Anderson Dynasty

Now that the coast is clear, Slate has an honest assessment of ObamaCare premiums. Helaine Olen writes:

Under this assault [from ObamaCare opponents], all too many ACA defenders turned into fanboys and fangirls, dismissing any issue raised against the law as inconsequential and exaggerated…

But this strategy might well come back to bite the Democrats. The bill for the health care expansion is coming due, just as the recipients will be heading to the ballot box to vote in the first primaries for the 2016 election. More than a few are likely to be annoyed.

Last week Oregon’s insurance commissioner, Laura Cali, announced that the state had approved a 25 percent premium increase for the largest health insurer on the state’s exchanges. The second largest insurer did even better: It received permission to boost its monthly charge to consumers by 33 percent…

And that sounds like a relative bargain compared with Minnesota and New Mexico, where the BlueCross BlueShield family is looking for increases of more than 50 percent. Even if the final numbers are lower than the asks, it seems quite likely these states will approve substantive premium increases.

The problem is simple. As Trudy Lieberman reported this month in Harper’s, the ACA made a decent stab at solving the problem of Americans lacking insurance. Unfortunately, the bargain struck to get the bill to a point where lobbyists for the hospital, insurance, and pharmaceutical industries to sign on, or at least not fight it, did not adequately address the issue of overall medical costs.

And that’s where the consumer comes in. Someone is “it,” the party paying the bill. And that “it” is increasingly you, whether you receive insurance on the exchanges or from an employer.

Mobile is no longer a by-product of the overall digital master plan and needs to be part of all rebranding strategies. When a company decides to rebrand -- whether it’s to stand out from competitors, eliminate a negative image, boost sales or introduce new features -- it’s always a crucial rite of passage. And with everything going mobile, a company’s mobile strategy plays an integral role in the process Below are five mobile marketing questions each marketer should ask themselves before embarking on a rebranding journey. 1. Do I now need an app? The reason this question is so important is because the answer to it could very well be no -- apps simply aren’t the best fit for every single company out there. So, when do you need an app? When you can offer mobile users a refined, well-rounded experience that correlates with your brand’s essence. The app should keep users constantly engaged and become another platform through which they can interact with the brand. On the flip side, when should you kill your app? Since many brands jump into launching an app just for the sake of having one, without thinking of the added value it would offer users, there are many apps out there that actually lack a real purpose. The best indication that your app isn’t worth your time and money is if it features the exact same content that’s displayed on your mobile site.

2. What should your website look like on mobile? When it comes to your website, chances are most of your audience will access it via their mobile device. In fact, just last month, mobile Internet use surpassed that of desktop. And let’s face it, in 2015 there’s nothing more embarrassing and annoying than having a site that looks awkward on the mobile screen. The bottom line is that the answer to this question will almost always be “go responsive," since it’s extremely difficult for brands to establish a mobile presence and not miss out on a significant market share without a responsive site. Even brands that have a mobile app must ensure that their website is mobile-friendly (especially after Google’s mobilegeddon) because not all consumers will download the app and continue to visit the company website using their mobile devices.

3. Should your brand speak a different language to its mobile users? Most users feel that mobile apps and responsive sites are the most efficient way to interact with brands, but if companies want to form an even deeper connection with consumers, they should “speak” to them in the right language. In a rebranding process, many brands change their logo or name in order to reflect a new identity. This new identity will most likely attempt to promote fresh new values and characteristics, and therefore, the language used by the brand should reflect this new “personality." A great way to implement this strategy is in a mobile app, especially with push notifications that address users in a relatable tone. 4. Am I targeting the right audience? When a company rebrands, chances are its target audience isn’t going to remain exactly the same. It’s a great opportunity to narrow down your audience and be even more specific about those you’re trying to attract. The same goes for your mobile marketing strategy: Your new brand’s audience definition should also apply in your mobile ad targeting. In fact, mobile is the perfect platform for brands who want to test different groups as potential target audiences. The targeting options are very specific and brands can A/B test countless messages to see what works before officially adopting it as part of their overall strategy.

Health-care providers accuse insurance network of acting as a cartel.

Blue Cross and Blue Shield health insurers cover about a third of Americans, through a national network that dates back decades. Now, antitrust lawsuits advancing in a federal court in Alabama allege that the 37 independently owned companies are functioning as an illegal cartel.

A federal judicial panel has consolidated the claims against the insurers into two lawsuits that represent plaintiffs from around the country. One is on behalf of health-care providers and the other is for individual and small-employer customers.

The antitrust suits allege that the insurers are conspiring to divvy up markets and avoid competing against one another, driving up customers’ prices and pushing down the amounts paid to doctors and other health-care providers.

The suits, which name all of the Blue Cross and Blue Shield companies as defendants as well as the Blue Cross Blue Shield Association, have already survived the insurers’ first major legal challenge.

