Tag Archives: healthcare

Women’s Health Stats For Montana

by D Gregory Smith

Simplified Health Care

WOMEN’S HEALTH IN MONTANA (DHHS REGION VIII) Female Population of MONTANA

Total state population: 989,415 (492,748 females; 496,667 males)

Health Status (Age-adjusted§ percent of adult females)

In poor general health: 4.4%

Activity limitation due to poor phys/mental health: 8.9%

No natural teeth: 5.4% Sources: 2010, BRFSS

Access to Care (Age-adjusted§ percent of adult females) No health insurance coverage (under 65): 21.2%
No personal doctor or primary care physician: 79.2% Saw a dentist in past year: 61.5%

Fact sheets are now available for each of the 50 states and the District of Columbia. Each fact sheet presents a snapshot of demographic characteristics as well as a variety of health status indicators for females within the area. These include:

·        Health Status

·        Access to Care

·        Health Conditions and Risk Factors

·        Preventive Services and Screenings

·        Mortality

·        Prenatal Care and Pregnancy Risk

·        Birth Outcomes

·        Sexually Transmitted Infections

·        Violence and Abuse

·        Mental Health and

·        Teen Health

For complete Montana stats, click here.

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Help Expand Medicaid in Montana!

by D Gregory Smith
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This session the Montana Legislature has an incredible opportunity to expand access to healthcare for 60,000 Montanans! Doing so would involve a minimal cost to the state, and have a major impact across our communities. Our legislators can do this by choosing to expand eligibility in the Medicaid program for individuals who live at or below 133% of the federal poverty level.  It will take a lot of effort on the ground across the state to pass this policy and we need your help!
We’re asking you to contact your Representative and Senator today and urge them to support Medicaid expansion! If we’re able to pass this expansion, it would be a huge victory for human rights in this state!
You can call and leave a message for your legislators at 406-444-4800 or you can fill out an online form by clicking here.  We’ve included some key facts and talking points at the end of this message.   Click here to find out who your legislators are.
We’re asking for your help because this is a once in a generation chance to expand an effective public healthcare program and get Montanans the care they need! But this policy won’t just help our neighbors who can’t afford health insurance. It will also have an incredible effect in our local and state economies. By expanding eligibility to our state Medicaid program, Montana will be investing in our workforce, creating new jobs, and giving a much needed boost to our economy. For more details on the economic impact of Medicaid expansion click here.
Expanding our Medicaid program is the right choice for Montana.  If we make that choice, 100% of the costs of expansion will be paid for through federal funding for the first 3 years. Beginning in 2017, Montana will pick up a small portion of the costs, paying no more than 10% from 2020 forward. This means that by investing a small amount of state dollars in our administrative capacity to expand the program, we can open access to healthcare for up to 60,000 Montanans.
We are so excited about this opportunity, and we’ll keep you updated as this policy discussion progresses.  For now, we hope you’ll write your legislators and let them know how important it is to support Medicaid expansion! 
Thank you for your continued support!
Sincerely,
Kim Abbott
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Identification of LGBT Needs in the Exam Room

by The Mind Alive
A physician performs a routine checkup on a pa...

A physician performs a routine checkup on a patient at the medical clinic. (Photo credit: Wikipedia)

Last time you were in an exam room, did you feel that the attending physician received all the information needed to gain an accurate perspective of your plight? Did you share everything you felt you should, no matter how personal? Did said physician even ask about anything, aside from the usual short list of inquiries we are all too familiar with in that particular setting?

If you are a physician, do you really get the answers you need from your patients? Or perhaps it is just too uncomfortable when talking about sexual health and behaviors. More likely, they do not disclose the details out of discomfort, or even fear.

LGBT persons have shown to have some unique healthcare needs, sometimes experiencing disparities in care. LGBT patients are often uncomfortable or inhibited from talking openly with healthcare providers about sexual orientation, gender identity, and sexual behaviors. Certain sexual behaviors do not automatically define that patient as LGBT, and not all LGBT patients are going to have similar sexual behaviors. Truthfully, it’s not about whether a person is a member of the LGBT community or not. It’s about the individuals choices and behaviors that could be putting their health at risk, as well as the health of others. In order to cover everyone’s needs, patients must speak openly with providers. Providers must delve into the patients behaviors and understand where the risk behavior is at for each patient. I am going to lay out a few examples, ideas, and suggestions for physicians, as well as patients.

