have that.”

After decades of shuttling patients, Noneo has the work down to a steady and familiar rhythm. Four hours after dropping off her cousin for dialysis, Noneo picked her up at the clinic as she dropped off the next dialysis patient. On a clipboard, she logged the hours and mileage for each appointment.

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Just off the historic U.S. Route 66 in eastern New Mexico, a 10-bed hospital has for decades provided emergency care for a steady flow of people injured in car crashes and ranching accidents.

It also has served as a close-to-home option for the occasional overnight patient, usually older residents with pneumonia or heart trouble. It’s the only hospital for the more than 4,500 people living on a swath of 3,000 square miles of high plains and lakes east of Albuquerque.

“We want to be the facility that saves lives,” said Christina Campos, administrator of Guadalupe County Hospital in Santa Rosa. Its leaders have no desire to grow or be a big, profitable business, she said.

But even with a tax levy to help support the medical outpost, the facility lost more than $1 million in the past six months, Campos said: “For years, we’ve been anticipating kind of our own demise, praying that a program would come along and make us sustainable.”

Guadalupe is one of the nation’s first to start the process of converting into a Rural Emergency Hospital. The designation was created as part of the first new federal payment program launched by the Centers for Medicare & Medicaid Services for rural providers in 25 years. And though it is not expected to be a permanent solution to pressures facing rural America, policymakers and hospital operators alike hope it will slow the financial hemorrhage that continues to shutter those communities’ hospitals.

More than 140 rural hospitals have closed nationwide since 2010, and health policy watchers aren’t sure how many of the more than 1,700 rural facilities eligible for the new designation will apply. CMS officials said late last month that seven have already filed applications. Dr. Lee Fleisher, director of the Center for Clinical Standards and Quality at CMS, said how long it will take to review the applications will vary. The agency declined to provide the names or locations of hospitals seeking the designation.

Facilities that convert will get a 5% increase in Medicare payments as well as an average annual facility fee payment of about $3.2 million in exchange for giving up their expensive inpatient beds and focusing solely on emergency and outpatient care. Rural hospitals with no more than 50 beds that closed after the law passed on Dec. 27, 2020, are eligible to apply for the new payment model if they reopen.

The new program “strikes me as the first time we are saying, you know, maybe we can just take the beds away,” said Dr. Paula Chatterjee, an assistant professor at the University of Pennsylvania’s Perelman School of Medicine. Outpatient and emergency visits already make up about 66% of Medicare payments for rural hospitals that are eligible to convert, according to Chatterjee’s recent research.

Still, she found that many would likely need to scale up some outpatient services, such as telehealth and substance use care. Even then the payment model might not be able to shift the “foundational pressures” of declining, aging, and sicker populations that are making it hard to deliver care in rural America, she said.

“This feels like rearranging deck chairs on the Titanic,” Chatterjee said.

More than 50 hospitals and other organizations have expressed interest in the rural emergency designation, said Janice Walters, chief operating officer of programs for the Rural Health Redesign Center, which has a federal grant to provide technical assistance to facilities interested in converting.

Most hospitals “are still trying to figure out, ‘Is the math going to work?’” Walters said.

Those showing immediate interest are very small, with three or fewer patients staying overnight any given day, and, generally, they long ago gave up maternity care to save on expenses. The federal law will need to be amended to help larger rural hospitals with more overnight stays, said Brock Slabach, chief operations officer for the National Rural Health Association.

“It’s enough for now,” Slabach said. “But is it going to be enough for the long term? I don’t think so.” Top priorities for the group include adding the ability for hospitals to participate in a federal drug discount program and allowing for longer patient stays.

At Stillwater Medical in Oklahoma, Chief Administrative Officer Steven Taylor said the switch already makes sense for two of the system’s smaller hospitals that “have struggled financially.” The small regional health system’s outpost in Perry, which rarely has more than two inpatients a day, has already filed an application, and its facility in Blackwell will likely do so soon, he said.

