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Here’s what needs to happen for digital health care information-sharing to actually become a successful reality

This is a contributed post by Aneesh Chopra, president of CareJourney and former U.S. chief technology officer in the Obama administration. It is in response to a Recode op-ed by Jared Kushner, senior adviser to the U.S. president, and Seema Verma, administrator of the U.S. Centers for Medicare Medicaid Services, which argues for progress in digital health care data.

A vision delivered needs relentless focus on execution

Jared Kushner and Seema Verma’s vision of a patient-centered health care information-sharing ecosystem through the MyHealthEData initiative drew near-universal praise, including my immediate take following last Tuesday’s announcement.

In the days that followed the launch, a multi-stakeholder coalition, of which I am a part, pledged to enable consumers to access all of their health and coverage information to share and use as they see fit. The U.S. Centers for Medicare and Medicaid Services (CMS) courted more developers to aid 53 million Medicare beneficiaries in navigating the delivery system. And the Department of Veterans Affairs recruited an initial cohort of 11 leading health systems to join in an “Open API Pledge” to push the industry faster toward a common language that can work for doctors and hospitals regardless of which particular IT system runs on the back end — including a new method for accessing group records when permitted.

Aside from the technical and regulatory actions, the initiative represents a fundamental change in the country’s default position when it comes to health data sharing. That is, from a focus on breaking down silos through direct connections across our fragmented health care system to a new paradigm where patients have the power to aggregate and share their records via the applications and services that can now compete to help them make best use of it.

This means safer care for our loved ones as clinicians use historical data to more accurately diagnose problems and prescribe interventions that won’t inadvertently do harm. It also means more efficient care as they order fewer repetitive tests or unnecessary hospitalizations, which contribute to the estimated 30 percent waste in the health care delivery system.

Alas, there isn’t an “easy” button to make it happen magically with policy statements, as we witnessed following President George W. Bush’s 2004 State of the Union pronouncement that within a decade, most Americans would have electronic access to their complete health information. Unlike moonshots, however, this vision is both practical and achievable.

In that context, I see three areas we must focus on as a nation to realize Jared and Seema’s vision:


The Obama Administration’s initial rules qualifying hospitals for their share of $37 billion in incentive payments required them to make electronic copies of health information available when patients discharged within three days, a relatively straightforward technical assignment that 93 percent have successfully met at last count. However, the rules allowed hospitals to file an exemption should patient’s not ask. A more sobering number is 53 percent, the share of hospitals reporting, under penalty of perjury, that not a single patient requested an electronic copy of their discharge instructions. I wonder whether any of those patients knew that they could even ask.

Pace of change

Since President Bush put us on the path of electronic health records, we’ve successfully digitized most of the manila folders that we used to see in our doctor’s offices, but only standardized a fraction of that information into a machine-readable language that other doctors, hospitals or care teams’ IT systems could interpret and use. We need more industry commitment to standardize the complete health record as we point that information to any app of a consumer’s choice. To that end, I’m hopeful CMS’s plan to incentivize health plans contracting with the government via changes to Star ratings and the VA’s “Open API Pledge” will bring more well-capitalized sectors to the center of this effort.

Empire strikes back

Jared and Seema chose to share this vision with an audience of thousands of health IT companies, developers and purchasers, many of whom profit from today’s friction-filled health data sharing economy. Success for MyHealthEData will undoubtedly result in lower costs — and thus less revenue — for firms whose business plans call for monetizing patient data, rather than competing on how to best help patients, clinicians and the care teams who serve them make the best use of that information. Some of those firms will respond in a manner that will violate new rules against “information blocking,” while others might ​skirt below that threshold while still adding excess transaction fees or threatening developers with intellectual property violations tied to data use.

Overcoming these barriers will not only take a “whole of government” approach, as Jared and Seema called for, but a true national movement to answer this call — so that a lower-cost, higher-quality health care system is within reach for all Americans, without a moment to waste.