In any healthcare position, you will find people from diverse backgrounds and lifestyles. Different interests, tastes, and mindset. The right approach will reassure patients that the provider is knowledgeable, genuine, concerned, confidential and accepting. This enables the patient to open up and discuss the very private matters of sexual behavior, often in this society a ‘taboo’ subject.

Ask the patient to tell a bit about themselves. As the patient, make sure you indulge your sexual partner(s), safe sex practices, and concerns. Some behaviors have an amount of risk attached to them that is often unknown to the patient.  A physician might ask “Do you have any questions or concerns about your sexuality, sexual orientation or sexual desires?”. Use gender-neutral terms and mirror the patient’s terminology to better understand how they identify. For example, asking “do you have a partner or spouse?” “Are you currently in a relationship?” “What do you call your partner?” are all good ways to decide how the patient will identify without offending them with clinical terms which may sound cold and ‘labeled’. From here the in-depth sexual questions begin: “Are you sexually active?” “When you have sex, do you have sex with men, women or both?” “Are you and your partner monogamous?” “How many sexual partners have you had in the past year?” “Do you have vaginal sex, anal sex, or both?”. These and many more are the key to finding out just what unique needs your particular patient might have.

It is important to differentiate between sexual identity and sexual behavior. Providers need to discuss sexual behavior with patients regardless of sexual identity in order to define risk-assessment, ascertaining what activities they engage in and to learn what they are doing to prevent the transmission of disease.

And for the majority of readers, as  patients we have a personal responsibility to find the courage to openly discuss in confidence all of our behaviors and desires with our doctors, nurses, therapists and counselors, etc. This is extremely important. We cannot rely on someone to read our thoughts and know the truth.

Stand up and be proud of yourself. I can almost guarantee that the person treating you has heard it all. And if they haven’t, they will soon enough.

Clinicians Asked To Screen All Patients For HIV

by D Gregory Smith

The US Preventive Services Task Force (USPSTF) strongly recommends that clinicians screen all people aged 15 to 65 years for HIV infection, according to a draft recommendation statement posted online November 20. The statement also recommends HIV screening for all pregnant women, including those who present at the time of labor, and for younger adolescents and older adults who are at increased risk.

“The draft recommendation reflects new evidence that demonstrates the benefits of both screening for and earlier treatment of HIV,” task force member Douglas K. Owens, MD, said in a USPSTF news release. “Because HIV infection usually does not cause symptoms in the early stages, people need to be screened to learn if they are infected. People who are feeling well and learn they are infected with HIV can begin treatment earlier, reduce their chances of developing AIDS and live longer and healthier lives.”

Although US prevalence of HIV infection is nearly 1.2 million and annual incidence is about 50,000, nearly one quarter of those infected are unaware that they are HIV-positive. Since the first reports of AIDS in 1981, more than 1.1 million people have been diagnosed with AIDS and nearly 595,000 have died from it.

Combined antiretroviral therapy (ART) has been shown to reduce the likelihood of HIV transmission, and earlier initiation of treatment lowers the risk for AIDS-related complications.

In issuing this recommendation, the task force hopes to improve and maintain the health of persons who are already infected with HIV, to delay the onset of AIDS, and to lower the risk for HIV transmission.

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Medicaid Expansion Likely To Lower Deaths

by D Gregory Smith

Medicaid expansion under the Affordable Care Act is contentious- mostly because Republicans don’t want to give President Obama any credit- for anything. But if this study, reported today by the New York Times, is any indication, not going forward could be deadly.

Senate Passes Insurance Industry Aid Bill

Senate Passes Insurance Industry Aid Bill (Photo credit: Mike Licht, NotionsCapital.com)

Into the maelstrom of debate over whether Medicaid should cover more people comes a new study by Harvard researchers who found that when states expanded their Medicaid programs and gave more poor people health insurance, fewer people died.

The study, published online Wednesday in The New England Journal of Medicine, comes as states are deciding whether to expand Medicaid by 2014 under the Affordable Care Act, the Obama administration’s health care law. The Supreme Court ruling on the law last month effectively gave states the option of accepting or rejecting an expansion of Medicaid that had been expected to add 17 million people to the program’s rolls.

Seems fairly reasonable. So why would anyone reject the expansion?