Keeping emergency services “is the most important thing” for the small communities, he said. The new model requires a 24-hour emergency department and a clinician on call. It also caps the average length of patient stays at 24 hours — which Taylor said is not a problem. One patient may need to be watched for 12 hours for chest pain while another, with pneumonia, may need to stay for 36 hours, but that will average out to less than 24 hours for the year, he said.

Plus, he said, anybody who needs more intense care can be transferred to their regional hospital in Stillwater. Oklahoma, like other states, is working to update state laws for licensing or regulations to ensure hospitals can be credentialed with the rural emergency designation quickly.

John Henderson, president and chief executive of the Texas Organization of Rural & Community Hospitals, agreed with other speakers at the National Rural Health Association’s February policy conference in Washington, D.C. The new rule “could be a relief valve” for very small rural hospitals, he said. A two-bed facility in Crosbyton confirmed for Henderson earlier that day that it was the first in Texas to be approved for the new payment mechanism.

Henderson said he knew of several more of the state’s 158 rural hospitals that are applying or have already applied, and others are considering it: “These are the folks that are just hanging on.”

Dr. Denise Brown, CEO of virtual care provider Fident, spoke up from the front row during Henderson’s presentation. Her company uses telehealth so doctors and other clinicians can work virtually with multiple hospitals in different states. Brown said she was concerned that hospitals that convert won’t have enough ambulances available to transport or a place to send sicker patients, especially if they aren’t part of a larger health system.

Heads began to nod throughout the crowded room. Many rural hospitals needed every bed they had during the worst of the covid-19 pandemic, and to give up those beds now seems counterintuitive.

Those same rural hospitals often find that larger facilities refuse to take their patients who need specialized care, Brown said.

“How do I know that I can guarantee somebody a bed?” Brown said, adding that she prefers rural hospitals keep patients longer. How would she explain to concerned family members that their loved one was “two or three hours from home”?

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Social Security adjudicators working on applications for benefits have licensed professionals to evaluate the case and rate them regarding the person’s ability to perform any work. Physicians and licensed psychologists never see the applicants, only the information in the file.

Applicants that can’t lift at least 5 lbs. for a specific length of time may still be seen as able to do sedentary work, and here’s where the cards are stacked against them.

The Dictionary of Occupational titles, last updated in 1977, lists over 12,700 jobs many available for unskilled, sedentary workers at that time. Among the jobs are shoe sole gluer, fish scaler, nut sorter, dowel inspector, and egg processor. Where in the US do we have people gluing soles on shoes or sorting nuts?

A pinball machine repairer is still available, but how would a person with sedentary issues be able to do that? The jobs are still listed as existing here, and adjudicators see that as a valid reason to deny benefits to a disabled person. Shouldn’t the listings be updated? Who’s responsible for that?

Some people receive benefits who can do other than sedentary work and be employed in a variety of jobs. I recall a man that field workers found lying under his truck doing repairs on it. Another man was engaged in a home repair business, a third was pulling a boat trailer, and the list continues.

How do I know about this? I worked as a medical consultant for Disability for over a decade, and I attended meetings where they pointed out recent fraud. Adjudicators told me about the old job listings they were using to deny benefits, and as long as they were in that book, they were used.

Those who knew they didn’t deserve benefits know one thing that protects their fraudulent claims; many states may have only two field inspectors to check up on questionable claims.

How does Disability know about these claimants? It’s simple; someone reported them to Social Security. As far as I know (from my years working there), there are no regular visits to check up on those receiving benefits. A paper trail tracks some on a one, three, or never basis according to their assigned disability rating. The last are those seen as rated with no medical improvement expected, such as terminal cancer or, perhaps, another terminal illness that will result in death within one year.