Aneesh Chopra is the president of CareJourney and former U.S. chief technology officer in the Obama administration. He is the author of “Innovative State: How New Technologies Will Transform Government.” He was also a Recode 100 advisory board member in 2017.

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Giving patients control of their health information will help give patients control of their health

This is a contributed post by Jared Kushner, senior adviser to the U.S. president, and Seema Verma, administrator of the U.S. Centers for Medicare Medicaid Services. We’ve also asked Aneesh Chopra — former U.S. chief technology officer under the Obama administration and current president of CareJourney — to write a response, which you can read here.

Giving patients control of their health information

Health innovation is accelerating at a striking pace. In the past year, we have seen advances in treatments that could not have been imagined a generation ago. Yet while technology is changing every area of our lives, we continue to lack control of our most coveted information: Our health data. And as the costs of health care continue to rise, Americans are demanding this control so that they may make the best decisions based on the value and quality of their care.

The President has been clear through executive order that his administration is committed to putting patients in control of their health care, so that they may drive competition and better value. Agencies across his administration have been working to make these goals a reality by leveraging innovation to create efficiencies and by eliminating government burdens that have deprived Americans of the ability to control their own health information and shop for value.

While tremendous progress has been made in ensuring health providers use Electronic Health Records (EHRs), patients too often are not able to access and share their records, and their doctor often lacks the complete picture of their health. The inefficiencies created by closed data systems can lead to duplicative testing, possibly missed opportunities to improve outcomes and an inability for doctors to coordinate patient care. And in an era of artificial intelligence, precision medicine and robotic surgeries, our doctors paradoxically are reconciled to the use of fax machines to transmit patient data.

Last week, the administration launched the MyHealthEData initiative, a major step toward truly putting patients first and giving them the control of their health information that they demand and deserve. This administration-wide initiative, led by the White House Office of American Innovation, is designed to empower patients to control their health data and decide how it will be used, all while keeping the data safe and secure. And the administration is putting a strong, robust effort behind changing policies to accomplish these goals.

The Department of Health and Human Services (HHS) — through the Center for Medicare Medicaid Services (CMS), the National Institutes of Health (NIH), the Office of the National Coordinator for Health Information Technology (ONC) and the Department of Veterans’ Affairs — will use their authority to encourage and reward health care providers to fully adopt EHR and data sharing.

CMS is showing its commitment to putting patients first by relaunching its existing Blue Button portal to empower Medicare beneficiaries with the ability to gain direct control over their Medicare data so that they may make better health care decisions and achieve better outcomes. In Blue Button 2.0, beneficiaries will be able to authorize that their data be shared with caregivers, or even app innovators who may design technologies that enable these beneficiaries the ability to make more informed health care decisions.

The possibilities for better care through Blue Button 2.0 data are seemingly limitless, and may include enabling the creation of health dashboards for Medicare beneficiaries to view their health information in a single portal, or allowing pharmacies to know whether a patient is getting healthier due to medication adherence.

Soon CMS will release policies that make clear that providers and health plans must share data with patients in a usable electronic format. In doing so, we will double down on our commitment to protecting consumer privacy and make sure that our efforts to protect Americans from fraud and abuse are as rigorous as our efforts to give them control of their records.

Just imagine if we could choose to track our medical history throughout our lives, aggregating our doctors’ visits, claims data and health information gathered every second through wearable technology. Or if we could authorize researchers to use our information to develop cures that could save millions of lives, furthering the efforts at the NIH and ONC with their Sync for Science program.

Much work has been done to achieve adoption of electronic health records, thereby transitioning patient information from paper to digital form. Now we must travel the last mile to a destination where patients have control of their own health records and innovators are unleashed to develop new technologies that create better health outcomes and less of the frustration that is so often felt by patients and doctors alike.

Once we have achieved a system in which information is flowing freely from the patient to the provider, the advances in coordinated patient care that will result will be even greater than we can imagine today. We will create a health care ecosystem that allows and encourages the health care market to tailor its products and services to compete for patients on the basis of value convenience, customization and quality, in a way that continues to keep privacy at the forefront. And the healthier our citizens and the more efficient our health care system, the lower our costs will be.

