Got Healthcare? Affordable Care Act PP (July 2013)Kevin Kane
The Affordable Care Act presentation that Citizen Action of Wisconsin presents with around the state. How the ACA impacts you and how to talk about it.
Better health outcomes at less cost - future nhs stage, 4pm, 2 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
A PowerPoint presentation examining Canada's healthcare system in comparison to other healthcare systems throughout the world. It examines Canada's standing in key healthcare indicators, and the advantages and disadvantages of keeping Canada's current system versus adopting a mixed system. Furthermore, key features of the highly regarded healthcare systems of Japan and Italy are discussed and ways to improve Canada's current system are examined.
Got Healthcare? Affordable Care Act PP (July 2013)Kevin Kane
The Affordable Care Act presentation that Citizen Action of Wisconsin presents with around the state. How the ACA impacts you and how to talk about it.
Better health outcomes at less cost - future nhs stage, 4pm, 2 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
A PowerPoint presentation examining Canada's healthcare system in comparison to other healthcare systems throughout the world. It examines Canada's standing in key healthcare indicators, and the advantages and disadvantages of keeping Canada's current system versus adopting a mixed system. Furthermore, key features of the highly regarded healthcare systems of Japan and Italy are discussed and ways to improve Canada's current system are examined.
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
The Canadian healthcare system: May 20, 2011CFHI-FCASS
This presentation was given on May 20, 2011, as an overview of healthcare in Canada to a group of American Congressional Fellows on Parliament Hill. The Fellows were in Canada on an official visit, sponsored by the Department of Foreign Affairs and International Trade Canada (DFAIT), as part of an exchange with the Parliamentary Internship Programme. The group included 20 mid- to senior career professionals from various departments in the American and some foreign Governments, professors from American universities and journalists. They also include a number of Robert Wood Johnson Foundation Fellows, who are all medical professionals.
During the webinar, attendees will be presented with:
- An overview of the basic roles and responsibilities of federal and provincial governments within our healthcare system
- A review of the key players and structures operating within the system
- The differences between engaging politicians and bureaucrats when advocating within the healthcare system. Each has important and different roles to play.
This presentation discusses IHME's research in public financing of health in developing countries, including study design, findings, study limitations, and recommendations for governments and future research.
For more information please visit www.healthmetricsandevaluation.org
A view on canada healthcare sector and go to market strategy formulationSuman Mishra
An overview on
- Canada Healthcare Market , how it compares with other common wealth countries and US
- Deep Dives into Canada Government Healthcare Market
- The Value chain of Canada Healthcare Market
- The market size and key players
- The trends observed in the market
- Some Key Recommendations while formulating the "Go to Market"
Ottawa, 25 May 2011 -- Canada 2020 hosted a panel discussion on Health Care 2014: Creating a Sustainable Health Care System. With the current Federal-Provincial health care agreement expiring in March, 2014, Canada 2020 wanted to contribute to the debate over the shape of a future agreement.
This is the presentation by Michael Kirby, Chair, Mental Health Commission of Canada. Visit www.canada202.ca for details.
Presentation by Kirby Farrell, President and CEO, Broad Axe Technology Partners and Andy Archer, MSc, MBA, Vice President, Broad Axe Technology Partners
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
The Canadian healthcare system: May 20, 2011CFHI-FCASS
This presentation was given on May 20, 2011, as an overview of healthcare in Canada to a group of American Congressional Fellows on Parliament Hill. The Fellows were in Canada on an official visit, sponsored by the Department of Foreign Affairs and International Trade Canada (DFAIT), as part of an exchange with the Parliamentary Internship Programme. The group included 20 mid- to senior career professionals from various departments in the American and some foreign Governments, professors from American universities and journalists. They also include a number of Robert Wood Johnson Foundation Fellows, who are all medical professionals.