Reports may prompt the inspectors to make a trip out into the field. Nosey or unhappy neighbors and vigilant citizens keen to report fraud are the banes of those who are inappropriately collecting benefits. No reports might mean a cursory trip occasionally to check up on someone. Otherwise, various forensic methods will be used to catch the fraudsters.

Think how many people have been denied because they couldn’t find a fish scaling job. Also, think about the stress, the endless hours of trying to contact someone to help, or the process of giving up in depression. Isn’t it enough that they want to work and can’t? How demeaning is that?

Don’t we determine our self-worth by how we contribute to society or our families? Being pushed aside like this is saying the disabled are worthless, and that’s not as bad as it gets. Some may commit suicide. I don’t have data on that, but it’s not a bad guess on my part.

If you or someone you know has been denied Social Security Disability benefits, you have a right to ask for a reconsideration and a review after that by a judge. Should you not be satisfied with the outcome, contact the local office of your state’s Federal Senator and ask for a “sensitive inquiry” on their part.

You can also contact an attorney who specializes in these cases. Their fee is set by law and determined by how much money (often back benefits) is realized.

The post Ruling Against the Disabled and Denying Social Security Benefits to Them appeared first on Medika Life.

“Medicaid is the single largest payer for mental health services in the United States and is increasingly playing a larger role in the reimbursement of substance use disorder services. Individuals with a behavioral health disorder also utilize significant health care services — nearly 12 million visits made to U.S. hospital emergency departments in 2007 involved individuals with a mental disorder, substance abuse problem, or both.”

Eighty-two million-plus people are served by Medicaid each year. If the need is so great, and it is admittedly the case, what is the reason reimbursement rates for Medicaid patients are so low? Don’t low-income individuals or families deserve to be on equal footing in terms of any healthcare with other families who live above the poverty line? States determine who is eligible for the program, and it can be quite wide-ranging and daunting for any individual to figure out what services they have available to them.

What are the current rates in a state like New York or New Jersey for Medicaid reimbursement for mental health services? Figuring out the payments and co-pay isn’t for the faint of heart. As usual, it’s convoluted and requires billing experience, and that’s the reason that career may receive a bump in persons needed.

Medicare pays covered providers about $77.81 for 30 minutes of individual therapy. Not everyone will use that 90832 code. Higher billing rates are a prime issue here and . billing is left to ethical and legal issues. But Medicaid, for the same session, could pay less than $60.

In some cases, previously, the rate was about $50. When many psychotherapists are charging over $100/hr (and in NYC it could be $300/hr.), who is going to accept a Medicaid patient? Therapists have a right not to accept patients and some will do so if the individual doesn’t have “adequate” reimbursement.

It is a disturbing fact of life that, when potential patients call for a therapy appointment, they will often indicate they have insurance coverage. How demeaning for them. The bottom line is that money can be a major issue for care. One woman, who indicated she believed every therapist was qualified, wrote a book on her experiences.

I heard of a case where a therapist, in a large practice run by a psychiatrist, was in a session with a Medicaid patient when the door suddenly burst open. The psychiatrist told the patient to get out and never come back again.

It was an unwritten rule in the practice that Medicaid patients would not receive services. The therapist, not knowing of this practice, had agreed to see the patient, a young man with HIV and prior drug addiction.

One of the major problems that lead to quality differences must be considered. Anyone who has a thriving practice and sees a few pro bono cases, may not accept Medicaid cases. Who will accept them? Money is a great temptation and knavery waits for its opportunity.

Although we do hear of occasional whistleblowers reporting unethical and fraudulent Medicaid cases, many who receive the care either don’t realize the care is by unqualified persons or would be reluctant to report. Just as there are pill mills, there are Medicaid/Medicare mills run by unscrupulous therapists who reap the profits and care little about anything other than filling appointments.

Some practices book patients for multiple sessions, one after the other, for additional therapy during one day with other therapists. Ever notice those “hot boxes” outside the doorways to offices?