The days of finding creative ways to hold patients hostage to a particular health care system soon will be over. It will no longer be acceptable to limit access to patient records or prevent patients and their providers from seeing their complete health history.

Through MyHealthEData, we have the opportunity to place our health data in the palm of each of our hands, and it is the goal of this administration to remove the barriers that are preventing this from occurring. When we control our own health information, only then will we truly be empowered to make our own health care decisions. In a world where Uber and Google have become verbs, technology has the power to put patients in the drivers’ seat of their own health care, where they belong.

Jared Kushner is the senior adviser to the president and the director of the White House Office of Innovation. Seema Verma is the administrator of the U.S. Centers for Medicare Medicaid Services.

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Health IT Is On FHIR: Fast Healthcare Interoperability Resources For Beginners


The health IT industry has been buzzing about FHIR (or fast healthcare interoperability resources — pronounced “fire”) since it was introduced by Health Level Seven (HL7) as a proposed interoperability standard. HL7 is a not-for-profit organization that has been developing ANSI-accredited standards for hospital information systems since 1987.

Take a moment to think about the various administrative systems in place in today’s health systems (such as billing and scheduling) and the many disparate clinical systems (like laboratory services, radiology, etc.) with which they need to interact. HL7 standards created a standardized application programming interface (API) to enable the exchange of these business and clinical transactions. In other words, it created a common language that all health IT systems could use to interpret and process medical records and data.

As someone who works in health IT, I appreciate the basic and straight-forward approach FHIR takes. Because it is based in simple API design, it allows developers to create plug-and-play applications that can interface with any EHR (electronic health record) and feed information directly into the provider workflow. It eliminates the problematic gaps that may take place in a typical document-based exchange.

Not only is it simple, but it also creates more usable data that can be searched even at a granular level. Today’s standards are based on C-CDA (consolidated clinical document architecture), which is designed to transfer entire documents rather than single resources or singular pieces of data. FHIR technology, on the other hand, enables the exchange of smaller resources or specific data elements and is based on modern, open-web protocols like those used by search engine browsers. For a physician needing access to a single immunization record, FHIR technology can process and return exactly the piece of data needed, not an entire case file of hundreds of pages that must then be searched through like a proverbial needle in a haystack.

If you believe the hype (and I think I do), the latest proposed standard could be a game-changer — and just in time to answer the need created by value-based health care models. Now more than ever, all stakeholders — patients, providers and payers — need secure ways to exchange data and information. And as a greater focus on population health emerges, the need for systems that can work together and stream real-time data to guide decision making will be essential.

What is especially exciting to me is the potential for FHIR to contribute to the development of technology apps to help manage patients outside of the hospital. Imagine an app that could passively collect blood glucose readings from a patient and simultaneously transmit them to a personal health record, to a physician’s smartphone and to a pharmacy to adjust insulin levels for a refill prescription that is picked up and delivered to the patient within minutes. Without the technical capabilities provided by FHIR, this real-time exchange of data would not be possible.

FHIR also stands to be the conduit by which patients themselves are finally able to access their longitudinal records to manage their own health. FHIR will enable the multitude of data files that reside in disparate systems to sync, creating one source of patient data. Multiple provider records, test results, data gathered from wearable devices, medication details and much more can converge into one all-inclusive medical record that can then be used to guide and improve health care decisions and delivery.

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The Health 202: Tillerson’s rhetoric didn’t match reality on global health


As Rex Tillerson exits the State Department, he leaves behind a confusing trail of mixed messages about whether the Trump administration wants to support or undermine U.S. funding for global health.

President Trump’s tweet yesterday morning that he’d fired Tillerson was sudden yet not surprising given the former oil executive’s fraught year as the country’s top diplomat. Tillerson’s tenure was marked by repeated clashes with the White House, a massive exit of talent from the agency he leads and an extreme reticence to interacting with the media.

