Consumer Insights and Kaiser Initiative on SDOH

By Clive Riddle, May 10, 2019

McKinsey has just published various insights from their 2019 Consumer Social Determinants of Health Survey, which found that compared to those whose social need is met, respondents (2,010 surveyed with government program coverage or uninsured and below 250% of federal poverty level) that:

  • Reported food insecurity were 2.4 times more likely to report multiple ER visits, and 2,0 times more likely to be hospitalized
  • Reported unmet transportation needs were 2.6 times more likely to report multiple ER visits, and 2,2 times more likely to be hospitalized
  • Reported unmet community safety needs were 3.2 times more likely to report multiple ER visits

Encouraging news from the survey for health plan advocates of SDOH was that 85% of respondents reporting unmet social needs said they would use a social program offered by their health insurer. Regardless of their social needs, respondents were interested in these types of health plan SDOH programs as follows: 

  • 50% were interested in grocery store discounts for healthy foods
  • 48% were interested in free memberships at local gyms
  • 45% were interested in a wellness dollar account used towards wellness services of their choice
  • 41% were interested in total reimbursement of home improvement purchases to address health issues
  • 40% were interested in after-hours drop-in clinics at lower or no cost 

Speaking of health plans, Kaiser Permanente has just announced their new Thrive Local initiative, a “a social care coordination platform” with “a network of public agencies and community-based organizations that will support” Kaiser “members to meet their social needs.”


Kaiser says that “starting this summer, closed-loop and bidirectional communication will provide confidence that referral, follow-up and ongoing patient/family engagement happen. Improved cross-sector collaboration and communication will also reduce the unintentional trauma and stigma that our patients and families may experience. Beyond Kaiser Permanente members and patients, community-based organizations will also benefit through improved decision support, automation, and relevance of the referrals they receive from their health system. This connectivity and interoperability between health care and social organizations and agencies will redefine the meaning of ‘provider network’ in this new world as the network of providers of health, health care, and social needs to address total health of our communities.”


Kaiser Permanente is partnering with Unite Us to launch the program, as tells us that Thrive Local within three years “will be available to all of Kaiser Permanente’s 12.3 million members and the 68 million people in the communities Kaiser Permanente serves.





CBO: Coverage by Oration

by Clive Riddle, May 3, 2019

 The Congressional Budget Office has been quite busy as of late, preparing reports that can serve as reference resources in response to Orators residing in Congress, the White House and the campaign trail, that are espousing healthcare coverage policy proposals, whether those proposals being orated involve Medicare for All, Medicare for Some, Death to the ACA, or other such schemes.

On May 1st, the CBO released a 34-page report:  Key Design Components and Considerations for Establishing a Single-Payer Health Care System, serving as a roadmap that “describes the primary features of single-payer systems, and it discusses some of the design considerations and choices that policymakers will face in developing proposals for establishing such a system in the United States.”

The report is organized by these categories of components and design considerations: 

  • How would the government administer a single-payer health plan?
  • Who would be eligible for the plan, and what benefits would it cover?
  • What cost sharing, if any, would the plan require?
  • What role, if any, would private insurance and other public programs have?
  • Which providers would be allowed to participate, and who would own the hospitals and employ the providers?
  • How would the single-payer system set provider payment rates and
  • purchase prescription drugs?
  • How would the single-payer system contain health care costs?
  • How would the system be financed? 

In May 2nd, the CBO released a 42-page report: Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2029, which “project that federal subsidies, taxes, and penalties associated with health insurance coverage for people under age 65 will result in a net subsidy from the federal government of $737 billion in 2019 and $1.3 trillion in 2029.”

 The report tells us that:

  • Between 240- 242 million people are projected to have health insurance each month during 2019-2029. The number of uninsured is projected to rise from 30 million in 2019 to 35 million in 2029.
  • Net federal subsidies for insured people will total $737 billion in 2019 and $1.3 trillion in 2029.
  • Medicaid and CHIP account for 40 - 45 percent of the federal subsidies, Medicare accounts for about 10 percent, and subsidies for ACA marketplace coverage account for less than 10 percent.

On April 18th the CBO provided a blog post: CBO Releases Four Products Explaining How Its New Health Insurance Simulation Model Works that describes how they generate estimates of health insurance coverage and premiums for the population under age 65, such as for the May 2md Federal Subsidies report.


 Also on April 18th, the CBO released an 11-page report:  Health Insurance Coverage for People Under Age 65:  Definitions and Estimates for 2015 to 2018 that “explains how CBO defines health insurance coverage, describes how CBO combines data from various sources to produce estimates of different types of coverage in past years, and shows such estimates for the years 2015 to 2018.” 


The report:  

  • Describes how CBO defines health insurance coverage (private and public) for people under 65 who are not institutionalized and who are not members of the active-duty military;
  • Describes the individual data sources CBO uses to compile preliminary estimates of historical outcomes, and the limitations of those sources; and
  • Compares preliminary estimates of historical outcomes with CBO’s integrated estimates of coverage (that are consistent with each other and that sum to accurately depict the total population) for 2015 to 2018.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Most Americans grateful for their job's health coverage, but still struggle with healthcare costs

Most people with employer-sponsored insurance are generally happy with their health plans, but many still struggle with healthcare affordability, according to a Kaiser Family Foundation/Los Angeles Times survey.