During the webinar, attendees will be presented with:
- An overview of the basic roles and responsibilities of federal and provincial governments within our healthcare system
- A review of the key players and structures operating within the system
- The differences between engaging politicians and bureaucrats when advocating within the healthcare system. Each has important and different roles to play.
This presentation discusses IHME's research in public financing of health in developing countries, including study design, findings, study limitations, and recommendations for governments and future research.
For more information please visit www.healthmetricsandevaluation.org
A view on canada healthcare sector and go to market strategy formulationSuman Mishra
An overview on
- Canada Healthcare Market , how it compares with other common wealth countries and US
- Deep Dives into Canada Government Healthcare Market
- The Value chain of Canada Healthcare Market
- The market size and key players
- The trends observed in the market
- Some Key Recommendations while formulating the "Go to Market"
Ottawa, 25 May 2011 -- Canada 2020 hosted a panel discussion on Health Care 2014: Creating a Sustainable Health Care System. With the current Federal-Provincial health care agreement expiring in March, 2014, Canada 2020 wanted to contribute to the debate over the shape of a future agreement.
This is the presentation by Michael Kirby, Chair, Mental Health Commission of Canada. Visit www.canada202.ca for details.
Presentation by Kirby Farrell, President and CEO, Broad Axe Technology Partners and Andy Archer, MSc, MBA, Vice President, Broad Axe Technology Partners
Presentation by Joyce Green Pastors, RD, MS, CDE, Diabetes Nutrition Specialist, Virginia Center for Diabetes Professional Education and Assistant Professor of Medical Education in Internal Medicine, University of Virginia School of Medicine
Presentation by Bonnie Britton, MSN, RN, ATAF Telehealth Program Administrator, Vidant Health and Seth VanEssendelft, Vice-President for Financial Services, Vidant Medical Center
Presentation by Mike Brett, MD, Medical Director for LIFE Programs, Lutheran Senior Life and Kelly Besecker, Vice President, Sales & Marketing, A-Frame Digital
Presentation by Janet S. Wright, MD, FACC, Executive Director, Million Hearts Initiative, Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Innovation Center
Presentation by Robin A. Felder, PhD, Professor and Associate Director of Clinical Chemistry and Pathology, former Director of the Medical Automation Research Center and Chair, Medical Automation
Presentation by Lashanna Brunson, MS, BCBA, Research Coordinator, Parent Implemented Training for Autism through Telemedicine, Center for Excellence in Disabilities, West Virginia University
Harvard's Robert Greenwald on Texas MedicaidOneVoiceTexas
Robert Greenwald, JD, Clinical Professor of Law and Director of Center for Health Law and Policy Innovation at Harvard Law School, presented an in-depth analysis forum of the federal health reform Affordable Care Act and associated transformation of the Texas Medicaid system. On January 24 in Austin, he spoke to sever audiences on the challenges and opportunities specific to Texas including why the Affordable Care Act’s Medicaid expansion is so important to the provision of cost- effective, high quality care and treatment to low income uninsured Texans.
Professor Greenwald has over 20 years of experience in the fields of health law and policy. His Center is recognized as a national leader in Affordable Care Act implementation and in efforts to improve healthcare access and health outcomes for the uninsured and underinsured.
One Voice Texas and the Harris County Healthcare Alliance sponsored the event.
Health Care Reform and Harm Reduction: Laura Hanen, Rachel McLean - HRC 2010Harm Reduction Coalition
A presentation by Laura Hanen (NASTAD) and Rachel McLean (California Department of Public Health) on what health care reform means for harm reduction and drug user health. Presented at the Harm Reduction Coalition's 8th National Conference, November 18-21, 2010 in Austin, Texas.
The Affordable Care Act: Success or Failure?