I also heard of a master’s-level licensed therapist who accepted Medicaid and provided therapy for children who were sexually abused. After more than four years of therapy with one boy, the therapist, when questioned, admitted that he had not received any advanced training. Where was management in this case? He works at a local mental health center.

The boy was not making progress in this therapy, but the mother felt she had no recourse to obtain therapy with someone else. Everyone she called refused services once she indicated it was a Medicaid case.

But it’s not only in psychotherapy that the lower-income patients receive care from an unlicensed, neophyte, or inadequately trained individuals. A highly experienced ENT physician admitted to me that he was no longer doing surgery because “I get about $3 for an operation that costs $1,500,” he said. I think he was engaging in hyperbole because I’m sure Medicaid pays more than that for ENT surgeries.

How Medicaid can be made more equitable in terms of reimbursement is a question for everyone, but especially the politicians in each state. Services to anyone must be done on need, not payments, but that’s where it stands now. As they say, money talks. Does your state offer charity care for those in need?

The post Inadequate or Unqualified Therapy Because of Low Medicaid Reimbursement? appeared first on Medika Life.

The Biden administration and state officials are bracing for a great unwinding: millions of people losing their Medicaid benefits when the pandemic health emergency ends. Some might sign up for different insurance. Many others are bound to get lost in the transition.

State Medicaid agencies for months have been preparing for the end of a federal mandate that anyone enrolled in Medicaid cannot lose coverage during the pandemic.

Before the public health crisis, states regularly reviewed whether people still qualified for the safety-net program, based on their income or perhaps their age or disability status. While those routines have been suspended for the past two years, enrollment climbed to record highs. As of July, 76.7 million people, or nearly 1 in 4 Americans, were enrolled, according to the Centers for Medicare & Medicaid Services.

When the public health emergency ends, state Medicaid officials face a huge job of reevaluating each person’s eligibility and connecting with people whose jobs, income, and housing might have been upended in the pandemic. People could lose their coverage if they earn too much or don’t provide the information their state needs to verify their income or residency.

Medicaid provides coverage to a vast population, including seniors, the disabled, pregnant women, children, and adults who are not disabled. However, income limits vary by state and eligibility group. For example, in 2021 a single adult without children in Virginia, a state that expanded Medicaid under the Affordable Care Act, had to earn less than $1,482 a month to qualify. In Texas, which has not expanded its program, adults without children don’t qualify for Medicaid.

State Medicaid agencies often send renewal documents by mail, and in the best of times letters go unreturned or end up at the wrong address. As this tsunami of work approaches, many state and local offices are short-staffed.

The Biden administration is giving states a year to go through the process, but officials say financial pressures will push them to go faster. Congress gave states billions of dollars to support the coverage requirement. But the money will dry up soon after the end of the public emergency — and much faster than officials can review the eligibility of millions of people, state Medicaid officials say.

In Colorado, officials expect they’ll need to review the eligibility of more than 500,000 people, with 30% of them at risk of losing benefits because they haven’t responded to requests for information and 40% not qualifying based on income.

In Medicaid, “typically, there’s always been some amount of folks who lose coverage for administrative reasons for some period of time,” said Daniel Tsai, director of the CMS Center for Medicaid and CHIP Services. “We want to do everything possible to minimize that.”

In January the eligibility of roughly 120,000 people in Utah, including 60,000 children, was in question, according to Jeff Nelson, who oversees eligibility at the Utah Department of Health. He said that 80% to 90% of those people were at risk because of incomplete renewals. “More often than not, it’s those that just simply have not returned information to us,” he said. “Whether they didn’t receive a renewal or they’ve moved, we don’t know what those reasons are.”

Arizona Medicaid director Jami Snyder said 500,000 people are at risk of losing Medicaid for the same reasons. She said that processing all the eligibility redeterminations takes at least nine months and that the end of the federal funding bump will add pressure to move faster. However, she said, “we’re not going to compromise people’s access to care for that reason.”