Medicaid expansions are controversial, not just because they cost states money, but also because some critics, primarily conservatives, contend the program does not improve the health of recipients and may even be associated with worse health. Attempts to research that issue have encountered the vexing problem of how to compare people who sign up for Medicaid with those who are eligible but remain uninsured. People who choose to enroll may be sicker, or they may be healthier and simply be more motivated to see doctors.

The New England Journal study reflects a recent effort by researchers to get around that problem and allow policy makers to make “evidence-based decisions,” said Katherine Baicker, an investigator on the study who served on former President George W. Bush’s Council of Economic Advisers.

“I think it’s a very significant study in part because of the paucity of studies that have really looked at health outcomes of insurance coverage,” said Karen Davis, the president of the Commonwealth Fund, a nonpartisan research foundation. “Actual mortality studies are few and far between. This is a well-done study: timely, adds to the evidence base, and certainly should raise concern about the failure to expand Medicaid coverage to people most at risk of not getting the care that they need.”

A Republican-appointed official calling this “evidence based”- will it be enough? Probably not. But the evidence is still there:

“So often you hear, ‘Oh well, poor people just shoot each other, and that’s why they have higher mortality rates,’ ” said Diane Rowland, executive vice president of the Kaiser Family Foundation, a nonprofit group. “In the midst of many claims about what Medicaid does and doesn’t do, it actually shows that it cannot only be beneficial for health, but in preventing some of the premature deaths of the uninsured.”

Janet M. Currie, director of the Center for Health and Well-Being at Princeton, said the new study, combined with the Oregon research, should help transform the Medicaid debate into one about dollars, rather than over whether covering poor people improves health.

“This says, well there is benefit to giving people insurance,” Dr. Currie said. “Maybe you don’t want to pay the cost, but you can’t say there’s no benefit.”

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AZ Governor Jan Brewer To Supreme Court: Overturn Same-Sex Benefits

by D Gregory Smith

Governor while meeting with United States Pres...

Arizona Governor Jan Brewer is asking the Supreme Court to overturn same-sex partner benefits for Arizona state employees. The Arizona Daily Sun reports:

Legal papers filed by Attorney General Tom Horne contend that a three-judge panel of the appellate court got it wrong when it concluded earlier this month that it is illegal for the state to provide health care and other benefits to the partners of married workers while refusing to do the same for same-sex couples.

He said the state is allowed to make such distinctions.

In the opinion of several lawmakers in Arizona (who disagree with the move), this appeal is purely “to make a point” against immorality- oh, and to save the state some money. The Daily Sun again:

Hanging in the balance is whether gay workers will lose benefits they have had since 2008. That is when then-Gov. Janet Napolitano got her Department of Administration to rewrite the state’s personnel rules to expand the definition of who is a “dependent” for purposes of state employment.

Under those rules, that included someone living with the employee for at least a year and expected to continue living with that person. The rules, which did not specify the gender of the partner, also required a showing of financial interdependence and an affidavit by the worker affirming there is a domestic partnership.

But in 2009, after Napolitano resigned to take a post in the Obama administration, the Republican-controlled Legislature approved — and Brewer signed — a state law narrowing the definition and specifically excluding unmarried couples.

… According to the Department of Administration, there are 226 employees of the state, the University of Arizona and Arizona State University who are receiving same-sex domestic partner benefits. He said the annual cost is slightly more than $5 million a year.

Does this sound familiar? Prop 8, anyone? The question is whether the balance of social opinion and acceptance will have an affect on this decision. Fascinating also that this request comes just as the general elections ramping up…

Full story here

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Why Romney Won’t Repeal Obamacare

by D Gregory Smith
Mitt Romney Steve Pearce event 056

Mitt Romney Steve Pearce event 056 (Photo credit: Wikipedia)

Just as I suspected. If Mitt Romney wants to (as he claims) overturn Obamacare, it’s going to cost the taxpayers billions of dollars to rollback the healthcare changes already underway. Not to mention the debt cliff that he will need the cooperation of Democrats to negotiate.

Ryan Lizza from the New Yorker:

Mitt Romney, speaking just before noon today, declared that on his first day in office, “I will act to repeal Obamacare.” I think he chose his words carefully. As President, he may indeed “act” to repeal it on Day One, but I don’t believe he will actually be able to overturn the law.