Janet Coffman, MPP, PhD
Edward Yelin, PhD
GME Grand Rounds 4/15/14
UCSF San Francisco
http://medschool2.ucsf.edu/gme/
mHealth Israel_US Telehealth + Reimbursement Post CoVID_King & SpaldingLevi Shapiro
Overview of the US Telehealth and Reimbursement Landscape, pre and post CoVID-19. Sections include distinction between telehealth and telemedicine, growth in telemedicine adoption, evolving policies and priorities of CMS and Medicare, intense interest in the telehealth from the public markets, increase in scope and scale of deployments nationwide, reaction of current sector leaders to entry by bigger competitors, market trends and dynamics, regulatory changes, employer deep dive, overview of the employer market, employer wants vs. actions, employer telemedicine deep dive, top impediments including payment models, deployment and compliance, deployment, Plan Benefits, Wellness, GHP, structure, Wellness EAP and DM, non-GHP deployment, ERISA issues, excepted benefits, reimbursement changes, telehealth reimbursement, Remote Physiological Monitoring, Reasonable and Necessary, commercial coverage, etc
Third of three presentations on "What is Telehealth, Why Telehealth and Telehealth Demo" as part of the Pennsylvania Telehealth Roundtable that took place on September 30, 2014.
First of three presentations on "What is Telehealth, Why Telehealth and Telehealth Demo" as part of the Pennsylvania Telehealth Roundtable that took place on September 30, 2014.
Second of three presentations on "What is Telehealth, Why Telehealth and Telehealth Demo" for the Pennsylvania Telehealth Roundtable that took place on September 30, 2014.
Presentation by Sherilyn Pruitt, MPH, U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Rural Health Policy, Office for the Advancement of Telehealth
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
Rough Waters Ahead: Navigating Health Reform, the Future of Health Care and Telemedicine's Expanding Role
1. Rough Waters Ahead:
Navigating Health Reform,
the Future of Health Care, and
Telemedicine’s Expanding Role
John F. Duval
Virginia Commonwealth University Health System
March 18, 2013
2. Agenda
• Quick overview of the Affordable
Care Act
• What’s popular, what’s controversial
• The promise and key disconnects
– Costs
– Workforce adequacy
– The States: Medicaid Expansion and
Insurance Exchanges
• Stay tuned
–
–
–
–
What we don’t know
Critical disconnects
What is happening in spite of reform
Telemedicine’s expanding role
1
3. What is good about
the health care
delivery system?
4. John’s List
•
•
•
•
•
•
•
•
•
•
Robust medical community, well represented by specialties
Strong & dedicated allied health workforce
Best education system in the world across all disciplines
Cutting edge technologies & pharmaceuticals
Strong research basis
Social safety net
Modern physical plant
Improving transparency & accountability
Improving quality & safety
Major economic engine, frequently largest employer
3
5. What is not good
about the
health care
delivery system?