Still, officials and groups who work with people living in poverty worry that many low-income adults and children — typically at higher risk for health problems — will fall through the cracks and become uninsured.

Most might qualify for insurance through government programs, the ACA insurance marketplaces, or their employers — but the transition into other coverage isn’t automatic.

“Even short-term disruptions can really upend a family,” said Jessie Mandle, deputy director of Voices for Utah Children, an advocacy group.

‘More Marginalized People’

Low-income people could still be in crisis when the public health emergency ends, said Stephanie Burdick, a Medicaid enrollee in Utah who advocates on behalf of patients with traumatic brain injuries.

In general, being uninsured can limit access to medical care. Covid vaccination rates among Medicaid enrollees are lower than those of the general population in multiple states. That puts them at higher risk for severe disease if they get infected and for exorbitant medical bills if they lose their insurance.

“They’re more marginalized people,” Burdick said. She said she worries “that they’re going to fall off and that they’re going to be more excluded from the health care system in general and just be less likely to get care.”

Burdick knows this firsthand as someone who experienced traumatic brain injury. Before covid-19, she would periodically lose her Medicaid benefits because of byzantine rules requiring her to requalify every month. The gaps in coverage kept her from seeing certain specialists and obtaining necessary medicines. “I really do remember being at the pharmacy not being able to afford my medication and just sobbing because I didn’t know what to do about it,” she said. “It was horrible.”

The covid Medicaid continuous coverage requirement was enacted under the Families First Coronavirus Response Act, which gave states an increase of 6.2 percentage points in federal funds if they agreed to maintain eligibility levels in place at the time.

The boost meant tens of billions of additional dollars would flow to states, estimates from KFF show. The U.S. Department of Health and Human Services can extend the public health emergency in 90-day increments; it is currently set to end April 16.

Groups that advocate for the needs of low-income Americans say the renewal tidal wave will require outreach rivaling that of almost a decade ago, when the ACA expanded Medicaid and created new private insurance options for millions of people.

Independent research published in September by the Urban Institute, a left-leaning think tank based in Washington, D.C., estimated that 15 million people younger than 65 could lose their Medicaid benefits once the public health emergency ends. Nearly all of them would be eligible for other insurance options, including heavily subsidized plans on the ACA marketplaces.

Tsai said the 15 million estimate provides a “helpful grounding point to motivate everybody” but declined to say whether the Biden administration has its own estimates of how many people could lose benefits. “I don’t think anyone knows exactly what will happen,” he said.

Tsai and state officials said they have worked hand in hand for months to prevent unnecessary coverage loss. They’ve tried to ensure enrollees’ contact information is up to date, monitored rates of unreturned mail, worked with insurers covering Medicaid enrollees, and conducted “shadow checks” to get a sense of who doesn’t qualify, even if they can’t disenroll people.

Some enrollees could be renewed automatically if states verify they qualify by using data from other sources, such as the Internal Revenue Service and the Supplemental Nutrition Assistance Program.

For others, though, the first step entails finding those at risk of losing their coverage so they can enroll in other health benefits.

“It’s a big question mark how many of those would actually be enrolled,” said Matthew Buettgens, a senior fellow in Urban’s Health Policy Center and author of the September report. One factor is cost; ACA or job-based insurance could bring higher out-of-pocket expenses for the former Medicaid enrollees.

“I am particularly worried about non-English speakers,” said Sara Cariano, a policy specialist with the Virginia Poverty Law Center. “Those vulnerable populations I think are at even higher risk of falling out improperly.” The law center is planning enrollment events once the unwinding begins, said Deepak Madala, its director of the Center for Healthy Communities and Enroll Virginia.

Missouri, already sluggish in enrolling eligible people into the state’s newly expanded Medicaid program, had 72,697 pending Medicaid applications as of Jan. 28. Enrollment groups worry the state won’t be able to efficiently handle renewals for nearly all its enrollees when the time comes.

