Who Knows Your Business?: Your Digital Health Footprint

Thanks to the California Healthcare Foundation for this informative info-graphic on how third parties may be tracking your online activities.  Perhaps now's the time to reconsider Google's Incognito browsing option.

Just Released: Preventive Services for Women & the ACA

This month’s Visualizing Health Policy infographic takes a look at preventive health services for women, including missed opportunities for preventive counseling on risk factors (such as smoking or alcohol) and sexual health issues (such as contraception, sexually transmitted infections, and domestic violence), the effects of lack of insurance on rates of mammograms and other screening tests for women, and how costs are a barrier that cause some women to postpone preventive services or skip a recommended test or treatment. It also reveals that a substantial proportion of women are unaware that the Affordable Care Act (ACA) requires private plans to cover many preventive services without cost sharing, and that many women regard clinicians as the most trusted source for information on the ACA.
 
              


Visualizing Health Policy is a monthly infographic series produced in partnership with the Journal of the American Medical Association (JAMA). The full-size infographic is freely available on JAMA’s website and is published in the print edition of the journal.

Customer Update: 23andMe reaches out to "genetic pioneers"

As I continue to follow the fate of 23andMe, here's an email the company sent to its existing customers last week:  Dear 23andMe Customers, I'm writing to update you on our conversation with the U.S. Food and Drug Administration and how it impacts you. If you are a customer whose kit was purchased before November 22, 2013, your 23andMe experience will not change. You will be able to access both ancestry and health-related information as you always have. 23andMe has complied with the FDA's directive and stopped offering new consumers access to health-related genetic results while the company moves forward with the agency's regulatory review processes. Be sure to refer to our 23andMe blog for updates. We stand behind the data we have generated for customers. Our lab partner adheres to strict quality standards that are part of the Clinical Laboratory Improvement Amendments of 1988 - known as CLIA. These are the same standards used in the majority of other health and disease-related tests. You are among the first people in the world to ever get access to their genomes. You are genetic pioneers. Thank you for your ongoing support and we look forward to continuing to serve you. Anne Wojcicki Co-founder and CEO, 23andMe

23andMe May Be On the Chopping Block

You may have been following the FDA's crackdown on genetic testing company 23andMe.  I know that I have been, as one of over 500,000 individuals who have purchased 23andMe's Personal Genome Service. Anecdotally, I have recommended 23andMe to many friends and colleagues - I really enjoyed seeing my ancestry, risk of disease, and learning more about my DNA.

[23andme.com]

In May, the FDA asked 23andMe, a Google-backed company, for more information about their genetic testing service. When the company failed to reply, last week the FDA ordered 23andMe to stop marketing its genetic test because it said the company has not provided adequate evidence that the tests were accurate. In its warning, the FDA further expressed concerns that patients receiving genetic information without medical guidance might seek unnecessary, and possibly harmful, medical testing or treatment. Interestingly, the FDA's warning letter does not mention that it has received any customer complains about 23andMe's service.

Until this week, 23andMe had not provided comment about the FDA warning letter that leaked  last week. On Tuesday night,  23andMe co-founder Anne Wojcicki finally spoke out. Wojcicki admitted that she failed to respond to the FDA's concern and highlighted a problem with the FDA's approval system. The agency, she said, "is set up to approve individual tests, but 23andMe tests about a million components of a person's DNA. Filing for a million approvals would be impossible."

CLIA Certification

[darkdaily.com]

In addition to needing FDA approval for its genetic tests, 23andMe also had to obtain Clinical Laboratory Improvement Amendments (CLIA) certification from The Centers for Medicare and Medicaid (CMS). All lab testing performed on humans must have CLIA certification. The CLIA Program sets standards for these labs and assigns scores 1, 2 or 3 for each of the following criteria:

1. Knowledge
2. Training and experience
3. Reagents and materials preparation
4. Characteristics of operational steps
5. Calibration, quality control, and proficiency testing materials
6. Test system troubleshooting and equipment maintenance
7. Interpretation and judgment

Click here for more information on CLIA Law & Regulation.