6. John’s List
•
•
•
•
•
•
•
•
•
•
Current costs and growth rate are economically not sustainable
≈ 50 million uninsured
Racial / economic / geographic disparities in access to care
Unnecessary variations in amount / quality of care provided and some care
is not evidence based
Quality and safety accountability improving, but still too opaque
Economic incentives between provider and insurer communities not
aligned
Regulatory structure / licensure laws result in inefficient use of workforce
Sickness as opposed to wellness focused
High administrative overhead is wasteful
Education costs of healthcare workforce are borne by providers and
government payors
5
7. Patient Protection and Affordable Care Act (PPACA):
Signed into Law March 23, 2010
• Most comprehensive change in healthcare finance since
1964 Medicare & Medicaid legislation
• Reforms the actuarial financing model for health services
in the United States
• Improves access to care for most citizens and reduces the
number of uninsured
• Reins in unpopular insurance industry practices
• Increases quality and safety of health care
• Improves transparency of health and insurance
information
• Creates Health Insurance Exchanges in each state
• Provides option for Medicaid Expansion in each state
• And much, much more
6
8. PPACA: What is Popular?
• Extends insurance coverage to 32 million people
• Allows parents to cover children up to the age of 26 under their
private insurance plans
• Eliminates lifetime dollar limits on benefits imposed by most
medical plans
• Prevents medical plans from denying insurance and benefits based
on preexisting conditions
• Limits the amount insurers spend on administrative costs versus
medical costs (Medical Loss Ratio)
• Provides more transparency with publically reported metrics
related to quality, safety, and patient outcomes
7
9. PPACA: What is Controversial?
• Mandates individuals have health insurance by 2014 or pay a penalty
• Expands Medicaid coverage to residents with incomes up to 133% of the
federal poverty level (FPL)
– Federal government will cover all costs for this group starting in 2014 and
will phase down to 90% by 2020
• Role of the States
– Health Insurance Exchanges
– Medicaid Expansion
• Requires some employers with 50+ employees who do not offer health
insurance to pay a penalty
• Significantly reduces Medicaid and Medicare Disproportionate Share Hospital
(DSH) allocations
• New taxes on Individuals, health insurance sector, and manufacturers of
pharmaceuticals and medical devices
8
10. PPACA: What the Law Doesn’t Cover
• PPACA does not adequately address important issues facing
the health delivery system including:
– Impending physician and nursing shortages
– Rapidly escalating costs and their cause within our hospitals and
health systems
– Large variations in medical practice observed across the nation
– Financing of graduate medical education / other workforce
issues
– Foreign national population
– Costs of those who opt out
9
13. Murphy’s Law of health care
legislation:
“If it can cost more than the
highest available official
estimate, it probably will.”
Senate Joint Economic Commission
12
14. Will They Be Right?
• Coverage expansions
cost $938 billion over
10 years
• Federal deficit reduced
by $124 billion over 10
years
Source: Kaiser Family Foundation, 2011
13
15. A Lesson from History…
Program (Estimate Year)
Original estimate Actual cost
Medicare Part A (1965)
$9b/1990
$67b/1990
All of Medicare (1967)
$12b/1990
$110b/1990
ESRD program (1972)
$100m/1974 $229m/1974
Medicaid DSH (1987)
Mcare Home Care (1988)
< $1b/1992
$17b/1992
$4b/1993
$10b/1993
Source: Senate Joint Economic Committee, 7/31/09
14
19. Health Care Labor Force
• Projected shortages BEFORE health care reform
• Reform makes some efforts to begin addressing
shortages
BUT
• The law covers 32 million new patients nationally and
approximately 1 million in Virginia
• That may not add up…
18
20. Will There Be Enough Doctors?
• Pockets of physician shortages now
• 40% of practicing physicians ≥ age 55
• In Virginia, a recent survey showed one-third
were ≥ age 55 and 10% ≥ age 65
• How many more will we need?
– E.g., currently 6,830 geriatricians nationally
• That is only 1 for every 1,900 seniors ≥ age 75
• IOM indicates 36,000 needed by 2030
Sources: Alliance for Health Reform, 2011; Virginia DHP, 2009; Institute of Medicine, 2008
19
21. What About Other Health Professionals?
• 33% of nursing workforce ≥ age 50
– More than half of these plan to retire within 10
years
• Will an improved economy
reduce supply?
• Nursing shortage projected
to grow to 260,000 RNs by 2025
Source: Alliance for Health Reform, 2011
20
22. What other health professionals may be needed?
•
•
•
•
•
•
•
•
•
Case Managers/Social Workers
Physical/occupational therapists
Pharmacists
Medical technologists
Clinical psychologists
Dieticians
Rehabilitation counselors
Medical coders
Health information technicians
21
27. Policy Issues for State Medicaid Expansion
Opt In
• Long-term cost
• Long-term support (Workforce, etc.)
• Long-term benefits of reduced uninsured population
Opt Out
•
•
•
•
Cost of larger uninsured population
Federal leverage – What sticks still remain?
Lost dollars to state
Tax exportation
26
28. Stay Tuned
•
•
•
•
What we don’t know
Critical disconnects
What is happening in spite of reform
Telemedicine’s expanding role
27
31. He Wasn’t Discussing Reform, But…
“There are things we
know that we know.
