Kaiser Health News

Researchers in California regularly use a database to search for trends, confirm potential cancer clusters and identify disparities in screening and outcomes.

As a congressman, Pence was an early advocate for defunding Planned Parenthood.

Health systems in Arizona, Colorado, Nevada and Texas are establishing small facilities with robust outpatient services to target specific regions.

More and more organizations are harnessing kiosks as a venue for less expensive and more accessible care but it remains unclear whether they can achieve similar results with existing personal devices. 

The organization praised the U.S. Army’s 75th Ranger Regiment for its successes in treating combat casualties under difficult conditions while virtually eliminating preventable deaths.

Struggling with long wait times, the Veterans Affairs Health Care System is trying something new: a partnership with the CVS Pharmacy chain to offer urgent care services to more than 65,000 veterans. The experiment begins today at the VA’s operations in Palo Alto, California. Veterans can visit 14 “MinuteClinics” operated by CVS in the San Francisco Bay area and Sacramento, where staff will treat them for conditions such as respiratory infections, order lab tests and prescribe medications, which can be filled at CVS pharmacies. The care will be free for veterans, and the VA will reimburse CVS for the treatment and medications. Whether the partnership will spread to other VA locales isn’t yet clear. The collaboration comes amid renewed scrutiny of the nation’s troubled VA health system, which has tried without much success to improve long wait times for veterans needing health care. Despite a $10 billion “Veterans Choice” program allowing veterans to receive care outside the closed VA system, vets nationwide wait for an appointment even longer than they did before the program started in 2014, according to a federal audit. The MinuteClinic partnership is not part of the Veterans Choice program. “The concern has always been, how do we make sure veterans get the care they need in a timely way and in a way that works for the veteran?” said Dr. Stephen Ezeji-Okoye, the Palo Alto VA’s deputy chief of staff. The deal indicates that the VA is willing to try outside partnerships to meet veterans’ needs, he said. “We want to have not just timely access but geographic access to care.” Sarah Russell, the Palo Alto VA’s chief medical informatics officer, came up with the idea, said Ezeji-Okoye. The VA will integrate MinuteClinics’ patient records with its own electronic health records to provide consistency of care, Ezeji-Okoye said. The Palo Alto VA fares better than some other facilities nationwide in providing timely care to veterans, according to VA data, and Ezeji-Okoye said most patients with urgent care needs are seen quickly. But the system was so busy in the past year that about 11 percent of appointments at its network of hospitals and clinics — which stretch south from Sonora to Monterey — could not be scheduled within 30 or fewer days, which is considered an acceptable timeframe,VA data show. That includes appointments that would require urgent care. More than 5,000 appointments system-wide were scheduled more than 30 days out, but each hospital and clinic’s performance varied widely. At a Fremont clinic, less than 2 percent of appointment requests could not be scheduled within 30 days. At the VA’s rural Modesto clinic, by contrast, more than 17 percent of requests were not be scheduled within 30 days. Once the MinuteClinic operation is well underway, Ezeji-Okoye anticipates that between 10 and 15 veterans — from among the estimated 150 who call the Palo Alto VA’s advice nurse hotline daily — will be treated at the retail clinics on any given day. About 95,000 veterans are eligible to use the Palo Alto system, one of the VA’s largest in the Western United States. About 65,000 use it every year. The $330,000 pilot project will be evaluated after one year. CVS’ MinuteClinic president, Dr. Andrew Sussman, hopes it can be rolled out nationally if it succeeds. CVS is by far the biggest player in retail pharmacy clinics, operating 1,135 of them in 35 states. “We’d love to have that opportunity to expand after we go through this phase,” Sussman said. “We’re well suited to help because of our large footprint and ability to see people on a quick basis.” It is unclear, however, what the VA’s nationwide plans are. The Veterans Health Administration office did not respond to Kaiser Health News’ request for comment. Blake Schindler, a retired Army major who lives in Santa Clara near one of the participating MinuteClinics, was intrigued, but cautious about the MinuteClinics. He counts himself lucky because unlike some other veterans, he has access to the U.S. military’s TRICARE health insurance program for active and some retired service members. “It could make a big difference, but how much access are the veterans going to have? That was the big problem with the Veterans Choice program; it didn’t end up the way it was supposed to,” said Schindler, 58. “I’m always hopeful when I hear about these things; I keep an open mind until I have experience with it,” he added. This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation. Twitter: @HealthITNews Like Healthcare IT News on Facebook and LinkedIn

An experimental program called Independence at Home saved an average of $13,600 per patient during its first year. 

Long-term care, out-of-pocket spending, and even dental care are among the challenges that America faces in the next few years but Bernie Sanders, Donald Trump and Hillary Clinton are not saying nearly enough about their intentions in those areas. 