U.S. District Judge R. David Proctor last year declined to dismiss them, saying that the plaintiffs “have alleged a viable market-allocation scheme,” which, if proven, could be an antitrust violation. Judge Proctor also said certain federal antitrust exemptions for the insurance business didn’t appear to apply to the behavior at issue in the lawsuits. The suits have moved into the discovery phase; the plaintiffs are seeking class-action status.

 Antitrust experts who aren’t involved in the litigation say the suits pose a high-stakes test for the companies, which have long been at the heart of the American health system. “It is a very big deal,” said Tim Greaney, a professor at Saint Louis University School of Law. “The dollars involved are potentially huge.” He and others say the litigation will take years to resolve, unless a settlement is reached.

Both plaintiff groups have prominent attorneys. The legal team for the health-insurance customers includes David Boies, who represented federal antitrust regulators against Microsoft Corp. Whatley Kallas, a firm that has won high-profile settlements from insurers on behalf of physicians, is helping to lead the provider case.

The Blue Cross and Blue Shield companies trace their roots to the 1930s, when hospital and doctor groups started insurance plans to help people pay for medical care. Hospital plans used the Blue Cross name, and the physician plans were sold under the Blue Shield banner. Eventually, the names were trademarked.

Today, the Blue Cross Blue Shield Association licenses the brands to the insurers that use them. Companies typically hold exclusive rights to the Blue Cross and Blue Shield names within a certain territory.

Most of the 37 Blue Cross and Blue Shield companies are not-for-profit. Many do business in a single state. The biggest Blue Cross and Blue Shield company is publicly traded Anthem Inc., which operates the plans in 14 states. In a few places, Blue-branded plans compete directly against one another, as in California, where Anthem Blue Cross battles Blue Shield of California.

The Blue association says its licensing deals simply codify trademark rights that date back decades and “do not constitute an agreement to do anything unlawful.” Federal regulators have long known about the licenses and taken no antitrust action, the insurers said in a court brief. The association also says its arrangements ensure that its members focus on building the Blue brand, and increase competition by helping the Blue companies ally to go up against national insurers.

“This is a model that has withstood scrutiny over our entire history,” said Scott Nehs,general counsel of the Blue association. “There’s no smoky room involved, there’s no dividing up.” Also, he said, the insurers’ rates are closely watched by state regulators.

The plaintiffs, however, allege that the Blue association is controlled by its members, who use it to engage in “illegal market division.” The customer suit says the association also limits the amount of insurance business insurers can do under non-Blue brands. The suit also alleges that the Blue agreements result in “inflated premiums.”

“You have less competition in a market, so prices are higher,” said William Isaacson, an attorney with Boies, Schiller & Flexner LLP, which represents the customer plaintiffs. “That’s one of the basics of antitrust law.”

The suit filed by the health-care providers alleges that because of “decreased competition, health-care providers, including the plaintiffs, are paid much less than they would be” without the Blue association’s agreements. “The fact that someone’s been doing something a long time doesn’t make it right, and doesn’t make it legal,” said Joe Whatley, a lead attorney for the provider plaintiffs. Mr. Whatley declined to say whether there were settlement negotiations under way but said “we are always open” to talks.

The plaintiffs have “some surprisingly strong claims,” said Mark Hall, a professor at Wake Forest University School of Law. “It’s sort of antitrust law 101 that direct competitors can’t agree to divvy up their territory.”

Still, said Scott E. Harrington, a professor at the University of Pennsylvania’s Wharton School, “it’s going to be hard to show those entities are making the large margins implied by” the allegations. The Blue Cross and Blue Shield plans don’t always have big profits, he said.

Glenn Melnick, a professor at the University of Southern California, said the two sets of plaintiffs in the case had diverging interests, because higher payments to health-care providers would likely push up premiums for insurance customers. “They appear to be arguing conflicting outcomes,” he said.

The Blue plans often have significant market share. According to an analysis by the Kaiser Family Foundation, Blue Cross and Blue Shield companies were the biggest players in the vast majority of states’ small-business and individual insurance markets in 2013, the most recent data available. In some states, their share was a commanding one. Blue Cross and Blue Shield of Alabama held 91% of the individual business and 97% of the small-group market in its state.

A spokeswoman for Blue Cross and Blue Shield of Alabama referred questions to the association, which said that the insurer competes with 10 other companies selling commercial health insurance, and that a federal survey showed Alabama has the lowest average family premiums in the U.S. and among the lowest employer premiums.

Ultimately, the antitrust cases may hinge on tensions between the laws governing trademark rights and the antitrust statutes, antitrust experts said. A restaurant operator, for example, can legally license its brand to franchisees, granting each a certain territory. The question is whether the Blue setup is more like a franchising arrangement or if it involves unacceptable agreements between potential rivals, said Barak D. Richman, a professor at Duke University School of Law.

“You’ll be looking for cartel-like behavior or the protection of intellectual property,” he said. “That will probably be the most significant evidentiary test.”