There are known
unknowns. That is to say
there are things that we
now know we don't
know. But there are also
unknown unknowns.
There are things we do
not know we don't
know.” D. Rumsfeld
30
32. Critical Disconnects
•
•
•
•
•
•
•
•
Cost estimates?
Economic impact
Access to providers
Graduate medical / other education
Implementation unknowns
Payment alignment with delivery goals
Tort reform
Medicaid/Medicare requirements /
provider cuts / Disproportionate Share
Hospital payments
• Undocumented foreign nationals
• Personal responsibility
• And more…
31
33. Ongoing efforts, even before
(in spite of) reform
•
•
•
•
•
•
•
Quality improvement
Increased safety
Greater efficiency
More transparency
Coordinated care
Healthier populations
Integrated providers
32
35. How can we use telemedicine to
address critical disconnects?
• Combating the rising cost of care
– Reduces emergency transport costs from rural communities to urban areas
– Decreases ED admissions and readmissions through remote telemonitoring
• Providing high-quality care
– Decreases mortality and length of stay with Tele-ICU coverage
– Initiates more timely treatment with ED-ED consults via telemedicine
• Meeting care demands
– Provides rural and underserved communities expanded access to specialists and subspecialists
• Overcoming provider shortages
– Expands reach of providers who prefer to live in larger cities by giving them remote access to
rural patients
– Creates additional capacity for traveling physicians by removing barriers of time and distance
• Achieving patient satisfaction
– Improves patient satisfaction by providing care in a timely fashion
– Keeps care local – only the most serious cases should be packed and shipped to tertiary centers
Source: Telemedicine: An Essential Technology for Reformed Healthcare
(Computer Sciences Corporation, 2011)
34
36. The Potential of Telemedicine
• Emergency Medical Services
– TeleECG on ambulances transmitted to cardiologists via
smartphones or other devices
– Immediate treatment started in transit before patient hits ED
• Telesurgery using robot surgical systems
– MD Anderson received a $1M contribution from AT&T to seed
its venture into remote surgical care for cancer patients
– If successful, surgical cases would occur in rural and
underserved Texas communities rather than Houston
35
37. VCUHS Telemedicine Strategic Plan
Mission Statement & Vision
Mission Statement:
VCUHS Telemedicine supports the mission of the Health System by offering
confidential, timely and cost-effective medical services to patients; removing
distance barriers throughout the Commonwealth of Virginia; providing
superior, compassionate and innovative patient care.
Vision:
Integrate Telemedicine as a part of VCUHS’ strategy to respond to Affordable
Care Act mandates and grow its relationships with community and regional
providers, hospitals and community health centers.
36
38. Goals of VCUHS Telemedicine Program
• Develop and grow relationships with all correctional
facilities in order to provide access and decreases costs
• Utilize telemedicine in under-served and rural areas to
reduce health care disparities
• Leverage the clinical, educational and outreach efforts
of our Centers of Excellence to provide specialty
expertise across the Commonwealth
• Develop innovative models of care using telemedicine
that keep care local and provide care for complex
patients in their homes
37
41. VCUHS Telemedicine Expands to Meet Needs
of Outlying Communities: Post-2010
Correctional:
Before 2010
Community Based:
Growth since 2010
Pending Contracts/Negotiations
Updated 1/1/2014
40
42. VCUHS Telemedicine provides increased access
to specialists in South Hill, Virginia
• VCUHS utilizes telemedicine to expand access to patients
at Community Memorial Healthcenter:
• Clinical Telepsychiatry Services – Inpatient and Long Term Care
• ICU Intensivist support
• Virginia Tobacco Commission Grant expands Patient Access
• Two new wireless telemedicine units and MCU bridge
• Multidisciplinary tumor conferences, clinical research and
Telemed consults
• Massey Cancer Center case conference review and provider
collaboration – Southern Virginia
41
43. VCUHS is working with several outlying community providers
to launch ED-ED Pediatric Telemedicine
Goal: Improve access and quality by providing telemedicine consults to pediatric patients
admitted to Virginia community hospital Emergency Departments
Objectives:
– Provide physician based pediatric critical care in terms of stabilization and
intervention for children in need of transfer to CHoR
– Provide visual report for nursing hand-off
– Physician based screening for pediatric “puzzlers” (i.e., skin rash, lab finding, etc.)