Trump didn’t specifically cite Tillerson’s health-care policies as a reason for giving him the boot — the president instead pointed to disagreements in key areas of foreign policy such as the 2015 Iran nuclear deal and the approach to North Korea. But it’s easy to see why the two men were not on the same page when you look at how they approached major U.S. funding streams for priorities such as HIV/AIDS, maternal health and more.

Trump and Tillerson’s rhetoric did at times sounded quite positive toward funding major global-health initiatives. Trump used his first address to the United Nations to brag about U.S. investments in programs to take on AIDS, infectious diseases and human trafficking. And Tillerson occasionally expressed public support for global health programs, for example praising the Bush-era PEPFAR program in a major speech in October.

“PEPFAR has empowered people around the world to take their lives and their counties back,” Tillerson said at the time. “The Trump administration is committed to building on the progress we have already made by accelerating our approach that focuses on the hardest-hit populations.”

But the picture looks different when you consider Trump’s budget requests. The president called for sweeping cuts to virtually every funding stream in his 2018 budget plan last year and in the 2019 version the White House released last month.

The president’s most recent budget requested cuts of 18 percent for PEPFAR, which distributes medical supplies to combat HIV/AIDS in the developing world. The budget document seeks a 32 percent reduction for the Global Fund to Fight AIDS, Tuberculosis and Malaria; a cut of 24 percent for maternal and child health; and a whopping 50 percent slash for family planning and reproductive health.

“There was this rhetorical support, but the proposed cuts were so significant there seemed to be a disconnect,” said Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation.

It’s unclear precisely why the administration has called for such deep cuts to global health aid. For one thing, it’s one area Republicans in Congress are typically eager to fund. Congress routinely allocated even more dollars for global aid than President Barack Obama requested during his two terms. A major hallmark of George W. Bush’s presidency was dramatically expanding AIDS funding through both PEPFAR and the global fund — now the two biggest funding streams for global health initiatives.

There’s another reason the proposed cuts were puzzling. Foreign assistance makes up less than 1 percent of the federal budget, and less than one-fourth of that goes to global health. So trying to trim these programs would do next to nothing to move the needle on U.S. spending, regardless of deficit concerns.

Tillerson didn’t publicly push back against the Trump budget, which would have been unusual for a Cabinet member, anyway. But he provided little evidence that he was making global health any kind of priority for the State Department. Instead, he’ll be best remembered for his effort to reorganize the agency, for which he received much criticism as key positions remained unfilled for months.

“I don’t know that global health was a particular focus for Secretary Tillerson at all,” Thomas Bollyky, senior fellow for global health at the Council on Foreign Relations, told me. “He tended to focus pretty heavily on institutional issues, a big departure from the past.”

The Onion poked fun yesterday:

Morale Low At State Department After Only Employee Fired

A post shared by The Onion (@theonion) on Mar 13, 2018 at 10:01am PDT

Sen. Chris Murphy (D-Conn.) questioned whether Tillerson’s successor, CIA Director Mike Pompeo, will continue the restructuring: 

There is one way global health programs appeared to be sheltered from the staffing upheaval in Foggy Bottom. Experts say Tillerson left in place or brought on top administrators with strong backgrounds in global health, including Deborah Birx, who oversees PEPFAR, and Mark Green, head of USAID.

But, as with many other areas of Trump’s administration, it’s often hard to figure out the direction or priorities for top Trump appointees. That is how many global health experts said they’ll remember Tillerson.

“Part of the problem is this administration has been inconstant in its support,” said Jeff Sturchio, president of Rabin Martin, a global health consulting firm. “You never know if it’s going to change its tune overnight.”

The president discussing Rex’s departure:

This story, tweeted by the Post’s Ashley Parker, is a good illustration of how Trump treated Tillerson:

Abortion rights groups weren’t pleased Tillerson had enacted new bans on funding for organizations that provide abortions. Planned Parenthood tweeted that CIA Director Mike Pompeo, Trump’s choice to replace Tillerson, likely won’t be any better.