One-quarter of people with healthcare coverage are paying so much for deductibles and out-of-pocket expenses that they are considered underinsured, according to a new study. An estimated 31 million insured people are not adequately protected against high medical costs, a figure that has doubled since 2003, according to the 2014 national health insurance survey by the Commonwealth Fund.

ADVERTISEMENTRising deductibles — even under ObamaCare — are the biggest problem for most people who are considered underinsured, according to the 22-page report.

“The steady growth in the proliferation and size of deductibles threatens to increase underinsurance in the years ahead,” the report warns.

The data is an early warning sign for the Obama administration, which has promised that the millions of people who gained insurance under the president’s law would have affordable access to healthcare.

The survey found that millions of people are paying into the insurance system but are largely unable to reap the benefits.

People who purchase the lowest-quality health insurance are also less likely to see a doctor when they are ill or injured because they fear their high out-of-pocket costs.

“People who have high deductibles do tend to skimp on healthcare,” the study’s lead author, Sara Collins, told reporters.

When people do see a doctor, the costs accumulate quickly.

Half of underinsured adults and 41 percent of privately insured adults with deductibles of $1,000 or higher were paying off accumulated medical bills of $4,000 or more, the report found.

Still, the survey does not offer a clear picture on the workings of ObamaCare one year after its healthcare exchanges launched across the country. The data do not take into account people who lacked insurance before 2014.

“We’re unable to separately assess the effects of the law with these data,” Collins said. “What we’re seeing, though, in the data is ever-growing deductibles.”

The increase in deductibles is occurring even as the nation’s healthcare costs have flatlined overall, which the Obama administration has taken partial credit for.

The underinsured rate has flattened over the last several years, as well, with the biggest increases in the underinsured population occurring between 2003 and 2010.

If you would like more info on Telemedicine check out: 

By our count at the Galen Institute, more than 49 significant changes already have been made to the Patient Protection and Affordable Care Act: at least 30 that President Obama has made unilaterally, 17 that Congress has passed and the president has signed, and 2 by the Supreme Court.

CHANGES BY ADMINISTRATIVE ACTION

1. Medicare Advantage patch: The administration ordered an advance draw on funds from a Medicare bonus program in order to provide extra payments to Medicare Advantage plans, in an effort to temporarily forestall cuts in benefits and therefore delay early exodus of MA plans from the program. (April 19, 2011)

2. Employee reporting: The administration, contrary to the Obamacare legislation, instituted a one-year delay of the requirement that employers must report to their employees on their W-2 forms the full cost of their employer-provided health insurance. (January 1, 2012)

3. Subsidies may flow through federal exchanges: The IRS issued a rule that allows premium assistance tax credits to be available in federal exchanges although the law specified that they only would be available through an “Exchange established by the State.” (May 23, 2012)

4. Closing the high-risk pool: The administration decided to prematurely halt enrollment in transitional federal high-risk pools created by the law, blocking coverage for an estimated 40,000 new applicants, citing a lack of funds. The administration had money from a fund under Secretary Sebelius’s control to extend the pools, but instead used the money to pay for advertising for Obamacare enrollment and other purposes. (February 15, 2013)

5. Doubling allowed deductibles: Because some group health plans use more than one benefits administrator, plans are allowed to apply separate patient cost-sharing limits to different services, such as doctor/hospital and prescription drugs, allowing maximum out-of-pocket costs to be twice as high as the law intended. (February 20, 2013)

6. Small businesses on hold: The administration has said that the federal exchanges for small businesses will not be ready by the 2014 statutory deadline, and instead delayed until 2015 the provision of SHOP (Small-Employer Health Option Program) that requires the exchanges to offer a choice of qualified health plans. (March 11, 2013)

7. Delaying a low-income plan: The administration delayed implementation of the Basic Health Program until 2015. It would have provided more-affordable health coverage for certain low-income individuals not eligible for Medicaid. (March 22, 2013)

8. Employer-mandate delay: By an administrative action that’s contrary to statutory language in the ACA, the reporting requirements for employers were delayed by one year. (July 2, 2013)

9. Self-attestation: Because of the difficulty of verifying income after the employer-reporting requirement was delayed, the administration decided it would allow “self-attestation” of income by applicants for health insurance in the exchanges. This was later partially retracted after congressional and public outcry over the likelihood of fraud. (July 15, 2013)

10. Delaying the online SHOP exchange: The administration first delayed for a month and later for a year until November 2014 the launch of the online insurance marketplace for small businesses. The exchange was originally scheduled to launch on October 1, 2013. (September 26, 2013) (November 27, 2013)

11. Congressional opt-out: The administration decided to offer employer contributions to members of Congress and their staffs when they purchase insurance on the exchanges created by the ACA, a subsidy the law doesn’t provide. (September 30, 2013)

12. Delaying the individual mandate: The administration changed the deadline for the individual mandate, by declaring that customers who have purchased insurance by March 31, 2014 will avoid the tax penalty. Previously, they would have had to purchase a plan by mid-February. (October 23, 2013)