AB 1000 Increases Patients' Direct Access to Physical Therapists

California residents gained improved access to physical therapy services when Gov. Jerry Brown signed AB 1000 into law last month. Before the new law was passed, patients could only see physical therapists for an evaluation, fitness and wellness services, and treatment for a condition that had been the subject of a medical diagnosis.  In other words, patients seeking relief from pain and injuries had to wait to get a physician diagnosis before a physical therapist could treat them.  AB 1000, which goes into effect on January 1, 2014, expands patient access to physical therapy for immediate treatment for up to 45 days or 12 visits, whichever comes first.

There is no doubt that this is a victory for physical therapists across California who have continually fought for more direct access. Also beginning January 1, only physical therapists can own a physical therapy professional corporation.  Other health care providers, such as chiropractors and physicians, may be shareholders of up to only 49%.  Physical therapists can create multidisciplinary practices by hiring other licensed practitioners, including physicians, for their physical therapy corporations.

The most controversial provision in AB 1000 concerns referrals for profit, where providers refer individuals to services and facilities in which they have an ownership interest. In response to this concern, AB 1000 states that providers must disclose their ownership, verbally and in writing, to patients and inform patients that they have a choice of providers.

Unlike it's usual trend-setting, California is now the last of all other Western states to offer patients direct access to physical therapist treatment.

Actuarial Value: What Does It Mean?

Actuarial value is a term that has been frequently used in connection with health plans on the the federal and state exchanges. Let's take a minute to understand the term as a way to better understand the health reform law.

Actuarial value refers to the share of health care expenses the plan covers for a typical group of enrollees. The four tiers of health plans established by the ACA - bronze, silver, gold, and platinum - are based on the concept of actuarial value.  Each represents a different level of health insurance coverage. Thus, a platinum plan covers the greatest share of enrollees' medical expenses overall, while a bronze plan covers the least.

[hrhorizons.nacubo.org]

For example, in a bronze plan, 60% of an individual's health care expenses are paid for by the plan.  The individual will then be responsible for 40% of expenses through some combination of deductibles, co-pays, and coinsurance, collectively called "cost-sharing."  The higher the actuarial value, the less patient-cost-sharing the plan will have on average.

The levels of coverage provided by the ACA are key to each individual's coverage and how each will perceive the effects of health care reform. 

For an estimate of deductibles and coinsurance that would meet the tier thresholds defined in the ACA, please visit this study by the Kaiser Family Foundation.  It explains the the coverage tiers established in the ACA, presents the actuarial estimates from thee well-established actuarial and benefits consulting firms, and discusses the potential policy implications.

Health Care Reform Propels Shift in Mental Health Business Model

[comicartfans.com]

By now, many patients may have noticed a change in their doctors' offices. Perhaps you've been asked to sign new confidentiality agreements, or maybe your doctor moved into a larger office with more providers. The phenomenon of large provider groups gobbling up small health care provider practices has arrived, and it's having an especially significant effect on mental health providers. 

Psychiatrists and psychologists are feeling a loss of autonomy, as their patients and schedules are now being chosen and managed by larger institutions.  In some cases, these providers are also taking significant cuts to their paychecks.  Blue Shield of California, for instance, recently asked psychologists on their plans to accept anywhere from a 10- to 30- perfect discount for patients who will buy health plans through Covered California. (Kaiser Health News, 10/24/13.)

As more and more patients expect their mental health care to be covered by insurance, there may soon be a trend away from smaller practices who may not accept as many insurance plans. As patients

But the shift from solo/small practices toward large medical groups isn't all bad, especially not for patients. 

For patients, it may mean lower prices, especially when for mental health services. Where as patients might have paid $150 out of pocket for a therapy session, those same sessions may now be covered by insurance via the 2008 mental health parity law.  Mental health parity requires private and public insurers to cover mental health needs, if at all, just as they do physical health conditions, such as similar co-pays for for physical and mental health services.

In addition, quality of care has great potential to increase as a result of this shift. For example, mental health providers are becoming increasingly integrated into multidisciplinary practice and health clinics.  When a psychologist or psychiatric nurse practitioner sits alongside internists and pediatricians, a more holistic approach to patient care develops that can cut back on unnecessary tests and treatments, potentially saving money for institutions, as well as patients.