– Assist with ER disposition plan for subspecialty inpatient/outpatient follow-up
care
– Expand telemedicine collaboration to other specialties and services
– Develop a successful ED to ED model for state-wide roll out at other referring
hospitals
42
44. Independence at Home Demonstration
• In 2012, Virginia Commonwealth University applied for a consortium site to
demonstrate the value of the Independence at Home clinical model
– Partnered with MedStar Washington Hospital Center and the University of
Pennsylvania
– Based on VCU House Calls program that has provided in-home primary care for
more than 5,000 home-bound patients over the past 25 years
• Tests a payment incentive and service delivery model that utilizes physician and
nurse practitioner directed home-based primary care teams
• The Consortium will utilize remote diagnostics and telemonitoring as part of
the IAH program
–
–
–
–
–
Pulse oximetry
I-STAT devices
iCard IPhone EKGs
EKG harnesses for laptops
In-home telemedicine
43
45. Telemedicine’s Expanding Role
• Many challenges are coming our way:
–
–
–
–
Health reform implementation
Provider shortages, especially in rural and under-served areas
Aging of the Baby Boomers
Addition of previously uninsured population
• New strategies/models for providing access and quality care are essential
• Telemedicine is a maturing tool that will help stretch our workforce and
ensure all patients have access to needed care
– Offers opportunity to redeploy and reengineer workforce in ways that were
previously not attainable
– Holds promise for dramatically improving access and reducing health inequities in
rural and economically distressed areas
• It’s not a cure-all, but will help us as we figure out how to avoid this….
44
Editor's Notes
Let me be clear up front. We needed health care reform in this country. No question about it. Where I work and throughout the field in Virginia, we have been working hard to improve quality, make care safer, and reduce costs. Really, we’ve been trying to increase value in health care while also increasing community health.And the new health care reform law has promise in these areas. But will promise clash with reality?
Lots of reasons for this:Underestimated the level of demand for the proposed new benefits, perhaps due to insufficient data or a lack of experience administering those sort of benefits. On Medicare specifically, estimators could not have been expected to factor in future program expansions. And then, of course, the political process is sometimes brought to bear as well.
The Congressional Budget Office, a non-partisan scorekeeper responsible for estimating the cost of legislation, took their best shot at estimating what might happen with health care reform as it passed. Of course, they are bound by the same limitations described in the last two slides. What does that tell us about the odds that their estimates of the largest piece of social legislation in at least a generation, a controversial bill that stoked the flames of political passion throughout the belief spectrum, will prove to be accurate?
According to the U.S. Senate Joint Economic Commission, “experts’” history in accurately estimating the cost of health care programs is ridiculously bad. This table shows:The program establishedThe year the estimate was done (basically near program inception)The original estimated annual cost by a certain dateThe actual cost at that date. Medicare Part A is the hospital insurance portion of Medicare, which is the national insurance program for the elderly and disabled.ESRD is the kidney disease portion of Medicare.Medicaid DSH is for providers that treat a disproportionate share of the Medicaid population, to help motivate them to continue treating these patients despite payments that fail to cover the cost of care.As you can see, occasionally we have been off by half, and sometimes by factors of 10 or even 17. We appear to be pretty consistent in our ability to underestimate the cost of new health care programs.