By December, the Medicaid rolls in the state had swelled to almost 1.2 million people, the highest level since at least 2004. The state — one of several with histories of removing from the program people who were still eligible — did not say how many people could lose their benefits.

“I want to make sure that everybody that is entitled to and is eligible for MO HealthNet is getting the coverage that they need — all the way from babies to older individuals to individuals on disability,” said Iva Eggert-Shepherd of the Missouri Primary Care Association, which represents community health centers.

‘No End in Sight’

Some people argue the current protections have been in place long enough.

“There’s no end in sight. For two years, it’s still a quote-unquote ‘emergency,’” said Stewart Whitson, a senior fellow with the Foundation for Government Accountability. The conservative think tank has argued that states can legally begin trimming people from Medicaid rolls without jeopardizing their funding.

“This is the kind of problem that just grows worse every day,” he said of not removing ineligible people. “At the beginning of the pandemic, people were in a different position than they are now. And so responsible legislators and government officials in each state have to look at the facts as they are now.”

Tsai said “it’s quite clear to us” that for states to be eligible for the covid relief bill’s enhanced Medicaid funding, they must keep people enrolled through the emergency. “Those two things are interlinked,” he said.

Meanwhile, states still have no idea when the renewal process will begin. HHS has said that it would give states 60 days’ notice before ending the emergency period. The additional Medicaid funds would last until the end of the quarter when the emergency expires — if it ended in April, for example, the money would last until June 30.

“It’s hard to do a communication plan when you say, ‘You’ve got 60 days, here you go,’” Nelson of Utah’s Department of Health said.

Colorado officials had debated sending letters to enrollees when the public health emergency was nearing its scheduled end on Jan. 16 but held off, expecting that it would be extended. HHS announced a 90-day extension only two days before it was set to expire.

“Those kinds of things are really confusing to members,” Medicaid Director Tracy Johnson said. “OK, your coverage is going to end. Oh, just kidding. No, it’s not.”

KHN senior Colorado correspondent Markian Hawryluk and Midwest correspondent Bram Sable-Smith contributed to this report.

[Correction: This article was updated at 11:15 a.m. ET on Feb. 14, 2022, to clarify the federal funding increase that states received under the Families First Coronavirus Response Act.]

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Alan Rosenbloom, president, and CEO of the national non-profit Senior Care Pharmacy Coalition is the voice for many of the nation’s independent, long-term care (LTC) pharmacies. LTC pharmacies serve daily some 850,000 people residing in skilled nursing facilities, assisted-living facilities, and other long-term care settings. In this exclusive conversation, Rosenbloom provides insights into why lower medical costs and better outcomes are possible but require health ecosystem fair-play and clear Congressional support.

Bashe: You are a noted antitrust attorney dedicated to patient health access. How did you embark on your public health career and what attracted you to the Senior Care Pharmacy Coalition (SCPC) as the next step in that journey?

Rosenbloom: After law school, I developed expertise in long-term care (LTC) issues, including senior care. I represented nursing homes, assisted living, and continuing care retirement communities, and also ran healthcare trade associations. When SCPC approached me, I already knew the important role medications and access to them play in seniors’ quality of life and quality of care — and that of others with LTC needs. It was a natural extension of my expertise.

Policymakers Need to Prioritize Senior Care Needs

Bashe: Could you define the differences between LTC and retail pharmacies?

Rosenbloom: This is precisely why the SCPC, which represents LTC pharmacies exclusively, came together: policymakers often don’t understand the difference. This results in less-than-ideal outcomes for LTC pharmacies and the people they serve.

A retail pharmacy is in a store. People come in for medication and then buy chips, shampoo, and other kinds of convenience items; that’s where retail makes most of their profits. LTC pharmacies don’t provide anything but medications and services; they only get paid for those essentials.

