Diagnosis Blog: Checking Up on Health Blogs inthe Blogosphere

Objectives. We analyzed the content and characteristics of influential health blogs and bloggers to provide a more thorough understanding of the health blogosphere than was previously available. Methods. We identified, through a purposive–snowball approach, 951 health blogs in 2007 and 2008. All blogs were US focused and updated regularly. We described their features, topics, perspectives, and blogger demographics. Results. Approximately half of the bloggers in our sample were employed in the health field. A majority were female, aged in their 30s, and highly educated. Two thirds posted at least weekly; one quarter accepted advertisements. Most blogs were established after 2004. They typically focused on bloggers\u27 experiences with 1 disease or condition or on the personal experiences of health professionals. Half were written from a professional perspective, one third from a patient–consumer perspective, and a few from the perspective of an unpaid caregiver. Conclusions. Data collected from health blogs could be aggregated for large-scale empirical investigations. Future research should assess the quality of the information posted and identify what blog features and elements best reflect adherence to prevailing norms of conduct

Consumer Involvement in Medicaid Nursing Facility Reimbursement: Lessons from New York and Minnesota for State Policymakers

Medicaid is the major purchaser of nursing home care in the United States. State governments design their methods of reimbursing nursing homes to achieve desired policy objectives related to facility cost and quality, access to care, payment equity, service capacity, and budgetary control. Often, participation in the process of developing Medicaid payment policy is limited to state agency officials and providers of care and, occasionally, union representatives and state legislative staff. Invited less frequently to reimbursement policy discussions are consumer representatives. Lack of consumer involvement in the development of state rate setting systems has the potential to result in the adoption of methodologies that favor industry and government interests at the expense of issues important to residents and their families. It also has the potential to result in less creative changes to state reimbursement systems than might otherwise have been possible. All stakeholders, including consumer advocates, must be at the table if truly informed reimbursement policy reform is to take place. New York and Minnesota are two states where policymakers have prioritized consumer involvement in the development and implementation of Medicaid nursing home reimbursement policy. This has contributed to improvements in each state’s payment system to better encourage access, care quality, and quality of life. To understand the consumer role in Medicaid nursing home reimbursement, 24 in-depth interviews were conducted with 27 individuals in these states, including state agency officials, state legislators and legislative staff, consumer advocates (including ombudsmen), union staff, and nursing home industry representatives. Pertinent documents were reviewed as well

A Primer for Consumer Involvement in Medicaid Nursing Facility Reimbursement: Lessons from New York and Minnesota

Medicaid is the major purchaser of nursing home care in the United States. To ensure that providers behave appropriately, the federal and state governments have established an extensive set of regulations that nursing homes must comply with if they are to be reimbursed for patients insured by Medicaid. Consumers exert considerable influence here by focusing on regulations and enforcement of non-compliance. States also seek to align providers’ interests with those of other interested parties through controls and incentives built into state reimbursement systems, including with respect to facility cost and quality, access to care, payment equity, service capacity, and budgetary control. Prevailing lack of consumer involvement in the development and implementation of state rate setting systems has the potential to result in the adoption of methodologies that favor industry and government interests at the expense of issues important to residents and their families. All stakeholders, including consumer advocates, must be at the table if truly informed reimbursement policy reform is to take place. New York and Minnesota are two states where consumers have been successful in influencing the development and implementation of Medicaid nursing home reimbursement policy to better encourage access, care quality, and quality of life. To understand how consumers can acquire a seat at the table and be effective in influencing Medicaid nursing home reimbursement, 24 in-depth interviews were conducted with 27 individuals in these states, including state agency officials, state legislators and legislative staff, consumer advocates (including ombudsmen), union staff, and nursing home industry representatives. Pertinent documents were reviewed as well

Life and Death in the Mental-Health Blogosphere: An Analysis of Blog Content and Survival

