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Tuesday, August 20, 2013

HIX Update: here come the Oscars

New York is again in the Health IT news, HIX-related specifically (Health Insurance Exchanges).
Say Hi To Oscar: The New Kid That May Change Health Insurance
Forbes, Pharma and Healthcare 8/19/13, Nicole Fisher & Scott Liebman, Contributors

In five weeks from now, the Patient Protection and Affordable Care Act mandates the opening of health insurance exchanges around the country. At that time New Yorkers will be introduced to an innovative way of thinking about health care: Oscar. Three friends, and technology entrepreneurs, teamed up to do something that has been inconceivable to date—create a start-up health insurance company to take on conventional health insurers on the NY exchange. Oscar co-founders, Josh Kushner, Kevin Nazemi and Mario Schlosser, plan to change the health insurance industry through technological interfaces, telemedicine and real transparency. Their goal is to redesign insurance to be geared toward the user experience, to make patients seek out their insurer before their doctor.

Americans do not usually think of health insurance as an intimate part of the care process. When sick, individuals do not call their insurance company for care or support. The health insurance industry is considered confusing, at best. The ACA however, presents an opportunity for the reformation of health insurance as we know it, not because of its disappearance, but by making it an integral part of receiving quality care. According to one co-founder, “We want consumers to feel like they have a doctor in the family.” That family doctor he speaks of is Oscar.

Oscar will have one plan in each of the ACAs metal-tiered categories, and additional plan options for the Bronze and Silver tiers. Although Oscar will have some of the familiar pillars of the health care industry like co-pays and deductibles for in-person visits, it introduces new elements like free telemedicine, free generic drugs and online price comparisons. Oscar health insurance will pioneer “a consumer experience, not a processor of claims,” explained Nazemi, with the goal of simply guiding individuals through the complex health system in an integrative and safe way...
...Currently, the Oscar site is merely a welcome page and a list of open positions within the company. But, on October 1st, the site will be fully functioning, possibly putting other sites and insurers to shame. It is certain, given its creative employee background, that the feel and design of Oscar will be more user friendly than the state-based or federal sites.

According to Schlosser, the idea for consumer usage is to have a site where, “like Google, you can come use Oscar. You can type in your issue and we will help you find the best solution.” He explained that the entire experience will be interactive.

When asked about their role or faith in the success of the ACA, the team commented that, “the ACA is a catalyst for what we’re doing.” And the creators hope that Oscar will become a catalyst for the rest of the health insurance industry to be more transparent. They claim Oscar will set the stage for new expectations and behaviors by consumers, and that people already know they deserve more from their health care system.

Whatever the success of Oscar in the early stages of the exchange market in New York, one thing is for certain; Oscar has the potential to cause much needed disruption to health insurance and health care.
Should be interesting. Full article link here. More below, from The Washington Post.

Can three technologists, $40 million, and Obamacare change health insurance forever?
By Ezra Klein,  July 26 at 11:19 am

On Jan. 1, 2014, the federal government will begin subsidizing millions of people’s health insurance purchases through Obamacare. “At that point,” warned Byron York, an influential conservative columnist with the Washington Examiner, “the Republican mantra of total repeal will become obsolete.”

Three years after the law passed, one year after the U.S. Supreme Court upheld it, and nine months after Republicans lost the election that might have allowed them to repeal it, the Washington conversation is still about Republicans’ rearguard actions to undermine the Affordable Care Act and profit politically from the damage.

But in a cavernous room in New York’s SoHo district, a group of entrepreneurs is working to render the entire Washington conversation over Obamacare obsolete. There, Obamacare is no longer a political controversy: It’s a business opportunity. And a trio of young technologists have raised $40 million to take advantage of it...

The palpable (and candidly expressed) anxiety of the intransigent, uncompromising Right goes to their fear that, once the HIX process ensues and smooths out, voters may well in the aggregate come to like the PPACA tolerably well; they will be able to obtain health insurance coverage heretofore out of reach owing to income, age, and pre-existing conditions (including those latent in the genes), etc. They'll have become "addicted" to "dependency" on the federal government.