13. Insurance companies may offer canceled plans: The administration announced that insurance companies may reoffer plans that previous regulations forced them to cancel. (November 14, 2013)

14. Exempting unions from reinsurance fee: The administration gave unions an exemption from the reinsurance fee (one of ObamaCare’s many new taxes). To make up for this exemption, non-exempt plans will have to pay a higher fee, which will likely be passed onto consumers in the form of higher premiums and deductibles. (December 2, 2013)

15. Extending Preexisting Condition Insurance Plan: The administration extended the federal high risk pool until January 31, 2014 and again until March 15, 2014 to prevent a coverage gap for the most vulnerable. The plans were scheduled to expire on December 31, but were extended because it has been impossible for some to sign up for new coverage on healthcare.gov. (December 12, 2013) (January 14, 2014)

16. Expanding hardship waiver to those with canceled plans: The administration expanded the hardship waiver, which excludes people from the individual mandate and allows some to purchase catastrophic health insurance, to people who have had their plans canceled because of ObamaCare regulations. The administration later extended this waiver until October 1, 2016. (December 19, 2013) (March 5, 2014)

17. Bay State bailout: More than 300,000 people in Massachusetts gained temporary Medicaid coverage in 2014 without verification of eligibility, with the Obama and Patrick administrations using a taxpayer-funded bailout to mask the failure of the commonwealth’s disastrously malfunctioning

18. Equal employer coverage delayed: Tax officials will not be enforcing in 2014 the mandate requiring employers to offer equal coverage to all their employees. This provision of the law was supposed to go into effect in 2010, but IRS officials have “yet to issue regulations for employers to follow.” (January 18, 2013)

19. Employer-mandate delayed again: The administration delayed for an additional year provisions of the employer mandate, postponing enforcement of the requirement for medium-size employers until 2016 and relaxing some requirements for larger employers. Businesses with 100 or more employees must offer coverage to 70% of their full-time employees in 2015 and 95% in 2016 and beyond. (February 10, 2014)

20. Extending subsidies to non-exchange plans: The administration released a bulletin through CMS extending subsidies to individuals who purchased health insurance plans outside of the federal or state exchanges. The bulletin also requires retroactive coverage and subsidies for individuals from the date they applied on the marketplace rather than the date they actually enrolled in a plan. (February 27, 2014)

21. Non-compliant health plans get two year extension: The administration pushed back the deadline by two years that requires health insurers to cancel plans that are not compliant with ObamaCare’s mandates. These “illegal” plans may now be offered until 2017. This extension will prevent a wave cancellation notices from going out before the 2014 midterm elections. (March 5, 2014)

22. Reducing cost sharing reductions. The ACA originally called for out-of-pocket maximums to be lowered for enrollees with incomes between 100-400% FPL (Sec. 1402), but the provision proved unworkable for those 250-400% of FPL in combination with prescribed actuarial value requirements and was changed through regulation to apply to only those 100-250% of poverty. (March 11, 2014)

23. Delaying the sign-up deadline: The administration delayed until mid-April the March 31 deadline to sign up for insurance. Applicants simply need to check a box on their application to qualify for this extended sign-up period. (March 26, 2014)

24. Canceling Medicare Advantage cuts: The administration canceled scheduled cuts to Medicare Advantage. The ACA calls for $200 billion in cuts to Medicare Advantage over 10 years. (April 7, 2014)

25. More Funds for Insurer Bailout: The administration said it will supplement risk corridor payments to health insurance plans with “other sources of funding” if the higher risk profile of enrollees means the plans would lose money. (May 16, 2014)

26. Exempting U.S. territories: Despite earlier administration claims that “HHS is not authorized to choose which provisions [of the ACA] might apply to the territories,” HHSwaived six major requirements – such as guaranteed issue, community rating, and essential benefit mandates – that were causing serious disruption to health insurance markets covering 4.5 million residents of U.S. territories. (July 18, 2014)

27. Failure to enforce abortion restrictions. A GAO report found that many exchange insurance plans don’t separate charges for abortion services as required by the ACA, showing that the administration is not enforcing the law. In 2014, abortions were being financed with taxpayer funds in more than 1,000 exchange plans. (Sept. 16, 2014)

28. Risk Corridor coverage: The Obama administration plans to illegally distribute risk corridor payments to insurers, despite studies by both the Congressional Research Service and the GAO saying a congressional appropriation is required before federal agencies can make the payments. (Sept. 30, 2014)

29. Transparency of coverage: CMS delays statutory requirements on insurance companies to disclose data on the number of people enrolled, disenrollment, number of claims denied, costs to consumers of certain services, etc. (Oct. 20, 2014)

30. Tax penalty pass: Approximately 50,000 taxpayers filed income tax returns based upon inaccurate subsidy data they received from the federal government. The administration declared that if they received too large of a subsidy, they will not have to repay the government. The ACA requires, in Sec. 5000A, that “Any penalty imposed…shall be included with a taxpayer’s return…” (February 24, 2015)