AHH: The panel that advises the White House on cancer policy is calling for immediate action to curb high costs for medications. The President’s Cancer Panel released a report yesterday outlining a series of recommendations  to ensure cancer drugs, which can at times run more than $100,000 per year, are priced according to value. The panel also sought to push cheaper, generic versions of drugs to the market.

“Cancer patients should not have to choose between paying for their medications or paying their mortgages. For so many, it is truly a matter of life and death,” panel chairwoman Barbara Rimer said in a statement. “This is a national imperative that will not be solved by any one sector working alone.”

The report says the complex process that goes into getting a drug to the patient “has resulted in drug prices that often do not reflect the benefits experienced by patients.” “Achieving better alignment could improve the quality of cancer care; create incentives for development of innovative, effective new drugs; and help address increases in drug spending that are threatening to put high-value drugs out of reach for some patients,” it says.


OOF: So exactly why does the United States spend twice as much on health care as other wealthy countries? A new study suggests Americans are using health care at similar rates to other rich countries, and the real difference is in the exorbitant prices of procedures and treatments, The Washington Post’s Carolyn Y. Johnson reports. The finding doesn’t mean Americans aren’t overusing health care — it just means that we aren’t alone in doing so, Carolyn explains.

The sweeping study of health-care expenditures, published in the Journal of the American Medical Association, found higher spending in the United States isn’t driven by overuse but by high prices — including doctors’ and nurses’ salaries, hospital charges, pharmaceuticals and administrative overhead. That finding contradicts conventional wisdom. “The thinking goes that the American health care system is uniquely set up to incentivize wasteful imaging scans, oodles of unnecessary prescriptions and procedures that could have been prevented,” Carolyn writes.

The study compared the United States with the United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland and Denmark from 2013 to 2016 on nearly 100 different measures of care. It found the United States spent about twice as much per person on health care, an investment that produced the shortest life spans and the highest rate of infant deaths. 

Veterans Affairs Secretary David Shulkin speaks on Capitol Hill. (AP Photo/Jacquelyn Martin, File)

OUCH: Will David Shulkin be the next secretary to get fired? Trump is souring on his embattled VA secretary and telling aides he might replace him as part of a broader shakeup of his Cabinet, The Post’s Lisa Rein and Josh Dawsey report. Senior White House officials said Shulkin could be forced out within days and the New York Times has reported the president is considering Energy Secretary Rick Perry, an Air Force veteran, to replace Shulkin. Trump invited Perry to the White House for lunch on Monday but did not formally offer him the job.

“A physician and former hospital executive who won unanimous confirmation by the Senate last year, Shulkin has been a favorite of Trump’s, racking up legislative victories and fast changes at an agency the president railed against on the campaign trail,” Lisa and Josh write. “But months of turmoil in VA’s senior ranks have roiled the ­second-largest federal bureaucracy, which employs 360,000 people. Shulkin has said publicly that high-level political appointees installed by the White House are scheming to oust him over personality and policy differences.”

This file photo shows the Food and Drug Administration campus in Silver Spring, Md. (AP Photo/Andrew Harnik, File)

—Yesterday, House lawmakers rejected a “Right to Try” bill that would have allowed seriously ill patients to bypass the FDA to access to experimental treatments. Our colleague Laurie McGInley reports the 259-to-140 vote followed a “spirited debate in which GOP lawmakers portrayed the measure, which was strongly backed by President Trump and Vice President Pence, as a last chance at survival for desperately ill patients.” They also noted dozens of states have passed or introduced similar measures.

But Democrats argued the legislation would weaken critical FDA protections without addressing the fundamental obstacles to experimental drugs. On Monday, more than 75 patient groups sent a letter to House leaders calling for them to reject the bill. The groups, which included the American Cancer Society, Cancer Action Network and the American Lung Association, said it “would not increase access to promising therapies.” The letter said the proposed model would be “less safe” for patients than the existing program, called expanded access.