If Romney were to win in November, the first matter he’d have to deal with would be the fallout from the so-called fiscal cliff of December 31st, the day when some five hundred billion dollars worth of tax increases and spending reductions take effect, which could put the economy into another recession (if it’s not already in recession by then). This moment would perhaps be Romney’s greatest chance at repeal. Because the fiscal-cliff negotiations will be an enormous fight over the size and scope of the federal government, every government policy will theoretically be open to debate—including, Romney might insist, repeal of the A.C.A.

But it’s a fantasy. The negotiations would be dead before they started if Republicans demanded repeal as a price for a Grand Bargain on taxes, spending, and entitlements. The fiscal-cliff negotiations will undoubtedly include a great deal of horse-trading that will infuriate and cheer partisans on both sides. But there is literally nothing Republicans could offer Democrats in return for repealing the Party’s greatest achievement since the Johnson Administration.

The reality of the huge (enormous) cost of repeal will pull the bloom off the rose PDQ. It’s insanity.

Read the rest: http://www.newyorker.com/online/blogs/newsdesk/2012/06/why-romney-wont-repeal-obamacare.html#ixzz1zr4S7Yoi

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Tester Stands Up

by D Gregory Smith

Senator Jon Tester’s office released the following today:

Jon Tester, U.S. Senator from Montana

Image via Wikipedia

Senator Jon Tester today released the following statement after voting against a controversial amendment by Sen. Roy Blunt, R-Mo., that would have allowed employers to deny health insurance coverage, including contraception, for any employee based on “moral convictions”:

“This is a reckless attempt to undermine individual freedom and restrict access to health care for women.  This measure is unprecedented and out-of-touch with Montana, and it would have prevented women from making their own healthcare decisions.”

The amendment did not define “moral convictions,” meaning an employer could have denied insurance coverage for anything from blood transfusions and diabetes screenings to HPV vaccinations and treatment of HIV.

The measure failed by a vote of 51-48, failing to reach the 60 votes needed for approval.

It sounds like it would have given employers the right to discriminate for insurance coverage.

I’m especially glad the release specifically mentioned HIV- we have hundreds of Montanans living with HIV who are enrolled in health insurance through their employers….

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Kaiser Permanente Announces HIV Challenge

by D Gregory Smith

When healthcare gets it right, I think it’s important to notice.
Contrary to the HMO stereotype, Kaiser Permanente has taken on the challenge of HIV and instituted policies and guidelines for the effective care and treatment of persons with HIV- to dramatic effect:

English: The Ordway Building, One Kaiser Plaza...

Image via Wikipedia

Kaiser Permanente announced (January 26th) the Kaiser Permanente HIV Challenge to help health care providers nationwide improve health equity for people living with HIV by increasing access to HIV care and improving health outcomes.

The HIV Challenge was announced at the Center for Medicare & Medicaid Innovation Care Innovations Summit in Washington, D.C. ( www.hcidc.org ).

Kaiser Permanente, the nation’s largest nonprofit health care provider, has treated more than 60,000 people since the HIV epidemic emerged 30 years ago, and has reduced disparities among its current HIV population of more than 20,000 people by working to meet or exceed the objectives of the U.S. National HIV / AIDS Strategy.

The crux of the HIV Challenge (kp.org/hivchallenge) is to challenge other private health care providers and public and community health clinics to increase the number of HIV-positive people getting effective treatment by sharing Kaiser Permanente’s toolkit of clinical best practices, provider and patient education materials, mentoring, training and health IT expertise.

(Watch the excellent video series about Kaiser’s HIV Challenge here)

HIV is still an epidemic in the United States, with 56,000 people becoming infected each year and more than 1.1 million Americans living with HIV, but one in five people with HIV don’t know they are infected.

“The organizations presenting challenges here today are pushing the best minds in the country to create a better health care system. They represent exciting solutions to help address some of the nation’s most urgent health needs,” said CMS Acting Administrator Marilyn Tavenner.

Health care disparities are gaps in the quality of care associated with inequities encountered by racial, ethnic, poor and marginalized groups. The HIV Challenge is part of Kaiser Permanente’s larger work to identify, measure, research and eliminate disparities in health and health care in the United States. To learn more go to kp.org/healthdisparities.