CHANGES BY CONGRESS, SIGNED BY PRESIDENT OBAMA:

31. Military benefits: Congress clarified that plans provided by TRICARE, the military’s health-insurance program, constitutes minimal essential health-care coverage as required by the ACA; its benefits and plans wouldn’t normally meet ACA requirements. (April 26, 2010)

32. VA benefits: Congress also clarified that health care provided by the Department of Veterans Affairs constitutes minimum essential health-care coverage as required by the ACA. (May 27, 2010)

33. Drug-price clarification: Congress modified the definition of average manufacturer price (AMP) to include inhalation, infusion, implanted, or injectable drugs that are not generally dispensed through a retail pharmacy. (August 10, 2010)

34. Doc-fix tax: Congress modified the amount of premium tax credits that individuals would have to repay if they are over-allotted, an action designed to help offset the costs of the postponement of cuts in Medicare physician payments called for in the ACA. (December 15, 2010)

35. Extending the adoption credit: Congress extended the nonrefundable adoption tax credit, which happened to be included in the ACA, through tax year 2012. (December 17, 2010)

36. TRICARE for adult children: Congress extended TRICARE coverage to dependent adult children up to age 26 when it had previously only covered those up to the age of 21 — though beneficiaries still have to pay premiums for them. (January 7, 2011)

37. 1099 repealed: Congress repealed the paperwork (“1099”) mandate that would have required businesses to report to the IRS all of their transactions with vendors totaling $600 or more in a year. (April 14, 2011)

38. No free-choice vouchers: Congress repealed a program, supported by Senator Ron Wyden (D., Ore.) that would have allowed “free-choice vouchers,” that the Hill warned “could lead young, healthy workers to opt out” of their employer plans, “driving up costs for everybody else.” The same law barred additional funds for the IRS to hire new agents to enforce the health-care law. (April 15, 2011)

39. No Medicaid for well-to-do seniors: Congress saved taxpayers $13 billion by changing how the eligibility for certain programs is calculated under Obamacare. Without the change, a couple earning as much as much as $64,000 would still have been able to qualify for Medicaid. (November 21, 2011)

40. CO-OPs, IPAB, IRS defunded: Congress made further cuts to agencies implementing Obamacare. It trimmed another $400 million off the CO-OP program, cut another $305 million from the IRS to hamper its ability to enforce the law’s tax hikes and mandates, and rescinded $10 million in funding for the controversial Independent Payment Advisory Board. (December 23, 2011)

41. Slush-fund savings: Congress slashed another $11.6 billion from the Prevention and Public Health slush fund and $2.5 billion from Obamacare’s “Louisiana Purchase.” (February 22, 2012)

42. Less cash for Louisiana: One of the tricks used to get Obamacare through the Senate was the special “Louisiana Purchase” deal for the state’s Democratic senator, Mary Landrieu. Congress saved another $670 million by rescinding additional funds from this bargain. (July 6, 2012)

43. CLASS Act eliminated: Congress repealed the unsustainable CLASS (Community Living Assistance Services and Supports) program of government-subsidized long-term-care insurance, which even the Democratic chairman of the Senate Finance Committee dubbed a “Ponzi scheme of the first order.” (January 2, 2013)

44. Cutting CO-OPs: Congress cut $2.2 billion from the “Consumer Operated and Oriented Plan” (CO-OP), which some saw as a stealth public option, blocking creation of government-subsidized co-op insurance programs in about half the states. Early reports showed many co-ops, which had received federal loans, had run into serious financial trouble. (January 2, 2013)

45. Trimming the Medicare trust-fund transfer: Congress rescinded $200 million of the $500 million scheduled to be taken from the Medicare Part A and Part B trust funds and sent to the Community-Based Care Transition Program established and funded by the ACA. (March 26, 2013)

46.  Eliminating caps on deductibles for small group plans: Congress eliminated the cap on deductibles for small group plans as part of the SGR “doc fix.” This change gives small businesses the freedom to offer high deductible plans that may be paired with a Health Savings Account. (April 1, 2014)

47. Making the risk corridor program budget neutral. The Consolidated and Further Continuing Appropriations Act of 2015 provides that CMS may not transfer funds from other accounts to pay for the risk corridor program. Expenditures cannot exceed the funds collected in 2014, blocking CMS from making multi-year calculations. (December 16, 2014).

CHANGES BY THE SUPREME COURT:

48. Medicare expansion made voluntary: The court ruled it had to be voluntary, rather than mandatory, for states to expand Medicaid eligibility to people with incomes up to 138 percent of the federal poverty level, by ruling that the federal government couldn’t halt funds for existing state Medicaid programs if they chose not to expand the program.

49. The individual mandate made a tax: The court determined that violating the mandate that Americans must purchase government-approved health insurance would only result in individuals’ paying a “tax,” making it, legally speaking, optional for people to comply.