“The FDA’s expanded-access program, which receives about 1,000 requests a year for experimental drugs, already approves 99 percent of the appeals,” Laurie explained. “But drug companies often balk at providing experimental drugs outside of clinical trials. The right-to-try legislation does not compel pharmaceutical firms to provide sought-after therapies.”

Logos of CVS and Aetna are displayed on a monitor above the floor of the New York Stock Exchange shortly after the opening bell in New York on Dec. 5, 2017. (REUTERS/Lucas Jackson)

—CVS Health and Aetna shareholders have voted to approve the merger between the pharmacy benefits manager and major health insurer. CVS first announced the deal to buy Aetna for $69 billion in December. Yesterday, the two companies held meetings where more than 98 percent of CVS shareholders’ ballots and 97 percent of Aetna shareholders’ ballots were in favor of the deal, CNBC reported. Now it’s up to the Justice Department to approve it.

“When this merger is complete, the combined company will be well-positioned to reshape the consumer health care experience, putting people at the center of health care delivery to ensure they have access to high-quality, more affordable care where they are, when they need it,” CVS Health chief executive Larry Merlo said in a statement.

President Trump delivers remarks to reporters alongside then-HHS Secretary Tom Price and White House counselor Kellyanne Conway. (REUTERS/Jonathan Ernst)

—It appears former HHS Secretary Tom Price has paid back the government for the costs of his jet travel that resulted in his resignation last fall. In a letter raising new questions about travel costs associated with flights White House senior adviser Kellyanne Conway took with Price, Rep. Elijah Cummings (D-Md.) noted Price had paid the Treasury $60,000 to reimburse costs of his travel.

In his letter to House Oversight Chairman Trey Gowdy (R-S.C.), Cummings urged Gowdy to subpoena White House documents on Cabinet officials’ pricey travel that includes information on Conway. He wrote that Conway’s travel, as well as costs from another White House official cost taxpayers “tens of thousands of additional dollars.” Cummings’s letter details four trips, including travel in May 2017 for Price, Conway and several staffers totaling more than $44,530, another trip in July totaling more than $14,569 for all passengers and a trip in September.

“To date, the White House has refused to provide any documents at all, including those relating to Ms. Conway’s participation in these trips, whether she intends to repay the taxpayers for the cost of her travel, or whether the President is considering any disciplinary action against her in light of his decision to fire Secretary Price for participating in the same trips,” Cummings writes.

The White House dismissed the letter, saying the “partisan attack on Kellyanne is ridiculous,” per ABC News. Deputy White House press secretary Hogan Gidley added: “Members of the President’s Cabinet invite relevant White House staff for official travel to events advancing the President’s agenda. When White House staff accompany Cabinet Members their travel plans are arranged, secured and financed by the inviting agency.”

–A few more good reads from The Post and beyond:


  • The Senate Indian Affairs Committee holds an oversight hearing on opioids in the Indian community.
  • The Patient-Centered Outcomes Research Institute and the American Heart Association hold a briefing on cardiovascular disease.

Coming Up

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the 340B Drug Discount Program on Thursday.
  • VA Secretary David Shulkin testifies before the House Appropriations Subcommittee on Military Construction, Veterans Affairs and Related Agencies on Thursday.
  • HHS Secretary Alex Azar testifies before the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies on Thursday.

Activists laid 7,000 pairs of shoes on the lawn of the U.S. Capitol to represent every young person killed by a gun since the Sandy Hook massacre:

Education Secretary Betsy DeVos calls onCongress to pass gun control legislation “without delay:”

Here’s Stephen Colbert’s take on Trump ousting Secretary of State Rex Tillerson: 

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Seven years of Syria’s health tragedy

News release

After seven years of conflict in Syria, WHO has renewed its call for the protection of health workers and for immediate access to besieged populations.