Veterans are still waiting to see a doctor. Two years ago, vets were waiting a long time for care at Veterans Affairs clinics. At one facility in Phoenix, for example, veterans waited on average 115 days for an appointment. Adding insult to injury, some VA schedulers were told to falsify data to make it looks like the waits weren’t that bad. The whole scandal ended up forcing the resignation of the VA secretary at the time, Eric Shinseki. Congress and the VA came up with a fix: Veterans Choice, a $10 billion program. Veterans received a card that was supposed to allow them to see a non-VA doctor if they were either more than 40 miles away from a VA facility or they were going to have to wait longer than 30 days for a VA provider to see them. The problem was, Congress gave them only 90 days to set up the system. Facing that deadline, the VA turned to two private companies to administer the program — helping veterans get an appointment with a doctor and then working with the VA to pay that doctor. It sounds like a simple idea but it’s not working. Wait times have gotten worse. There are 70,000 more vets waiting at least a month for an appointment than there were at this time last year. The VA claims there has been a massive increase in demand for care, but the problem has more to do with the way Veterans Choice was set up. It is confusing and complicated. Vets don’t understand it, doctors don’t understand it and even VA administrators admit they can’t always figure it out. Veterans face delays and worry This is playing out in a big way in Montana. That state has more veterans per capita than any state besides Alaska. This winter Montana Sen. Jon Tester sent his staff to meet with veterans across the state. Bobby Wilson showed up to a meeting in Superior. He’s a Navy vet who served in Vietnam and is trying to get his hearing aids fixed. Wilson is mired in bureaucracy. “The VA can’t do it in seven months, eight months? Something’s wrong,” he said. “Three hours on the phone,” trying to make an appointment. “Not waiting,” he said, “talking for three hours trying to get this thing set up for my new hearing aids.” [See also: GAO: Veterans finding VA care hard to access.] Tony Lapinski, a former aircraft mechanic, has also spent his time on the phone, with Health Net, one of the two contractors the VA selected to help Veterans Choice patients. “You guys all know the Health Net piano?” he said. “They haven’t changed the damn elevator music in over a year!” That elicits knowing chuckles from the audience. Later during an interview, he said when he gets through to a person, “They are the nicest boiler room telemarketers you have ever spoken to. But that doesn’t get your medical procedure taken care of.” Lapinski has an undiagnosed spinal growth and he’s worried. “Some days I wake up and go, ‘Am I wasting time, when I could be on chemotherapy or getting a surgery?’ ” he said. “Or six months from now when I still haven’t gotten it looked at and I start having weird symptoms and they say, ‘Boy, that’s cancer! If you had come in here six months ago, we probably could have done something for ya, but it’s too late now!’ ” Lapinski finally got to a neurosurgeon, but he didn’t exactly feel like his Choice card was carte blanche. Doctors, it turns out, are waiting, too — for payment, he said. “You get your procedure done, and you find out that two months later the people haven’t been paid. They have got $10 billion that they have to spend, and they are stiffing doctors for 90 days, 180 days, maybe a year!” said Lapinski. “No wonder I can’t get anyone to take me seriously on this program.” He said he gets it. He used to do part-time work fixing cars, and he would still take jobs from people who had taken more than 90 days to pay him or bounced a check. But he did so reluctantly. “I had a list of slow-pay customers,” he said. “I might work for them again, but everybody else came before them. So why would it be any different with these health care professionals?” Hospitals, clinics and doctors across the country have complained about not getting paid, or only paid very slowly. Some have just stopped taking Veterans Choice patients altogether, and Montana’s largest health care network, Billings Clinic, doesn’t accept any VA Choice patients. Not