This list was originally published HERE on Galen.org and has been published on National Review Online. It was updated to 29 changes on December 10, 2013.

December 13, 2013 UPDATE: 30 changes (PCIP extension)

December 19, 2013 UPDATE: 31 changes (Hardship waiver)

January 14, 2014 UPDATE: 32 changes (Union reinsurance fee exemption)

January 14, 2014 UPDATE: (PCIP extended again)

January 21, 2014 UPDATE: 33 changes (Equal employer coverage delay)

February 3, 2014 UPDATE: 34 changes (Subsidies may flow through federal exchanges) (List is now ordered chronologically)

February 10, 2014 UPDATE: 35 changes (Second employer mandate delay)

March 5, 2014 UPDATE: 36 changes (Subsidies extended outside of exchanges)

March 5, 2014 UPDATE: 37 changes (Consumers can keep non-compliant plans until 2017)

March 26, 2014 UPDATE: 38 changes (Sign-up deadline delayed)

April 7, 2014 UPDATE: 39 changes (Small group deductible cap eliminated-passed by Congress and signed into law)

April 8, 2014 UPDATE: 40 changes (Cuts to Medicare Advantage in 2015 canceled)

May 22, 2014 UPDATE: 41 changes (More funds for insurer bailout)

July 18, 2014 UPDATE: 42 changes (Exempting U.S. Territories)                                                                                                                                 December 26, 2014 UPDATE: 46 changes (Failure to enforce abortion restrictions; Risk Corridor coverage; Transparency of coverage; Bay State Bailout)

January 7, 2015 UPDATE: 47 changes (Making the risk corridor program budget neutral)

February 24, 2015 UPDATE: 48 changes (Tax penalty pass)

March 2, 2015 UPDATE: 49 changes (Reducing cost sharing reductions)

TOLEDO — The new machine that could one day replace anesthesiologists sat quietly next to a hospital gurney occupied by Nancy Youssef-Ringle. She was nervous. In a few minutes, a machine — not a doctor — would sedate the 59-year-old for a colon cancer screening called a colonoscopy.

But she had done her research. She had even asked a family friend, an anesthesiologist, what he thought of the device. He was blunt: “That’s going to replace me.”

One day, maybe. For now, the Sedasys anesthesiology machine is only getting started, the leading lip of an automation wave that could transform hospitals just as technology changed automobile factories. But this machine doesn’t seek to replace only hospital shift workers. It’s targeting one of the best-paid medical specialties, making it all the more intriguing — or alarming, depending on your point of view.

Today, just four U.S. hospitals are using the machines, including here at ProMedica Toledo Hospital. Device maker Johnson & Johnson only recently deployed the first-of-its-kind machine despite winning U.S. Food and Drug Administration approval in 2013. The rollout has been deliberately cautious for a device that hints at the future of health care, when machines take on tasks once assumed beyond their reach.

Everyone is watching to see how this goes.

The world of web promotion and search engine optimization has never been a consistent one.

Constantly changing Google results algorithms compete with tricky marketers in what is essentially an arms race, with each side trying to gain a lasting advantage against the other. However, though the tools change constantly, the battleground stays the same.

We’re talking about keyword research. Every time a Google update levels the playing field again, it comes back to this: if you create high quality content that people read, you will gain prominence in Google results. And the best way to do this is with keyword research. We’ve got some great tips to help you make sure your blog has its keyword game in top form. Read on!

Make a list of the most important topics that you cover on your blog

One good way to conceptualize the idea of a keyword is to think backwards. What kind of people are you trying to attract? What is your ideal reader looking for?

Go back through your blog entries and mentally sort them into vague lists. If you use tags or categories, this can help a lot as well. Basically, you want to create large “content buckets” that you can fit most of your posts into.

Transform those content buckets into keyword lists

Once you’ve assembled some buckets that most of your posts fit into, you can identify keywords to fill those out. These are phrases that you’d like to rank highly on the search engine results page.

An example might be a blog about maternity fashion that provides some affiliate referral links to clothing stores where readers can buy the recommended clothes. This hypothetical maternity wear blog would want to rank highly on searches like “clothes to wear during pregnancy”, “maternity fashion”, and other searches like this.

This isn’t a be all, end all list of the keywords you’ll be using, but rather just to clear your mind of all the obvious ones.

Get a good mix of short tail and long tail keywords

Some keywords are easier (and cheaper) to rank on than others. The cheap, easy ones are long tail, and are associated with much less traffic than the short tail keywords, which are particularly popular and frequently searched. The web has tons of tools for all kinds of things, from business name generators to tools like the Google Adwords Keyword Tool, which is great for this sort of thing.

Use tools to get a great keyword spread

Other great tools for this are Topsy and Buzzsumo. Topsy helps you uncover the confusing and convoluted work of social media keywords. Topsy is essentially the Google Trends of social media, allowing you to page through the recent history of keywords on social media to identify trends in that medium.