Attacks on the health sector have continued at an alarming level in the past year. The 67 verified attacks on health facilities, workers, and infrastructure recorded during the first two months of 2018 amount to more than 50% of verified attacks in all of 2017.

“This health tragedy must come to an end,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Every attack shatters communities and ripples through health systems, damaging infrastructure and reducing access to health for vulnerable people. WHO calls on all parties to the conflict in Syria to immediately halt attacks on health workers, their means of transport and equipment, hospitals and other medical facilities.”

Health systems are being attacked in the very places where they are needed most. An estimated 2.9 million Syrians live in UN-declared hard-to-reach and besieged locations. WHO is providing health assistance to many of these areas but lacks consistent access.

In East Ghouta, nearly 400,000 people have lived under siege for half a decade. Basic health supplies have all but run out, and there are now more than 1,000 people in need of immediate medical evacuation.

“It is unacceptable that children, women, and men are dying from injuries and illnesses that are easily treatable and preventable,” said Dr Tedros.

Critical medical supplies are also routinely removed from inter-agency convoys to hard-to-reach and besieged locations. Earlier this month, more than 70% of the health supplies intended to reach East Ghouta were removed by authorities and sent back to the WHO warehouse. The items removed are desperately needed to save lives and reduce suffering.

Seven years of conflict have devastated Syria’s healthcare system. More than half of the country’s public hospitals and healthcare centres are closed or only partially functioning and more than 11.3 million people need health assistance, including 3 million living with injuries and disabilities.

WHO is committed to ensuring that people across Syria have access to essential, life-saving healthcare. Last year, WHO delivered over 14 million treatments across the country, including through cross-border and cross-line services.

“The suffering of the people of Syria must stop. We urge all parties to the conflict to end attacks on health, to provide access to all those in Syria who need health assistance, and, above all, to end this devastating conflict,” said Dr Tedros.

For more information, please contact:

Tarik Jašarević
Communications Officer
Telephone : +41 22 791 5099
Mobile: +41 793 676 214

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The real reason the US spends twice as much on health care as other wealthy countries

A sweeping new study of health-care expenditures found that the United States spends almost twice as much on health care as 10 other wealthy countries, a difference driven by high prices — including doctors’ and nurses’ salaries, hospital charges, pharmaceuticals and administrative overhead.

For years, it has been clear that Americans are not getting a good bang for their buck on health care. The United States spends more than any other country and gets much less, at least as measured by life expectancy or infant mortality. Policy fixes have tended to focus on the idea that medicine is being overused. The thinking goes that the American health care system is uniquely set up to incentivize wasteful imaging scans, oodles of unnecessary prescriptions and procedures that could have been prevented.

The new study, published in the Journal of the American Medical Association, suggests instead that Americans are using health care at similar rates to other rich countries, and the real difference is the prices of procedures and treatments. The finding doesn’t mean Americans aren’t overusing health care; it just means that we aren’t alone in doing so.

“The narrative that has come up, that has developed, is that America spends so much more because Americans demand more health care,” said Ashish Jha, a professor of health policy at the Harvard T.H. Chan School of Public Health. “We have done, through the Affordable Care Act and other policy efforts, almost nothing about prices. To me, that has been the big missed opportunity.”

The study compared the United States with the United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland and Denmark from 2013 to 2016 on nearly 100 different measures of care. It found that the United States spent about twice as much per person on health care, an investment that produced the shortest life spans and the highest rate of infant deaths. The United States used more imaging scans than most countries but spent much less on inpatient hospital care. Its utilization patterns were overall similar to other wealthy countries — leading the researchers to focus on other drivers of difference.

Nonspecialist doctors in the United States are paid on average $220,000 per year — double the average salary in the other countries. Nurses and specialists were also compensated better. Defenders of doctors’ higher salaries often point to the burden of medical school debt in the United States, but one study found that taking into account tuition cost didn’t explain the difference in earnings.

Administrative costs were 8 percent of gross domestic product in the United States, vs. 1 to 3 percent in other countries.