“Too many people are unaware they have HIV because access to effective prevention and care is insufficient,” said Michael Horberg, MD, director of HIV/AIDS for Kaiser Permanente, executive director of research for Mid-Atlantic Permanente Medical Group, and a member of the Presidential Advisory Council on HIV/AIDS. “People with HIV need to get into treatment because quality HIV treatment prevents others from getting infected. Patients on effective therapy and better case management are living longer and more productive lives. However, quality HIV treatment requires effort.”

Kaiser Permanente has demonstrated excellence in HIV clinical care outcomes with:

  • HIV mortality rates that are half the national average
  • 94 percent median treatment adherence among patients regularly in care and on antiretroviral therapy
  • No disparities among its black and Latino HIV-positive patients for both mortality and medication rates, compared to a 15 percent higher rate in the United States for mortality and for medication
  • 89 percent of its HIV-positive patients are in HIV-specific care within 90 days, compared to 50 percent in the U.S. within one year
  • 69 percent of all its HIV-positive patients have maximal viral control compared to 19 percent to 35 percent nationally

As part of its HIV Challenge effort, Kaiser Permanente is sharing these best practices and tools for private health care providers and community health clinics to replicate: quality improvement programs that measure gaps in care; testing, prevention and treatment guidelines; how to set up multi-disciplinary care team models that emphasize the “medical home” so HIV specialists, care managers, clinical pharmacists and providers work together; and education for both the provider and patient.

For more details on the HIV Challenge, to download the best-practices toolkit and to watch videos of success stories in setting up HIV clinics and reducing disparities, go to: kp.org/hivchallenge

“Our success in the treatment of patients with HIV/AIDS results from the excellence of our clinicians, our advanced IT systems, our integrated delivery system and our effective coordination across specialties,” said Robert Pearl, MD, chief executive officer and executive medical director of The Permanente Medical Group and Mid-Atlantic Permanente Medical Group. “In the same way that we have reduced the chances of our patients dying from cardiovascular disease and cancer significantly below the national averages, we have achieved outstanding clinical outcomes for our patients with HIV/AIDS.”

The National HIV/AIDS Strategy ( http://www.aids.gov/federal-resources/policies/national-hiv-aids-strategy/ ) calls for increased testing so that all Americans can know their HIV status, increased access to culturally sensitive prevention messages, community-targeted prevention and condom and clean needle access. NHAS also calls for improving access to quality HIV care because HIV medications not only improve individuals’ health and extend their life expectancy, they also reduce their risk of transmitting HIV to others. A recent scientific study found that effectively treating HIV patients with antiretroviral medications reduces HIV transmission by 96 percent. The study, known as HPTN 052, found that treating people with antiretroviral drugs before they are symptomatic can reduce the amount of virus in the blood sufficiently to reduce the risk of sexual transmission of HIV to an uninfected partner.

The Kaiser Permanente HIV Challenge is part of Kaiser Permanente’s ongoing research of HIV and HIV treatment. Published Kaiser Permanente research studies include:

  • A study that found there are no disparities by race or ethnicity in risk of AIDS and death among HIV-infected patients in a setting of similar access to care, despite lower anti-retroviral therapy adherence among Latinos and blacks compared to whites.
  • A study that found HIV-infected patients are at increased risk for cancer as a result of both their impaired immune system and lifestyle factors, such as smoking.
  • A study that found 17 measures, such as screening and prevention for infections and monitoring of antiretroviral therapy, should be adopted uniformly to improve the quality of HIV care and treatment nationwide.
  • A study that found that cholesterol medications can work well among certain HIV patients who are at risk for cardiovascular disease.

About the Care Innovations Summit:

Sponsored jointly by the Department of Health and Human Services, the Centers for Medicare & Medicaid Services, Health Affairs, and the West Wireless Health Institute, the Care Innovations Summit brings together more than 1,000 health care leaders, entrepreneurs, innovators, government officials, and finance experts to stimulate investment in a high-quality, sustainable health care system. Made possible by the Affordable Care Act and the Obama Administration’s commitment to open government, the Summit represents a new opportunity for industry and government to work together to help spur innovation in the public and private sectors to improve health care quality as never before and lower costs through improvement.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 8.9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: http://www.kp.org/newscenter .

For more information:
Danielle Cass, danielle.x.cass@kp.org, 510-267-5354
Farra Levin, farra.r.levin@kp.org, 510-267-7364

SOURCE Kaiser Permanente

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