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Exciting Times for a Growing Company

Two months ago, Qualis Health and HealthInsight announced their intention to merge. We’re thrilled to follow that up by announcing the merger is now in effect. You can read our press release here.

As CEO of the new merged organization, I’m encouraged and excited about the future of our work. Qualis Health and HealthInsight share a rich history of community-based, nonprofit health care quality improvement (QI) work, going back 40 years to when we served as Professional Standards Review Organizations for the Medicare program. Today, in addition to our QI work for Medicare and state Medicaid programs, we maintain a diverse portfolio of public‐ and private‐sector business operations across the U.S., and we employ more than 500 people in office locations across the country.

We’re proud of our past achievements and eager to engage with the challenges ahead. The merger will enable us to leverage our complementary strengths and draw on a deeper well of talent and expertise to achieve greater scale and synergy in improving population health and enhancing the quality and value of health care.

We view this as a true merger of equal partners, building on the successes, strengths and cultures of both organizations. Our new governing board is drawn from Qualis Health and HealthInsight, as is our senior executive team.

The new senior executive team has begun defining strategies to align our operations and position the merged company in the health care QI marketplace. A broader group of staff leaders from across our organizations are working to refine our management plans and build on a core set of shared cultural aspirations. And later this year, we will introduce a new company brand. Until then, we will continue to do business under our current brands and organizational names of Qualis Health and HealthInsight.

Please be assured that we intend to provide uninterrupted service as we progress toward full integration of our operations. While our names may change as a result of the merger, the project teams and contacts you are currently working with will not change.

In the meantime, please don’t hesitate to contact me with any questions or concerns you may have.

I am excited about our future and I hope you will join with me to help us reach our full potential.

 

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One Perspective on the Opioid Crisis

Pills and Syringe

I recently came across a headline in the Health Affairs news feed: “Does Naloxone Availability Increase Opioid Abuse? The Case for Skepticism.” Naloxone is a drug that quickly reverses the effects of opioid overdose. The authors critiqued a recent article in an online journal that is not peer reviewed that put forth the case that naloxone use was actually increasing opioid use and crime.

The article in question, “The Moral Hazard of Life Saving Interventions: Naloxone Access, Opioid Abuse and Crime,” concludes that naloxone availability results in reducing fears, increasing the use of opioids, increasing the number of people using opioids, and increased crime due to people stealing to support their addictions.

I read both the article and the resulting comments with interest and, while I can see both sides of this dilemma, even the authors state that naloxone is an effective harm reduction strategy. In reviewing the articles, I was reminded of a small, red cap that I kept on my desk for over a year. I had collected the cap from a medication vial containing naloxone.

Before joining HealthInsight, I was the director of a regional public health office. One day someone came into the lobby asking for help in the parking lot. A young man was in the back of a car: his lips were blue as the result of arrested breathing due to an overdose. I watched public health staff spring into action and deliver two doses of naloxone to the young man while I assisted with rescue breathing.

I saw this person revived and able to walk to the ambulance when it arrived.

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Solving the Morning Rush and How it Relates to Health Care

Child stretching in the morning

Until a few weeks ago, mornings at my house were quite the circus. Despite several “wake up -- we have to leave in 45 minutes, wake up -- we have to leave in 30 minutes …” calls, my children, ages 9 and 6, would wake up 15 minutes before we had to leave the house for school. Inevitably, this led to breakfast in the car, and spilling half of it, leaving their lunch boxes at home, and of course being late for school.

Seeking a solution to the chaos, I bought them a Lego Emmet alarm clock that sings the “Everything is Awesome” song from the Lego Movie. The children were thrilled at the prospect of waking up to their favorite song in the morning. That night, we set the alarm for 7:15 a.m., expecting to have our first calm departure for school at 8 a.m. To my dismay, the next morning was no different from the previous mornings. My children were fast asleep while the alarm clock declared the awesomeness of the situation. On the way to school, and yes, we were late again, I asked the children to think about why the alarm clock solution didn’t work. My 6-year-old chimed in from the back to say they couldn’t hear the alarm -- the volume was too low despite being turned up to the maximum. My 9-year-old suggested we buy another alarm clock with a louder alarm. So, I got them a louder alarm clock.

I used this experience as a teaching opportunity and asked them how they will know if their solution is a success. My 9-year-old responded to say it will be a success if they wake up when they hear the alarm ring. After some discussion, and a very simplified explanation of process measures and outcome measures, they decide success would be defined as ‘going to school on time.’ With some help, they tracked the number of times they woke up early, the number of times they got to school on time and the number of times mom didn’t yell at them. I guess this could be considered a balancing measure! They did this for a week and with some effort, I am proud to say mornings at our home are no longer chaotic but calm and peaceful. Well on most days—they are children after all!