Buzzsumo helps you make sure that your keyword list is as comprehensive as that of your competitors. It helps you analyze their sites directly, helping you to spot when a new trend in your industry or field is coming up and letting you stay on top of it.

Keywords: always relevant

As the years have gone by I have seen so many doctors at so many facilities in Southern California as well as doctors independently operating out of their own offices.  The doctor who has been far and away the most helpful is Dr. Jim Brodsky.  He was previously a Department head at USC.  He is a Pharmacist, explained to me you cannot understand a patient’s health unless someone looks at their blood under a microscope.  He told us it’s a $1200 test because a person has to actually look under a microscope. It is a box that must be checked on a lab requisition form called morphology and insurance companies howl like crazy if that box is checked. On three different occasions I visited his office feeling terrible.  I was exhausted; I remember how foggy my thinking was,   I was just not feeling well.  Dr Brodsky (Dr B as he is called affectionately by his patients) has his office set up with the equipment to do that test.  He pricks your finger to get a small amount of blood, swabs some on a microscopic glass slide and then pulls a very small tube of blood he inserts into his little machine that gives a read out of your Cholesterol and the accompanying blood related measurements.  

His office is equipped so what he sees under the microscope is recorded on a DVD disk and then you can see on his large TV screen in his office what he is seeing on his microscope. My pictures of my visit are shown here so you can understand how all this is set up.  In each of those three visits when I was feeling ill all my red blood cells were stacked up in columns like Pringles in a potato chip container and those were then intertwined like a ball of yarn. This condition is called Rouleau.   Your body has white blood cells which cruise around through your blood and pull out bacteria and spent red blood cells out of the blood to keep it clean and the body healthy.  The treatment is to take Vitamin D3 which gives quick results to un-stack the blood cells so they are free to float around inside the body allowing the white blood cells to cleanse the blood.  I’ll never forget that first morning being given some vitamin D3 swallowing a few and an hour and a half later in a business meeting and all my discomfort gone and I could think clearly allowing me to move on productively.  Attached is a picture of his TV screen showing my healthy blood no Rouleau being present. Note the clear round blood cells with the white blood cell in the middle that’s scooping up the bacteria in the blood.  Never ever have I experienced another doctor requesting this procedure yet it is pivotal in achieving a proper diagnosis.  

Having lived with a chronic medical problem for the past twelve years and trying to get relief from the medical profession has left me with some serious insight regarding the state of health care in America today.  Generally I have to say it’s pathetic.  From my experiences as a kid up through the results of testing from my latest doctor I have things going on inside me no medical professional has completely wrapped their arms around.  When I was a child I suffered from constipation and remember my mom giving me tablespoons of Castor Oil and then dad began buying me Citrate of Magnesia when I was in the later years of grammar school.  I’m certain it’s a situation a lot of kids have dealt with. I know my grandchildren have told me they have had similar problems.  

I just lived with it and as I got into high school I got involved with track and field and had an awful lot of success.  Both my junior and senior years of high school I went to the state track meet and had fantasies maybe I could make the Olympics.  All the problems I had all my life followed me during that time but I learned to live with it.  Finally I graduated and went on to college on a track scholarship again having great success my freshman year.  I had one race that the guys went to Denny’s and we all had a big pancake and eggs breakfast as we had done many times and at the end of that race I ran straight through the tape to the toilet and stayed there the entire day.  Awful is an understatement going through that.   After that I could never run again, when my metabolism got worked up it brought on intestinal problems and my running career was finished.  For years and years every time I went to a doctor I’d tell them what had happened and they would blow me off not examining anything.  The years went by and I always worked out mostly riding my bike or just going for long walks, never did I abuse my body with alcohol or any stimulant ever, I knew I was blessed and I took good of care of myself.  

Matthew Holt: I’m talking with one of the most interesting people in healthcare, Dale Sanders who these days is the Senior Vice President for Strategy for Health Catalyst, a really fast growing data warehousing analytics company. Dale, before that, did a bunch of stuff in the Air Force, at Intermountain, was involved with starting the Health Data Warehouse Association, and even for a while running the National Health IT System in Cayman Islands

Anyway we’re here to chat about some work that Health Catalyst is doing, that you guys have been doing these webinars, very successful ones, a few months and years. You actually had a big conference last year, which you’re repeating again this year, I know, but specifically coming up on April 22nd 1 – 2 PM PST is a webinar about Microsoft.

So let me tell you my Microsoft story from HIMSS last week I was in one of the last sessions in Thursday, actually, and it was a guy named Dave Francis talking about the future of consumer health. Someone said, “I am a Microsoft guy. I work for Microsoft. They send me out to health systems and I help in dealing with technical issues. You’re talking about the future of online consumer health. The Google Health guys, they had that thing, it failed. We have Healthvault, we failed and close it down. Oh no, we didn’t officially close it, so I’m not supposed to say that, but anyway”. So that’s the kind of way people think about Microsoft and healthcare. But you’re saying not so fast. So what’s the story here?