Retail pharmacists are aware of the prescriptions consumers fill at their location. However, they have no legal or professional obligation to have insights into prescriptions that may be filled at other retail locations. When you leave the pharmacy, that clinical relationship ends. LTC pharmacies are very different. The pharmacy is required by Medicare and Medicaid (and typically by states) to know much more about each patient’s overall condition including their entire medication profile. Often, people are coming from hospitals into LTC settings with a discharge summary including a detailed history of all their medications.

Bashe: The reality is we’ll all be under the senior care umbrella at some point and need a structure in place. In a nation where some 25% of the population will be over the age of 60 by 2030, what does SCPC see as the looming need?

Rosenbloom: If you need LTC, you ought to have access to the services that LTC pharmacies provide that retail pharmacies don’t. These services affect your quality of care and quality of life. Our mission is to influence public policy so that people who need LTC pharmacy services have access to them, regardless of who they are or where they live.

An estimated 14 million in America need LTC; a meaningful percentage are younger and disabled. They suffer physical and sometimes mental impairments that impact so-called Activities of Daily Living, such as getting out of bed in the morning, dressing, feeding themselves, and going to the bathroom independently. LTC is crucial for them.

Long-Term Care Pharmacies Prioritize Care Outcomes

Bashe: You and SCPC also conduct research on the LTC needs of Medicare beneficiaries. Can you share your insights?

Rosenbloom: We partnered with ATI Advisory and published a report in July 2021 analyzing Medicare patient data. This is part of what we hope will be an effective test of our hypothesis that LTC pharmacy services improve medication therapy for people in very meaningful ways.

For almost 30 years there’s been a movement to expand choices for seniors. Our research found that people dual-enrolled in Medicare and Medicaid, due to lower incomes and assets, are more likely to be women, and they are more likely to be Black or Latinx and living at home.

That’s a very important finding. It challenges some of the assumptions made about the need for expanded LTC services in the community by policymakers and advocates, who tend to divorce health care needs from LTC needs. Our analysis showed that if an individual needs LTC they are likely to have substantial health care needs, whether they’re living in a facility or at home.

As We Age, How Can Our Policy Leaders Protect Our Health

Bashe: What role does policy play in protecting our citizens’ interests, and which policies need to be addressed to ensure equitable care?

Rosenbloom: LTC pharmacy is overlooked in public policy to ill effect. A few years ago, there was an ongoing battle between two branches of the U.S. Department of Health and Human Services (HSS) — The Centers for Medicare and Medicaid Services (CMS) and the U.S. Food and Drug Administration (FDA), which had conflicting guidance. It took two years of effort and lobbying in Congress, with HHS, and with the White House to get an incomplete solution. Such conflicts put patients at risk and that’s why we are advocating for the Long-Term Care Pharmacy Definition Act, which would finally define LTC pharmacies in statute.

Also significant is the effort to expand Medicaid-funded home- and community-based services (HCBS) as part of the current reconciliation bill. Congress, the Biden Administration, and the Democrats have proposed adding at least $150 to $175 billion over 10 years for Medicaid-funded HCBS. We support expanding HCBS; it’s a good opportunity for LTC pharmacies to play a role in home-based settings.

Bashe: I appreciate your analysis of the complexities of rules, law, and policy and the internal conflict within HHS. Why don’t people realize that someone has to pay when people without sufficient economic resources arrive at an ER, not to mention that a hospital discharge staffer has to find a place — good, bad, or indifferent — for that patient’s post-acute care setting follow-up?

Rosenbloom: That’s a challenging question and it’s not unique to LTC policy or health care policy. I do think that the American health care system, which has been supported by government payment programs since 1965, has evolved into one that focuses on treatment, not prevention.