Thinking more about why this exercise was a success -- it was because the people who were the most impacted by the problem were the drivers of the change. In health care, there is an increasing realization that to improve outcomes, the health care system must begin to include the patient voice. To do this, we need to be asking patients, the users of the system, the question “What matters to you?” and not “What is the matter with you?”

For those of us working on solutions to better health care, we should ask ourselves what we can do to support a patient-driven revolution in health care.

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Oral Health for Seniors – Take Care of Your Teeth

 
ToothbrushI have been fortunate to have had healthy teeth all of my childhood and adult life, until now. As a child, my parents were diligent in making sure I had an annual oral checkup, and properly brushed my teeth. Cavities were filled and I never had a tooth ache. As an adult, I continued with similar maintenance, adding in semiannual hygienist visits. I never thought about cost because, even when I didn’t have dental insurance, maintenance was relatively inexpensive.

Now that I’m approaching Medicare age, I’m learning teeth don’t necessarily last forever, and I’m experiencing a bit of sticker shock on the cost of dental care for services beyond maintenance. When you start getting into crowns, bridges, implants, etc., even with dental coverage, the out of pocket costs are substantial.

54.7[i] million aged (65 or older) or disabled adults currently receive health insurance through Medicare. That number is expected to increase to over 70 million in the next 25 years as our population ages. Preventive personal care combined with seeing a dentist for annual maintenance are the most practical and least costly methods of preserving teeth and health. By catching early signs of infection or disease before they become more serious, you can avoid unnecessary physical discomfort as well as expenditures.


According to the National Health and Nutrition Examination Survey 2011-2012, of adults 65 and over, nearly

  • 19 percent of adults 65 and over had untreated tooth decay
  • 96 percent of all U.S. adults 65 and over with any permanent teeth had cavities (treated or untreated)
  • 19 percent had lost all of their teeth
Poor oral health can lead to periodontal (gum) disease, caused by bacteria in plaque. Irritated, swollen and/or bleeding gums are all signs of developing gum disease. Untreated, deep pockets can form, where more food particles and plaque can collect. As the disease advances, the supporting gums, bone and ligaments around the teeth can pull apart and result in tooth loss.

Oral health is often an overlooked component that could have impacts on overall health and well-being. Periodontal disease has also been linked with diabetes, heart disease and stroke. In addition, many seniors experience more challenges with oral health due to medication reactions, such as dry mouth, a common cause of cavities in older adults.

Original Medicare currently doesn’t offer dental coverage. However, many Medicare Advantage (MA) plans offer the service. Currently, about 63 percent of beneficiaries are enrolled in original Medicare (and 37 percent in MA). With the evolving health care provisions under the new administration, it will be important to keep a close watch on this coverage for both plans.

Other affordable options for dental services may be available through Federally Qualified Health Centers, private insurance and discounted rates offered by some dentists which can be accessed through the American Dental Association’s website here.

What can you do now? Follow the Centers for Disease Control and Prevention guidelines for maintaining Oral Health for Older Americans to prevent serious issues.

What will I do next? I’m switching to an in-network dental provider and getting as much work done as I can while I still have coverage!

Take care of your teeth and follow a preventive care schedule diligently to prevent problems that can affect the rest of your body. Think of your body as a beautiful sports car — and, the only car you will have for your entire life. To keep the car running smoothly long-term and to prevent any problems with the vehicle, you would likely follow the manufacturer’s preventive care schedule diligently. Do the same with your teeth – you won’t regret it.



[i] Medicare Enrollment Dashboard and Data File, available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMSProgramStatistics/Dashboard.html, accessed 3/17/2018
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Asking the Right Questions About Health Care Costs

Charts and graphs on a computer

In fall 2011, my husband found a skin growth on his neck. It wasn’t overly concerning, but I encouraged him to get it checked out. He went to a dermatologist who agreed it likely was benign, but suggested a biopsy to confirm, which took all of five minutes. We later received a surprise bill for $4,500!

It turned out that while the dermatologist was in network, the lab to which he sent the sample wasn’t. And we were charged a high facility fee because the dermatologist’s office was affiliated with a high-cost hospital, information that was news to us.

Why am I telling you this? Because I’ve worked in health care, with a focus on cost and affordability, for over 15 years. This experience and knowledge still did not save our family from an unforeseen medical expense.

The cost of care is receiving more and more attention. Kaiser Health News and National Public Radio have recently begun a Bill of the Month series in which they scrutinize health care bills in an effort to shed light on costs.

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