cool, said Montana Sen. Jon Tester, of Health Net and other contractors. “The payment to the providers is just laziness,” Tester said. “I’m telling you, it’s just flat laziness. These folks turn in their bills, and if they’re not paid in a timely manner, that’s a business model that’ll cause you to go broke pretty quick.” The VA now admits the rushed timeframe led to decisions that resulted in a nightmare for some patients. Health Net declined to be interviewed for this story. But in a statement, the company said that VA has recently made some beneficial changes that are helping streamline Veterans Choice. For example, the VA no longer demands a patient’s medical records be returned to VA before they pay. Meanwhile, though, veterans continue to wait. “If I knew half of what I knew now back then when I was just a kid, I would’ve never went in the military,” said Bobby Wilson. “I see how they treat their veterans when they come home.” Scheduling lags also irk the doctors’ offices and the VA And there’s another whole side to the coin. Doctors are frustrated in dealing with another government health care bureaucracy. In Gastonia, North Carolina, Kelly Coward dials yet another veteran with bad news. “I’m just calling to let you know that I still have not received your authorization for Health Net federal. As soon as I get it, I will give you a call and let you know that we have it and we can go over some surgery dates,” she told a veteran. Coward works at Carolina Orthopaedic & Sports Medicine Center, a practice that sees about 200 veterans. Dealing with Health Net has become a consuming part of her job. “I have to fax and re-fax, and call and re-call. And they tell us that they don’t receive the notes. And that’s just every day. And I’m not the only one here that deals with it,” she said. Carolina Orthopaedic’s business operations manager, Toscha Willis, is used to administrative headaches — that’s part of the deal with health care — but she’s never seen something like this. She said it takes, “multiple phone calls, multiple re-faxing of documentation, being on hold one to two hours at a time to be told we don’t have anything on file. But the last time we called about it they had it, but it was in review. You know, that’s the frustration.” It can take three to four months just to line up an office visit. The delays have become a frustration within the VA, too. Tymalyn James is a nurse care manager at the VA clinic in Wilmington, North Carolina. She said Choice has made the original problem worse. When she and her colleagues are swamped and refer someone outside the VA, it’s supposed to help the veteran get care more quickly. But James said the opposite is happening. “The fact is that people are waiting months and months, and it’s like a, we call it the black hole,” she said. “As long as the Choice program has gone on, we’ve had progressively longer and longer wait times for Choice to provide the service, and we’ve had progressively less and less follow through on the Choice end with what was supposed to be their managing of the steps.” The follow-through is lacking in two ways. The first is the lengthy delay in approving care. And after that’s finally resolved, there’s a long delay in getting paid for the care. At least 30 doctors’ offices across North Carolina are dealing with payment problems, some that have lasted more than a year. Carolina Orthopaedic’s CEO Chad Ghorley said his practice is getting paid after it provides the care. It’s the lengthy delay on the front end that burdens his staff and, he worries, puts veterans at risk. He’s a veteran himself. “The federal government has put the Band-Aid on it when there’s such a public outcry to how the veterans are taking care of, all right?” he said. “Well, they’ve got the Band-Aid on it to get the national media off their backs. But the wound is still open, the wound is still there.” Those experiences for both veterans and providers are typical. Congress is now working on a solution to the original solution, a bill is expected to clear Congress by the end of the month. This story is part of a partnership that includes Montana Public Radio, WFAE, NPR’s Back at Base project and Kaiser Health News. The article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