The purpose of this study was to describe a sample of mental-health blogs, to determine the proportion of sampled blogs still posting several years after identification, and to identify the correlates of survival. One hundred eighty-eight mental-health blogs were identified in 2007–08 and revisited in 2014. Eligible blogs were U.S.-based, in English, and active. Baseline characteristics and survival status were described and variation based on blog focus and survival examined. Mental health bloggers tended to be females blogging as patients and caregivers focusing on specific mental illnesses/conditions. The proportion of blogs still active at follow-up ranged from 25.5 percent to 30.3 percent depending on the definition of survival employed. Factors associated with survival included sponsorship/advertising and assumption of a professional/caregiving rather than patient/consumer perspective. Because professional- ly authored blogs with sponsorship/advertising tend to be longer lived, they may have disproportionate impact on the help-seeking behavior of individuals referred to them by search engine results. This suggests the need to promulgate and adhere to rules governing disclosure of real or perceived conflicts of interest, particularly given the growing use of industry paid/driven content

Meeting the demographic challenges ahead: Toward culture change in an ageing New Zealand

There are several innovative service delivery models in the United States (US) relevant to long-term care policy development and implementation in New Zealand. An especially fruitful source of innovation has been the culture change movement, which originated in the US but has begun to spread to New Zealand and other OECD countries. The culture change philosophy requires that providers respond to the values, preferences, and needs of care recipients. It also requires devolving authority to direct care workers who know their clients best, in addition to transitioning from sterile 'clinical' settings to more homelike environments. New Zealand has a more favourable policy context for improving long-term care than the US. Thus, it is critical that it build upon these short term advantages to promote further dissemination of the culture change ethos, thereby placing caregivers in a better position to meet current care challenges, not to mention those posed by growth in the elderly population ahead

Development of the Trout Trail of the Virginias

Abstract Despite the competitive advantage of trophy trout fishing venues in Virginia and West Virginia, there has historically been little cooperation between vendors. Our West Virginia University team worked with fishing-related tourism providers in the two states to gauge interest in developing a marketing cooperative for the industry. Over 30 tourism providers attended an initial exploratory meeting at Douthat State Park in Virginia and showed overwhelming support for developing a marketing cooperative to increase business and protect their investments in fish and fishing streams. This allied group included trophy trout fishing venues, guide services, lodges, and trout producers. Eight of the meeting participants, five from Virginia and three from West Virginia, agreed to start a cooperative marketing organization. Via electronic surveys (designed and administered using the Delphi process), the core members reached consensus on a name (Trout Trail of the Virginias or TTV), slogan, website address, membership benefits, and organizational structure

Implications of Rhode Island’s Global Consumer Choice Compact Medicaid Waiver for Block Granting Medicaid and Other Retrenchment

On January 16, 2009, the Federal government approved Rhode Island’s application for a Global Consumer Choice Compact Medicaid Waiver whereby the state became the first granted permission to operate its entire Medicaid program under the state plan and a single 1115 “research and demonstration” waiver. The Global Waiver has been implemented in the context of Republican proposals to turn Medicaid into a block grant which would give states substantially more flexibility administering the program in exchange for receiving an upfront allotment from the Federal government. Proponents have held up the Global Waiver as a successful example of what might be achieved nationally if all states received block grants to run their Medicaid programs. This study draws lessons from Rhode Island’s Global Waiver for the Medicaid block grant debate. Data derive from 325 archival sources and 26 semi-structured interviews. Results indicate that the Global Waiver is not a block grant but a capped federal match where the state is required to spend its own money before receiving the federal contribution. Moreover, the state did not receive unlimited discretion to administer Medicaid under the Global Waiver nor achieved nearly as much savings as has been claimed. Indeed, most savings obtained by Rhode Island during this time period derive not from efficiencies stemming from the Global Waiver but from increased federal spending and from measures the state could have implemented independently of the waiver. The generosity of the Global Waiver is in marked contrast to most block grant proposals which would substantially reduce the level of federal fiscal support. In the near future, turning Medicaid into a block grant is not going to occur in light of President Obama’s reelection. Identifying the implications of RI’s experience for Medicaid retrenchment and the block grant debate is important, however, as some states eschew expanding the program under the Affordable Care Act and as proponents continue to propose block grant approach to Medicaid reform, both in future budget proposals and presidential party platforms