Becker's Hospital Review

Friday, May 3, 2019

Insys’s John Kapoor Is First CEO Convicted of Opioid Racketeering

Insys Therapeutics Inc. founder John Kapoor was convicted of a racketeering conspiracy that drove sales of a highly addictive opioid while contributing to a nationwide epidemic.


Friday, May 3, 2019

Budget office: Caveats to government-run health system

Congressional budget experts said Wednesday that moving to a government-run health care system like “Medicare for All” could be complicated and potentially disruptive for Americans.

AP News

Thursday, May 2, 2019

Medicaid Work Requirements Hit Roadblocks

Toward the end of 2018, the Trump administration seemed to be marching briskly toward its goal of requiring able-bodied adults in Medicaid to prove they had jobs to participate in the public health plan for the poor.

Pew Trust

Wednesday, May 1, 2019

Officials declare measles outbreak in Pacific Northwest over

A measles outbreak that sickened more than 70 people, mostly children, in the Pacific Northwest is finally over even as the total number of cases nationwide continues to spike to near-record levels, officials said Monday.

AP News

Tuesday, April 30, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week: 

Medicaid, CHIP enrollment for kids dropped by 861,000 in 2018

An estimated 861,000 fewer children were covered by Medicaid and the Children's Health Insurance Program in 2018 compared with the year before, according to an analysis by Georgetown University's Center for Children and Families drawing on new CMS data.

Thursday, April 25, 2019 

Anthem Beats Earnings Estimates, Outlines Plans for Pharmacy Benefits Unit

Anthem Inc on Wednesday posted a better-than-expected quarterly profit and laid out its plans to transition most customers to its revamped pharmacy benefits business this year.

NY Times

Thursday, April 25, 2019

Pharma Lobby Nears Spending Records With Drug Prices Under Fire

Large drug makers and the industry’s primary trade group neared previous spending records on lobbying in the first three months of the year as President Donald Trump and Congress increased pressure to rein in the cost of medicine.


Tuesday, April 23, 2019 

More than 1 million Americans have lost health insurance since 2016

More than 1 million Americans have lost health insurance coverage since 2016, according to a new report from the Congressional Budget Office (CBO).

The Hill

Monday, April 22, 2019 

Hospitals Stand to Lose Billions Under ‘Medicare for All’

For a patient’s knee replacement, Medicare will pay a hospital $17,000. The same hospital can get more than twice as much, or about $37,000, for the same surgery on a patient with private insurance.

NY Times

Monday, April 22, 2019 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.


Robots Need DNA Too

by Kim Bellard, April 22, 2019 

DNA, it seems, never ceases to amaze. Now scientists are using it to create new kinds of "lifelike" mechanisms.   Pandora, we may have found your box. 

Researchers from Cornell recently reported on their advances.  They used something called DASH -- DNA-based Assembly and Synthesis of Hierarchical -- to create "a DNA material with capabilities of metabolism, in addition to self-assembly and organization – three key traits of life."

That sends chills up my spine, and not necessarily in a good way. 

Lead author Shogo Hamada 

The designs are still primitive, but they showed a new route to create dynamic machines from biomolecules. We are at a first step of building lifelike robots by artificial metabolism.  Even from a simple design, we were able to create sophisticated behaviors like racing. Artificial metabolism could open a new frontier in robotics.

The reference to racing in his quote refers to the fact their mechanisms were capable to motion -- likened to how slime mold moves -- and they literally had their "lifelike materials" racing each other.  If I'm reading the research paper correctly, the mechanisms were even capable of hindering their competitor."

Well, that's lifelike, all right.

It wasn't all days at the race track; oh-by-the-way, they also demonstrated its potential for pathogen detection, which sounds like it could prove pretty useful.

These mechanisms eat, grow, move, replicate, evolve,and die.  Dr. Luo 
says: "More excitingly, the use of DNA gives the whole system a self-evolutionary possibility.  That is huge."  Dr. Hamada adds: "Ultimately, the system may lead to lifelike self-reproducing machines."

Those chills are back.

There has been a lot of attention on engineering advances that will allow for nanobots, including uses with our bodies and so-called "soft robots," but we should be given equal attention to what is called synthetic biology.

Synthetic biology isn't necessarily or even predominately about creating new kinds of biology, as the researchers at Cornell are doing, but reprogramming existing forms of life. They're being programmed to eat CO2 (thus helping with global warming), help with recyclingget rid of toxic wastes, even make medicines

A Columbia researcher 
believes that new techniques for programming bacteria, for example, "will help us personalize medical treatments by creating a patient’s cancer in a dish, and rapidly identify the best therapy for the specific individual."

In the not-too-distant future, we're going to be programming lifeforms and "lifelike materials" to do our bidding at the molecular or cellular level.  We've been debating and worrying about when A.I. might become truly intelligent, even self-aware, but the Cornell research is giving us something equally profound to debate: how to draw the line between "life" and "things"?

Medicine, healthcare, and health are going to have to develop more 21st century versions.  What we've been doing will look like brute force, human-centric approaches.  Synthetic biology and molecular engineering open up new and exciting possibilities, and some of those possibilities will upend the status quo in healthcare in ways we can barely even imagine now.  

It's not going to be enough to think of new approaches.  We're going to have to find new ways to even think about those new approaches.  

In the meantime, let's go watch some DASH dashes!


This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting.