Insurer Accountability in the Next Generation of Health Reform

Democrats continue to debate how to extend health insurance coverage to the remaining uninsured and improve the affordability and quality of coverage and care. Prior intraparty debates—over whether to build upon the Affordable Care Act, create a public option, or expand the Medicare program to all (or more)—have centered on how to best accomplish these goals and whether health care delivery should be mediated through public versus private payers. These are worthwhile debates, but the history of health reform suggests that private health insurers are here to stay. This Article accepts the premise that future coverage expansions will likely rely on private insurers. Assuming so, I argue that more attention must be paid to holding these entities accountable for the government-subsidized benefits they offer. While the Affordable Care Act ushered in reforms that have addressed many historic insurance industry abuses, additional accountability measures are urgently needed to ensure access to care, increase affordability, and advance equity. This Article identifies several policy options that would help achieve these goals and could constitute part of an updated, post-Affordable Care Act patient bill of rights. Looking ahead, federal and state policymakers must pair coverage expansions with accountability mechanisms to maximize taxpayer value in subsidizing private coverage across a range of public programs

Implementing the Affordable Care Act: The State of the States

The Affordable Care Act is designed to improve access to coverage for millions of Americans. Because states are the primary implementers of these requirements, this report examines the status of state action on the three major components of health reform -- the market reforms, the establishment of health insurance marketplaces, and Medicaid expansion. The analysis finds that nearly all states will require or encourage compliance with the market reforms, every state will have a marketplace, and more than half the states will expand their Medicaid programs. The analysis also shows that federal regulators have stepped in where states have been unable or unwilling to take action. These findings suggest that regulators will continue to help ensure consumers receive the benefits of the law -- regardless of the state they live in -- but raise questions about how this variation might affect consumers as state insurance markets undergo significant transition in 2014

A Prospective, Controlled Trial of a Pharmacy-Driven Alert System to Increase Thromboprophylaxis rates in Medical Inpatients

Background: Although venous thromboembolism is an important cause of morbidity and mortality within the hospital, a significant proportion of at-risk inpatients do not receive measures known to reduce the risk of deep vein thrombosis and pulmonary embolism. Objective: To determine whether a pharmacy driven alert system would, compared to usual care, be associated with a higher rate of adequate VTE prevention measures among at-risk inpatients on a general internal medicine service. Design: Prospective, controlled trial. Setting: A university-based teaching hospital. Patients: Adults admitted (Monday through Friday) to the general internal medicine inpatient service from 6/19/06-9/21/06. Intervention: Pharmacist assessment of venous thromboembolism risk; pharmacist-driven alert to treating physician. Measurements: Proportion of at-risk patients receiving adequate thromboprophylaxis within 36 hours of admission. Results: Overall, 140 patients were at sufficient risk for VTE to be included. In the usual care group, prophylactic measures were ordered for 49 (61%) of the 80 patients at moderate to high risk. In the pharmacist-alert group, 44 (73%) of the 60 moderate to high VTE risk patients received adequate thromboprophylaxis (p = 0.15). Conclusions: Although we did not observe a statistically significant difference between the experimental groups, our results are consistent with previous reports suggesting that alert systems (whether computerized or human) can increase the proportion of hospitalized patients who receive adequate measures to prevent VTE

ACA Implementation Monitoring and Tracking: Rhode Island Site Visit Report

Assesses Rhode Island's progress in implementing the 2010 federal healthcare reform, including earlier reforms that facilitate Medicaid expansion, advances in establishing a health insurance exchange, and efforts to pass private market reform legislation

Observing Longitudinal Physical Activity and Sitting Patterns Throughout COVID-19 Restrictions Amongst UK Adults

© 1996 - 2023 CTI Meeting Technology - All rights reserved.Purpose: The COVID-19 global pandemic presented an insight into observing the changes in physical activity (PA) and sitting patterns of free-living adults during a unique period of intermittent enforced home confinement and free-living conditions. Evidence unequivocally indicates physical inactivity, facilitated by home confinement, is associated with greater risk of disease and mortality. This study aimed to monitor longitudinal PA and sitting patterns throughout the enforced COVID-19 restrictions, uniquely including all three UK national lockdowns between April 2020 and January 2021. Methods: 580 adults (41 ±21 y; 22% ♂ / 77% ♀ / 1% Other) participated in a longitudinal, observational study, encompassing all three UK national lockdowns between 19/4/20 – 23/1/21, using self-reported online surveys either daily or weekly for 6 months, then monthly to reduce survey fatigue. Pre-COVID data was based on the week prior to the first national lockdown. Participants recalled time engaging in PA and sitting per day for each diary completed throughout the study. Data was used to calculate MET-mins/week for total, low, moderate and vigorous activity, then averaged for each month. Friedman’s ranking test analysed differences between months for PA and sitting time. Results: Total, low, moderate and vigorous MET-mins/wk were significantly different across months (p < 0.001) and tended to decline month-on-month. PA levels were similar between lockdowns 2 and 3. Sitting time significantly increased (χ2(8) = 18, p = 0.02) across lockdowns 1-3, but decreased when restrictions were lifted. Conclusions: To avert the negative health impacts of ‘twindemics’ linking future disease pandemics and the physical inactivity pandemic, strict movement restrictions should be carefully considered in future given our data shows increased physical inactivity.Peer reviewe

Three professions come together for an interdisciplinary approach to 3D printing: occupational therapy, biomedical engineering, and medical librarianship

Background: Although many libraries have offered 3D printing as a service or available technology, there is a lack of information on course-integrated programs for 3D printing in which the library played a primary role. Therefore, librarians at the Touro College School of Health Sciences began exploring 3D printing for inclusion in the occupational and physical therapy curriculum. Case Presentation: The goal of this project was to educate occupational and physical therapy students and faculty about the potential applications of 3D printing in health care and provide hands-on experience, while increasing collaboration between librarians and faculty. Students’ tasks included designing and creating a 3D-printed assistive device as part of their course. Conclusion: Students were able to successfully print assistive devices, demonstrating the feasibility of 3D printing in a health sciences curriculum. Librarians involved with this project reached approximately 78 students and 200 other librarians and faculty members. 3D printing at Touro College continues to evolve and expand; the trial 3D printing course is being reviewed for formal adoption into the occupational therapy curriculum, and additional funding for 3D printing technologies is currently being allocated by Touro administration

Stomatal Physics

Stomata, microscopic pores on a leaf’s surface, regulate the diffusion of CO2 from, and the diffusion of water vapor to, the air. Stomata are responsible for fixing essentially all carbon in the biosphere and generating over 90% of the water vapor in the atmosphere over landmasses. Exactly how stomata respond to temperature, light intensity, and ambient CO2 and humidity, is still a matter of active debate. Most research probing this question focuses on identifying and unraveling complicated biochemistry. Recent investigations in our laboratory, however, indicate that much of stomatal behavior can be understood in terms of a simple vapor phase physical model

Consumer Return Chronology Alters Recovery Trajectory of Stream Ecosystem Structure and Function Following Drought

Consumers are increasingly being recognized as important drivers of ecological succession, yet it is still hard to predict the nature and direction of consumer effects in nonequilibrium environments. We used stream consumer exclosures and large outdoor mesocosms to study the impact of macroconsumers (i.e., fish and crayfish) on recovery of intermittent prairie streams after drying. In the stream, macroconsumers altered system recovery trajectory by decreasing algal and macroinvertebrate biomass, primary productivity, and benthic nutrient uptake rates. However, macroconsumer influence was transient, and differences between exclosures and controls disappeared after 35 days. Introducing and removing macroconsumers after 28 days resulted mainly in changes to macroinvertebrates. In mesocosms, a dominant consumer (the grazing minnow Phoxinus erythrogaster) reduced macroinvertebrate biomass but had little effect on algal assemblage structure and ecosystem rates during recovery. The weak effect of P. erythrogaster in mesocosms, in contrast to the strong consumer effect in the natural stream, suggests that both timing and diversity of returning consumers are important to their overall influence on stream recovery patterns. Although we found that consumers significantly altered ecosystem structure and function in a system experiencing rapid changes in abiotic and biotic factors following disturbance, consumer effects diminished over time and trajectories converged to similar states with respect to primary producers, in spite of differences in consumer colonization history. Thus, consumer impacts can be substantial in recovering ecosystems and are likely to be dependent on the disturbance regime and diversity of the consumer community

The origins and spread of stock-keeping: the role of cultural and environmental influences on early Neolithic animal exploitation in Europe

It has long been recognised that the proportions of Neolithic domestic animal species—cattle, pig and sheep/goat—vary from region to region, but it has hitherto been unclear how much this variability is related to cultural practices or to environmental constraints. This study uses hundreds of faunal assemblages from across Neolithic Europe to reveal the distribution of animal use between north and south, east and west. The remarkable results present us with a geography of Neolithic animal society—from the rabbit-loving Mediterranean to the beef-eaters of the north and west. They also demonstrate that the choices made by early Neolithic herders were largely determined by their environments. Cultural links appear to have played only a minor role in the species composition of early Neolithic animal societie