So, increasingly, we have to endure the maudlin Boehnerista/Ted CruzControl brinksmanship comprised of the threat to "shut the government down" on October 1st should the President and congressional Democrats fail to agree to the "defunding of ObamaCare" (principally meaning at this point scuttling the linchpin nacsent HIX rollout). GOP mouthpieces are all over the media trying to spin things as Obama "wanting to" shut down the federal government (and default on the federal debt).

08/21 NEWS SNIPPET: Sen. Ted Cruz (R-Texas) faced some unexpected guests at his Obamacare town hall on Tuesday night, enduring a line of hecklers multiple times during his speech.

Video footage from NBC News shows protesters shouting "USA! USA! USA!" The Washington Post reports that he also received chants of “you have health care, we should too!”...
My reaction to the "Defund" demand, posted far and wide.
I thought President Obama -- the Constitutional Law Professor, recall? -- gave a weak reply to the reporter who asked him during his pre-vacation Presser if HE was prepared to let the government shut down on October 1st. Well, that's blatantly false framing. Here's all you need to know about it, from the Constitution:

The Congress shall have power to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States; but all duties, imposts and excises shall be uniform throughout the United States;

To borrow money on the credit of the United States;

To make all laws which shall be necessary and proper for carrying into execution the foregoing powers, and all other powers vested by this Constitution in the government of the United States, or in any department or officer thereof.

The validity of the public debt of the United States, authorized by law, including debts incurred for payment of pensions and bounties for services in suppressing insurrection or rebellion, shall not be questioned.

The Congress shall have power to enforce, by appropriate legislation, the provisions of this article.

That's it. There's nothing else pertaining to passing laws and funding the federal government.

NOWHERE in the Constitution is the President authorized to [1] borrow money to run the nation and/or [2] repeal or "defund "his own law" (the Affordable Care Act). The authority to pass, amend, or repeal laws (and/or to borrow money or enact taxes to appropriate funds) is SOLELY the responsibility of Congress.

Congress has the power to override any Presidential veto should it become necessary. That is how it works. Should Congress fail to uphold the national debt as required, those voting to let the government go into default and shut things down will be in explicit violation of their Oaths of office and the Constitution and should be removed from office.

Don't fall for the jive. I know this is all largely brinksmanship posturing in the service of kissing the angry butts of the recess Town Hall Meeting mouth-breather ignoramuses (a significant percentage of them on Medicare and Social Security) who can't even spell "Civics Lesson," but this could all go terribly wrong. It's way past time to stand up to these morons. This threat to shut down the federal government and default on the debt unless Obama agrees to the defunding of the PPACA amounts to extortion. Recall the Oath to defend the nation from all enemies, "foreign or domestic"? These congressional extortionists fall clearly into the latter category. And they need to be loudly and unrelentingly called out on it. Thus far this is not really happening; the public in the aggregate has no clue as to the clarity and severity of the situation.

The President needs to get his act together and point out forcefully just where the responsibility lies on this issue. This pre-adolescent foot-stomping anti-governance nihilism has gone way too far. President Obama needs to make things clear both to the public and to the small handful of actual adults on The Hill.

I urge you all to write your senators and congressmen/women and tell them to Cut the Crap. And write the White House to urge the President to clearly state what OUGHT be obvious.
Now, it ought be clear (but probably isn't) that federal debt default (patently unconstitutional) and federal shutdown (arguably constitutional, notwithstanding its shoot-yourself-in-the-foot stupidity) might well be separate issues. Congress could authorize payment of existing debt (consistent with Amendment XIV) while refusing to allocate funding for ongoing federal operations.

DeMint: Republicans who oppose Defund Obamacare ‘need to be replaced
By Aaron Blake, Washington Post, August 20

Former senator Jim DeMint (R-S.C.) said in an interview broadcast Tuesday that congressional Republicans who oppose the Defund Obamacare effort “should be replaced.”

“I’m not as interested in the political futures of folks who think they might lose a showdown with the president,” DeMint said at a Monday town hall hosted by Heritage Action, the political arm of the Heritage Foundation, which DeMint leads.