Time will demonstrate the outcome of the experts’ cost estimates and health care reform’s impact on the economy and actual care in the US, but history and current economic trends give us plenty of reasons to be concerned.The health care reform law presents numerous other potential disconnects from reality, too. I want to take a few moments to highlight several of them.
It reminds me of an old Peanuts cartoon where, upon hearing that in life you win some and lose some, Charlie Brown responded, “That would be nice.”
Daunting demographics of an aging patient population and graying workforce created projected provider shortages BEFORE health care reform. Despite some nominal efforts in health care reform to address these problems, 32 million newly-covered patients exacerbate that situation. Adding more patients to an already inadequate workforce may not add up to improved access to care
There are not enough physicians now. Geriatricians, who specialize in patients age 75 and up, make an interesting example since baby boomers have just begun turning 65. The Institute of Medicine estimates we will need 36,000 of them by 2030, nearly six times the number we have today. It is a daunting task to educate so many new providers. But lower payments to these specialists lead medical students to select higher paying, procedure-oriented specialties.
Although the supply of nurses has fluctuated with changes in the economy (weaker financials forcing some nurses to delay retirement or to reenter the workforce), demand continues to grow. With health care reform’s focus on care coordination, who will guide patients in their needed care?Health care reform significantly expanded coverage. That’s not enough. Simply having an insurance card does not equal access to care. Having providers located somewhat nearby who are available to see you in a timely fashion are critical components of that equation.If we are ever going to come close to meeting patient demand, we need to be thinking about other policy changes to ensure that all providers are able to practice to the top of their training levels to meet patient needs and that payment policies incentivize the right mix of providers.
Of course, the supporting cast for patient care goes far beyond doctors and nurses. What role will these other providers play in caring for patients? Will there be enough of them, and will they be able to supplement the traditional physician and nursing roles in other ways? And our needs for behind-the-scenes players, like the people who complete the administrative processes and make sure the equipment and technology are working, will continue to grow as well.
Access to providers represents an even broader disconnect between health care reform and reality.
Another disconnect includes all of the question marks remaining in this large, complex law.
Health care reform is a huge, complex, politically controversial law. And much of the detail wasn’t even fleshed out. Who knows how many times the phrase, “The Secretary shall…” appears in the law? (Slide animation will phase in 1045 after you hit the advance button).Those are areas, of course, where Congress deferred the details to the administrative agency. Add to that the following phrases, which also appear many times: “the Secretary may…;” “the Secretary determines…;” and “the Secretary has the authority to….”With so much administrative latitude and details “To Be Determined,” in many areas it is not clear how health care reform will interact with reality. A recent example, the proposed regulations for one particular new payment and delivery model called Accountable Care Organizations, are more than 400 pages long and highly complex. That’s only one variation on what will be numerous types of payment and delivery reform. Will every proposed implementation piece be as cumbersome? Will such regulation promote or hinder innovation and improvement?
There is a significant amount about health care reform that we still don’t know.
So we’ve talked about some critical disconnects where the health care reform law missed the reality boat:Cost estimates may be offEntitlement growth could impact the economy in ways that necessitate changesEmployers may behave differently than assumedThere may be inadequate providers to care for patients and reform did not do enough to incentivize more providersAnd there is much we do not know about what implementation will bring.
So as I said in the beginning of this presentation – we needed health care reform. And even without the law, the health care field has been working to improve itself.In Virginia, we were already very low cost relative to our sister states, with relatively high quality. And we have been very focused on improving quality and safety of care. I could give you an entire presentation on our efforts to reduce infections one might incur while in the hospital. You’ve seen a great deal of technological advancements that improve efficiency. Greater transparency related to quality of care and efforts to be more transparent on pricing, despite our convoluted health financing system. We are doing much more to coordinate care and keep people healthy. We are encouraging active lifestyles and different provider types are doing more to work together for the good of the patient. But we still have more to do, and key questions revolve around how the mandates, incentives, and barriers included in the health care reform law will interact with the efforts that were already underway and the realities that currently exist.