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Friday, May 3, 2013

Health 2.0 Refactored 2013

Health:Refactored is a 2-day conference taking place in Silicon Valley, May 13 – 14, 2013 for developers and designers to learn and share the latest hacks, hone their skills, and make the necessary connections to thrive in the health industry.

With the industry rapidly evolving, the potential to improve lives through health technology is limitless. Whether you are a developer, designer, or just want to learn more about health tech, get yourself to Health:Refactored and build your expertise for the greatest impact.

They granted my press pass, so I will be there to learn and report. Then, on the 15th I will head up to Sacramento:

Hi Bobby,

We would be happy to offer you a complimentary registration as a member of the blogging media. I will get you signed up - look forward to meeting you next month! I've copied Chet Marchwinski, our Communications Director who will be participating in the summit as well.

Things are certainly ramping up.


The Centers for Medicare and Medicaid Services (CMS) has doled out more than $13.7 billion in EHR Incentive Program payments since the start of the program, according to the latest figures available for March (pdf). 255,772 eligible professionals (EPs) have receives payments so far, representing nearly half of the EPs in the country.  March saw $1.1 billion in payments to EPs and more than three quarters of eligible hospitals, signaling continuing success for the meaningful use program...


This NEJM article caused a torrent of crossfire political reactions.
The Oregon Experiment — Effects of Medicaid on Clinical Outcomes
Katherine Baicker, Ph.D., Sarah L. Taubman, Sc.D., Heidi L. Allen, Ph.D., Mira Bernstein, Ph.D., Jonathan H. Gruber, Ph.D., Joseph P. Newhouse, Ph.D., Eric C. Schneider, M.D., Bill J. Wright, Ph.D., Alan M. Zaslavsky, Ph.D., and Amy N. Finkelstein, Ph.D. for the Oregon Health Study Group
N Engl J Med 2013; 368:1713-1722May 2, 2013DOI: 10.1056/NEJMsa1212321

Despite the imminent expansion of Medicaid coverage for low-income adults, the effects of expanding coverage are unclear. The 2008 Medicaid expansion in Oregon based on lottery drawings from a waiting list provided an opportunity to evaluate these effects.

Approximately 2 years after the lottery, we obtained data from 6387 adults who were randomly selected to be able to apply for Medicaid coverage and 5842 adults who were not selected. Measures included blood-pressure, cholesterol, and glycated hemoglobin levels; screening for depression; medication inventories; and self-reported diagnoses, health status, health care utilization, and out-of-pocket spending for such services. We used the random assignment in the lottery to calculate the effect of Medicaid coverage.

We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression (−9.15 percentage points; 95% confidence interval, −16.70 to −1.60; P=0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures.

This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.
I'm now a Medicare bene. 67 years old, with the usual litany of manageable (and managed) afflictions that come mostly with having lived this long. I'm a 99214, a "moderately complex established patient."

I see my doc twice a year. Lab pulls annually (blood and urine, the usual broad panels). 

On a couple of generic maintenance meds. You can likely guess what they are.

I'm an uncontrolled, marginally "comparative effects research" experiment. Statistically df=3 at n-1 (4 visits in 2 years). Were I seeing my doc four times a year, n-1 df=15. For those few who took anything away from undergrad stats courses, this is "Inadequate Sample Size 101." (See "Standard Error of the Mean," "Power Analysis.")

Medicaid hating "conservatives" are all over this NEJM article. It proves that Medicaid is "ineffective."

What crap. The Instant Gratification Culture, Policy Wonk Division, Run Amuck.


Very nice use of online A/V tech.

More to come...

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