DeMint later told NPR: “I think (President Obama) knows that Republicans are afraid, and if they are, they need to be replaced.”

The Defund Obamacare movement seeks to get Republicans to commit to not voting to fund the government if Obamacare is included in that funding.

But several GOP senators have balked at the proposal, not wanting to risk a government shutdown that could be blamed on Republicans...

Obviously, the risk calculation concern here is obviously one of GOP-directed "blame" with Legs that might translate into further erosion of Republican control of Congress -- perhaps even loss of control. But, "risk calculations" apparently do not seem to enter into the minds of the nihilistic Defund/Shutdown/Default cohort. They want crisis, calamity even. Their look-ahead political worldview extends no further than the first week of October 2013.

OK, What does any of the foregoing have to do with Health IT?

Do I really have to explain it?


 By Caren Bohan

WASHINGTON, Aug 21 (Reuters) - U.S. Republican lawmakers, who staunchly oppose President Barack Obama's signature healthcare law, are considering using a fall showdown over the country's borrowing limit as leverage to try to delay the law's implementation.

The idea is gaining traction among Republican leaders in the House of Representatives, aides said on Wednesday. An aide to House Majority Leader Eric Cantor said the debt limit is a "good leverage point" to try to force some action on the healthcare law known as "Obamacare."

"There are plenty of discussions ongoing but no decisions at this point," said another leadership aide.

Republicans are weighing the tactic as an alternative to another approach that would involve denying funding for the law and threatening a possible government shutdown.

The push to deny funding for Obamacare has the backing of some prominent Republican senators, including Ted Cruz of Texas and Marco Rubio of Florida.

But many Republicans in both the House and the Senate oppose the shutdown strategy, viewing it as a reckless move that is bound to fail. Many worry the gambit would cause a backlash against their party ahead of the 2014 congressional elections.

When lawmakers return on Sept. 9 from their five-week summer recess, they will face two fall deadlines. If Congress does not pass a measure by Oct. 1 to keep federal agencies funded, the government will shut down.

Another standoff looms in late October or early November when lawmakers must pass an increase in the U.S. debt limit or face a default on the country's debt...
Yep. Tactical political "leverage," or extortion via threat of a dangerous unconstitutional act?

While I'm editorializing: This photo below is from a metastasizing stunt called "Overpasses for Impeachment."

I might have to call this "child abuse." We used to teach our children to respect American government and our legal system. Now we use them as props in the service of sedition.

"States will be required to check in with the federal hub for applicants’ immigration status, income level, etc. The federal hub is being built and rolled out at the same time that states are designing the rules for how their marketplaces will speak to and integrate with it. Again, it’s a bit like remodeling an airplane mid-flight."
From "In the Eleventh Hour," The Health Care Blog.

Twitter hashtag #HCUX

Top 10 Healthcare Usability Myths Debunked
Myth #1 Clinicians are Uncomfortable with Technology and just need more training
Fact: Current HIT systems often don’t fit the way end users think and work

Myth #2 Put it all on 1 screen to make it easier to use

Fact: Developers need to understand workflows and tasks to know what information is needed

Myth #3 Whoever has the Most features wins
Fact: Vet your current feature set. Less may be more

Myth #4 If they like it on the desktop, they’ll love it on mobile
Fact: Context and tasks matter more

Myth #5 If we allow clinicians to customize their screens they will be satisfied
Fact: Develop information architecture for users’ workflow

Myth #6 Usability is subjective
Fact: There are many types of usability measures (performance, cognitive, perceptions, motivation, costs, risk management etc.)

Myth #7 Usability = Only Pretty & Friendly
Fact: Usability = Patient Safety

Myth #8 Usability Stifles Innovation
Fact: Usability drives innovation. Got iphone?

Myth #9 Usability is the Vendor Responsibility
Fact: Usability is a joint responsibility

Myth #10 Meaningful Use Stage 2 is another year away
Fact: Start preparing now---usability takes time

More to come...

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