By Anna Gorman, Kaiser Health News Lacee Badgley, the mother of a seven-year-old, works full time as an insurance adjuster. Like most working parents, she finds making time for doctor’s appointments a challenge. “I don’t have the time or energy to drive around town and then wait,” she said. That’s why Badgley, 36, switched from her previous doctors to Zoom+, a medical provider and health insurer that aims to give patients more control and transparency. She can make same-day appointments through a mobile app, and she’s usually in and out within 30 minutes. “It’s one-stop shopping,” she said. “I am a big fan of getting everything quickly … I get my medication, my tests, everything in one visit.” Zoom, which serves patients in Portland, Seattle and Vancouver, Washington, is trying to buck the traditional health care system by offering what it bills as convenient, affordable care in a hip and user-friendly environment. The retail clinics, painted a vibrant turquoise, are stylish and simple. The prices are posted on the walls. Zoom was created by doctors Dave Sanders and Albert DiPiero to address problems that have plagued medical care for decades: rising costs, poor service and low quality, Sanders said. “We fundamentally wanted to change the system,” he said. The company targets millennials, who have been at the forefront of change in other industries. Zoom is designed for an imaginary patient named Sarah, who is in her early thirties and wants to get her health care the same way she gets other services in her life — quickly and efficiently. The waiting rooms clearly illustrate that dynamic: There are no magazines because patients don’t typically wait long enough to read. Zoom started as a single clinic in Portland 10 years ago and now has more than 30 locations. Last year, the company expanded in Portland and now offers dental care, mental health services and chronic disease management, as well as appointments with cardiologists, dermatologists and other specialists. It also opened a “performance studio” to help people reach their fitness goals and a clinic that treats emergencies such as broken bones and concussions. This year, Zoom began selling insurance through the Oregon health exchange. Sanders said that by having insurance members of its own, Zoom will be able to better assess its success at controlling expenses and improving care. Only about 2,500 have signed up for Zoom’s insurance, Sanders said. He hopes to expand the insurance arm over time and believes the overall model could be replicated in other cities. In some ways, Zoom is similar to Kaiser Permanente, which also provides medical care and insurance. But Kaiser is a closed system: It only accepts Kaiser members. Zoom is more of a hybrid, treating not only Zoom insurance members but people with other health plans and self-paying patients as well. As a result, the company is both a partner and a competitor to some other insurers. Of course, Kaiser is also a health care giant that operates in multiple states, while Zoom is much smaller and regionally contained. People covered by Zoom insurance can get care at Zoom medical facilities or with Zoom partners, including Oregon Health & Science University hospitals. In recent years, more health care providers have been offering insurance, but the vast majority of them are hospital systems, said Katherine Hempstead, director of coverage for the Robert Wood Johnson Foundation. It’s unique for a network of retail clinics to add an insurance arm, and Zoom’s model is distinct because it is selling a branded experience to a specific population, Hempstead said. One Zoom poster says the complete health system is “designed to make you happier, healthier, smarter, faster, sexier, creativer.” Hempstead said Zoom seems to be betting on the idea that young people are brand-loyal and view health much more broadly. As a result, they may be coming to Zoom not only to see a doctor but also to work with a fitness coach, get therapy or take cooking classes. “It’s a totally new-school approach,” she said. “A company like this is saying, ‘We will be the destination of everything you think of when you want to stay healthy.’ The question is: Will the economics work out?” That could be a challenge given how saturated the Portland insurance market is, said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute. And some insurers on the exchange are much more established. In addition, millennials aren’t typically heavy users of the health care system, though many come for regular checkups, she said. Zoom’s success as an insurer depends in part on convincing young people that insurance “is a valuable thing for them to get and maintain,” Corlette said. Attracting young, healthy consumers also helps balance out any older, sicker members. Other health care companies are marketing to millennials also, including New York-based insurer Oscar, which attracts younger consumers with its user-friendly technology. Oscar started selling coverage through Covered California this year. Harken Health, a subsidiary of UnitedHealthcare, assigns members in Chicago and Atlanta to a personal health coach, and — like Zoom — it also offers classes in cooking and yoga. Darcy Hoyt, a veterinarian, said she signed up for Zoom insurance after regularly using the clinics for the past few years. The monthly premiums to cover her and her two children are lower than what her previous insurer charged, and she appreciates knowing in advance how much everything will cost. “So far, so good,” Hoyt said. “For the relatively young, healthy families with kids falling off bikes and getting common colds, it’s very streamlined.” The model appeals to people who want a different approach to medicine that doesn’t have the “vestigial appendices of a health care system that has been around for 50 years,” said John McConnell, director of Oregon Health & Science University’s Center for Health Systems Effectiveness. “It’s like the iPhone,” McConnell said. “Zoom changed the paradigm … The whole way of delivering care is very different.” Zoom is selective about its patient population. While it sees privately insured patients and uninsured ones with the ability to pay, it doesn’t accept people who are on Medicaid or Medicare. By limiting whom they serve, McConnell said, the company’s providers may be cherry-picking the least costly patients and leaving other medical groups and hospitals to deal with medically needier people. Sanders countered that one company can’t be all things to all people and Zoom has decided to invest its resources in serving a population that was ignored by the health system before the Affordable Care Act came along. Zoom keeps costs low by providing care in neighborhood clinics and avoiding unnecessary tests and procedures. It relies heavily on nurse practitioners and physician assistants, and maintains small staffs. It also has its own electronic health record system. “The whole process has been stripped,” Sanders said. “We took out a lot of the people, we took out all the paper, we took out the whole Taj Mahal.” To advance its mission, Zoom has taken on regulators and state policymakers. It successfully lobbied for laws in Oregon allowing nurse practitioners to dispense medication and insurers to reimburse for more telemedicine. The emergency clinic is one place where doctors said they are able to avoid overhead and pass savings along to patients. For patients paying out of pocket, a visit costs under $300. Badgley, who has private insurance, came in to the clinic recently because she had been in bed for days with what she thought was the flu but still felt horrible after returning to work. She only had to explain once why she was there. In the exam room, Dr. Aviva Zigman pulled out a pen and wrote Badgley’s symptoms on an oversized white board, along with the tests she might need and how long the appointment would take. Soon afterward, Zigman quickly determined that Badgley had an ear infection and gave her some antibiotics. Zigman said that as a provider, the Zoom model is much more efficient than a typical emergency room for routine ailments and her patients can get what they need quickly. Another Zoom patient, Amy Cannon, 45, goes to the company’s new primary care clinic for management of her high cholesterol, prediabetes and high blood pressure. The clinic, which has a kitchen in the lobby, offers cooking and yoga classes on site. Cannon said it feels more like a private club than a doctor’s office, and the assistant greets her with a hug. “It’s ‘Cheers’ for health care,” Cannon said. “Everybody knows your name.” This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.