Dale Sanders: Yeah, it’s very interesting. In this webinar, I spend the first few minutes talking about my life on Microsoft. So I’ve been an IT now for 32 years, starting out in the Air Force and now in Health Catalyst. So I put this timeline together and I put all these significant events in my life that had some relationship to some event in Microsoft. Most of the time, it’s like horrible, right? I want to poke my eyes out. My Microsoft experience as a healthcare IT guy or just an IT guy in general has been terrible, right? Security problems, backwards compatibility problems, scalability problems. But now I’m very bullish in Microsoft, so it’s kind of unusual that I’ve completely turned my opinion

Matthew Holt: Perhaps because they’re no more the evil monopoly, they’re David vs Goliath?

Dale Sanders: Yeah. Really, it’s fascinating. This webinar is about their cultural transformation as much as it is their technical transformation. It’s fascinating, and I was never a big fan of Bill Gates, never a big fan of Steve Ballmer. They’re just contrary personalities to me.

Matthew Holt: They may care less about what you think.

Dale Sanders: Yeah, exactly. They may care less about what I think. But Satya Nadella is a different person. He’s the new CEO. I mean, he’s a very different personality. I have never met him personally, but I know folks who I trust in Microsoft that worked with him from the early ‘90s up until just recently. So they speak very highly of him and you can see it in a cultural transformation. Now, all their open source technology is kind of an amazing indication of that transformation.

One of the slides that I have in the webinar is from 2001, the quote from Steve Ballmer is that Linux is a cancer. In 2014 Satya Nadella, his quote is, “Microsoft loves Linux.” So about 25% of Microsoft’s new Azure Cloud offering is actually running on Linux servers. So it’s a very different culture now, and it’s rolling into their products too, their analytics products.

Matthew Holt: Fascinating! So what’s Health Catalyst is doing on its side? how much of this stuff that you guys are using in your analytics work on top of the data warehousing that you provide?

Dale Sanders: So we’re in this transition period where relational data warehouses are kind of reaching their limits. The truth is relational databases were built for transaction process. They were never really built for analytics, but we made them work for analytics and they’ve been pretty good for analytics. But now, we’re in a level of, not only data volumes, but data velocity, where real time unstructured streaming data is a big part of the analytics future of the industry, and relational database is not just setup for that. So we’re on the downhill side of relational data warehouses in analytics for healthcare.

But yet, it’s still just a little too early for a Hadoop and NoSQL. So what’s really cool about the Microsoft strategy is they bridged those two worlds very nicely with their product that’s called Analytic Platform Services, and that’s what we’re using. So half of that platform is a traditional, but very scalable massively parallel SQL database, traditional-relational database. It works very well for a lot of use cases. But then married up against that now architecturally is a Hortonworks Hadoop NoSQL technology base and they have this product called PolyBase that makes the transition between the two very easily. You can issue a query, a SQL query through PolyBase and take advantage of all those SQL skills you have in your organization and it will query that Hadoop Hortonworks platform just like it was a relational data warehouse.

So they’ve really done an amazing job with this transition of both the skills as well as the technology and the data to the future, very cool hybrid architecture.

Matthew Holt: In terms of the webinar do you have to be highly technical to understand it or is this more for the general business audience, to bring people like me who should know better up to speed? Give me a sense of who you’re aiming these webinars at.

Dale Sanders: I think it’s most appropriate for CIOs, for sure, so the C level in that context, chief data officers, chief analytics officers, probably VPs and directors. It’s not deeply technical, but I do have a few very technical slides that a systems administrator or system engineer might find interesting, but it’s more kind of the strategy, what’s Microsoft doing culturally, why do we think that they’re turning the company around? I’d say it’s more along the strategy layer than the implementation layer.

Matthew Holt: Anything else we should know about the webinar other than just to show up?

Dale Sanders: One of the messages that I’m going to drop early on is that speaking of who should attend, one of the mantras that I am leaving behind where I get an opportunity is that business now moves at the speed of software. Like it or not, you can have great facilities, you can have great people, but if you put bad software in their hands, they’re going to be no better than the limiting factor of software.

So I’m really encouraging C levels to be a little more informed about the software that’s now running their business because all business now runs at the speed of software, and we have to make smarter decisions about the software we’re purchasing. So that’s one of the themes in this message, is that I think Microsoft is building a technology platform for analytics that you can feel comfortable running your business on and trying to educate folks about why that’s the cases.

Matthew Holt: Yes. I like to say that it’s hard to be running a technology company now, if you’re not steeped in the technology. And of course more and more of companies are becoming technology companies, including hospitals and health systems.

Matthew Holt: So thank God, I’m close to the end of my career. I think for conference companies and bloggers, so far, it’s on the edge!

Dale Sanders:Yeah, definitely.