Implications of Rhode Island’s Global Consumer Choice Compact Medicaid Waiver for Rebalancing Long-Term Care under the Affordable Care Act

Federal approval of Rhode Island’s Global Consumer Choice Compact Global Waiver in 2009 provided Rhode Island with greater flexibility to modify its Medicaid program. Because 96% of long-term care expenditures in Rhode Island were directed toward institutional settings, a primary goal was to facilitate the state’s efforts to shift the locus of long-term care to non-institutional settings. This study draws lessons from Rhode Island’s experience with the Global Waiver for the long-term care rebalancing provisions of the Patient Protection and Affordable Care Act of 2010. Data derive from 325 archival sources and 26 semi-structured interviews. Results suggest that prospectively documenting home- and community-based services (HCBS) capacity is necessary to ensure that sufficient resources are available to meet the complex care needs of an increasingly larger service clientele. Results also suggest that increased reimbursement is especially important for attracting participating providers; so too is maintaining sufficient numbers of state regulators for purposes of monitoring quality. Barring the adoption of even more substantial changes in federal policy than included in the Affordable Care Act the distribution of long-term care spending is likely to remain stagnant in laggard states such as Rhode Island given just how difficult it is to make more than marginal progress despite the provision of additional options and incentives that otherwise should promote rebalancing. Nursing home care continues to be a mandatory benefit while most HCBS remains optional. This leaves investments in HCBS especially vulnerable to the vagaries of state budget and political processes, which when combined with the absence of minimum standards and requirements to cover all geographic areas and target populations, suggest persistent unmet need, both within and across states

Nursing Home Referrals within the Veterans Health Administration: Variation by Site and Payment for Care

Background: Veterans may receive Veterans Health Administration (VHA)-paid nursing home (NH) care in VHA Community Living Centers (CLCs), state veterans homes (SVHs), or community NHs; Veterans Affairs Medical Centers (VAMCs) must provide VHA-paid NH care to highly service connected (mandatory) Veterans; VAMCs have discretion to provide VHA-paid care to other Veterans, if resources allow. Study Objective: To examine how Veterans’ eligibility for different types of payment sources—VHA, Medicare, Medicaid, other—informs NH referral within the VHA

Implications of Rhode Island’s Global Consumer Choice Compact Medicaid Waiver for Designing and Implementing State Health Reform

Provisions in the Medicaid statute permit states to apply for waivers from traditional program requirements. On January 16, 2009, the federal government approved Rhode Island\u27s Global Consumer Choice Compact Waiver. In exchange for a cap on combined federal and state spending of $12.075 billion through 2013, Rhode Island received greater flexibility to adopt certain Medicaid program changes. This study analyzes the design and implementation of the Global Waiver to draw general lessons for health reform at the state-level, a key concern given ongoing state discretion to improve their health care systems under the Patient Protection and Affordable Care Act. Data derive from 325 archival sources and 26 semi-structured interviews. The Global Waiver would not have happened without political and ideological alignment between Rhode Island’s Republican Governor and the Bush administration and the fractured nature of the waiver’s opposition across provider and advocacy groups. The waiver was motivated largely by ongoing fiscal and programmatic pressures. Development was dominated by state officials, working over a short time period characterized by growing budgetary uncertainty. Dissatisfaction in the level of outside input contributed to distrust among stakeholder groups. Subsequent legislative constraints together with insufficient administrative personnel and antiquated information systems hampered implementation. So too did remaining divisions among those overseeing, advocating, and serving different beneficiary communities. Specific lessons include: ensuring sufficient levels of stakeholder input and transparency throughout the program design, approval, and implementation process; devoting adequate personnel and informational resources to program administration, including coordination across disparate elements of the state bureaucracy; and carefully considering the breadth and timing of the reform strategy pursued; factors that promote adoption, for example, may, in turn, impede implementation