Silos exist throughout the Federal payment programs. Medicare pays for hospital care and skilled nursing care, which is a small percentage of LTC, but part of the LTC system. If a skilled nursing facility transfers a patient to the hospital, it hits the hospital’s Medicare budget. It’s then an issue for Medicare policymakers on the hospital side but lowers costs on the nursing home side. This creates very perverse incentives from both budgeting and payment points of view, especially if the payers are incentivizing treatment over outcomes.

Bashe: LTC pharmacies strike me as organizations that cut out that middle layer — they get the medications in, they deliver them. It’s a tight link of the supply chain, which in other places is stretched out with several players taking their little percentage. What’s your perspective?

Among the Many Reasons Drug Costs Climb

Rosenbloom: One of the significant drivers of higher drug costs are the middlemen: pharmacy benefit managers (PBMs) and the insurance companies that provide drug coverage. The Medicare Part D program was created in such a way that the health insurers and Part D plans get payments, called rebates, from the manufacturer, which keeps premiums down. The Part D program is an unwitting accomplice: insurance companies demand ever-higher rebates through their PBMs, and manufacturers raise prices. Each blames the other, but insurance companies, manufacturers, and PBMs see their revenues go up.

Pharmacies do not see a revenue increase, it’s quite the opposite as insurance companies and PBMs charge pharmacies administrative fees well beyond what would be reasonable for processing claims. The projections for Part D expenditures are going down, in part due to increasing fees charged to pharmacies. Pharmacies subsidize the Federal spend to their own detriment; there aren’t huge margins in the pharmacy business, especially in the LTC pharmacy business.

If there’s a new fee that’s going to cost you 2% each claim, you pay the fee — you don’t have a lot of choices. You cannot exist as an LTC pharmacy if you don’t participate in Part D. Even if you are the largest LTC pharmacy, you have limited negotiating power compared to health insurers and PBMs.

Bashe: It seems that one hand pays the other. They’re making money on the spread on both sides of the patient-care model — on the drugs themselves and then on the margin. Do any existing policy solutions support lowering drug prices?

Rosenbloom: There are some proposals currently pending to address having Medicare negotiate drug prices with an international reference point, which would dramatically reduce rebates. Independent pharmacies are at risk of financial instability and possible bankruptcies because policymakers are not considering the downstream consequences on smaller market players. If we change models, we have to ensure LTC pharmacies don’t get stuck with the bill.

What we’ve seen on the insurance company, health care provider, PBM, and the large pharmacy chain side is both vertical and horizontal integration into health care conglomerates that dominate significant chunks of the market. We need to seriously look at enforcing the antitrust laws because when competition is suppressed, consumers may pay more for their medications or be directed to less effective medications if they are more profitable than the plans and PBMs.

Bashe: What concerns me is that health is more than a product or a pill that’s delivered on time. There’s also an inherent duty to help the patient. As we move towards scale and away from individualized care are we endangering the relationship between care provider and patient?

Rosenbloom: There are state laws and Medicare and Medicaid requirements that medications get to a resident in a facility within a certain period of time; in some cases, as quickly as four hours. Historically the LTC pharmacy was the model for serving people in nursing facilities, and there, the relationship is primarily with the facility. The LTC pharmacy has expanded into the assisted living environment, where the relationship is more directly with the patient. As we expand more into the home care environment, that personal dynamic becomes even more important.

Bashe: What’s the one thing health professionals, policy leaders, and people reading this piece really need to remember when looking at LTC pharmacies?

Rosenbloom: People should know the value that LTC pharmacy services provide to people with LTC needs, and recognize their positive impact on patient care outcomes. And then, pay for it appropriately.

Bashe: Mr. Rosenbloom, thank you. Health professionals must recognize that when the office visit is over, a patient still has health needs that must be addressed. The right medicine at the right time at the right cost will always be a lifesaving factor in the care relationship. In order for us to live long, sustainable lives, then supply chain management, digital information, and access to affordable medicines are essential. But, along with high-tech, the high-touch of long-term pharmacies is a key piece in the fragmented health ecosystem puzzle.

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