Pharmaceutical spending was $1,443 per person in the United States, followed by Switzerland at $939 per person. But the United States also had access to the most new, brand-name drugs, with 111 vs. 26 in Switzerland.

The notion that high prices are driving health-care spending isn’t new. In 2003, a Health Affairs paper called “It’s the Prices, Stupid” made a similar argument, with less comprehensive data.

But prices can be difficult to curb, because one person’s high price is another person’s profit margin or salary. Hospitals are often among the biggest employers in a region. Pharmaceutical companies offer American consumers big innovation but big price tags — and the debate about how or whether something needs to be done about drug costs has typically fallen apart under the weight of extensive lobbying by the industry. There are two main ways to lower prices, which fall along partisan lines: price-setting or  increasing competition.

“I feel like America has figured out how to do the worst of both,” Jha said. “We have, in Medicare, a price-setter that is very weak, and whenever Medicare tries to negotiate or get aggressive on prices, Congress intervenes and holds them back. Most markets are pretty inefficient with a lot of power with providers. Combine a weak price-setter with inefficient markets, and you have the American health care system.”

Jha told a story about a recent trip to Paris, where his briefcase was stolen. A generic beta-blocker that he takes daily, at a cost of about $1 a pill, was in his luggage. He needed a few more pills to hold him over during his trip. He went to a pharmacy to ask if it would be possible to get four pills.

The pharmacist dispensed the medication — the brand name version of the drug — at only 10 cents a pill.

“It was crazy. I thought, ‘What is going on? This is Paris, which we don’t think of as some cheap city,’” Jha said. “One thing that is undoubtedly clear to me from all the data I have looked at is, whether it’s hip replacement or an MRI, we spend much more [in the U.S.] per procedure than we do in these really expensive places like Switzerland or the U.K. — in ways that really don’t make any sense.”

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Alphabet Has Filed 186 Health Care Patents. Watch Out, World

Verily Life Science’s “study watch” designed to collect data during clinical studies. Verily is a spinout from Alphabet’s Google X incubator.

Big tech firms have already disrupted retail, media, finance and nearly every other industry. Up next? Life sciences, according to
Ernst Young

Between 2013 and 2017
filed over 300 patents tied to health care, according to a new report published by the Ernst Young Life Sciences division released Tuesday. Alphabet filed 186 patents, Microsoft filed 73 and Apple filed 54 in that time span, representing a 38% increase in the number of health-related patents filed by these three companies every two years.

This kind of deep-pocketed competition represents a new challenge to drug companies, Ernst Young says. EY argued that while blockbuster drug launches can still be incredibly lucrative, as reimbursement pressures have grown, the number of drugs that are actually achieving at least 50% of analysts’ peak sales forecasts has been falling since 2005. Instead, EY’s report suggests, life sciences companies need to focus on harnessing the data they have to develop digital platforms that could create a way for patients to understand their health in a way that AirBnb has helped consumers find a cheap room or Uber has helped find a ride.

“Some of the skills that tech companies have are exactly what the industry needs,” said Ernst Young global life sciences industry leader, Pamela Spence said, pointing to big tech firms’ wealth of data scientists on staff. “The rising demographics of an aging population and the emerging middle class around the world has suddenly created a huge additional market for health care.”

Like pharma doesn’t know it. EY says there have been nearly 90 deals since 2014 where life sciences companies have partnered with tech companies. Teva Pharmaceuticals partnered with
in 2016 to combine data pulled from wearable devices with a clinical trial monitoring Huntington diseases progression.  
has partnered with Verily Life Sciences, and Alphabet company, on sensors to be embedded in contact lenses. Roche recently purchased health-tech firm Flatiron for $1.9 billion.

Alphabet’s health care innovations thus far are running the gambit from artificial intelligence acquisition DeepMind and Verily, to its own partnerships with virtual diabetes clinic Onduo, smart operating room company Verb Surgical, and medical device startup Galvani Bioelectronics. Meanwhile, according to the types of patents they’ve filed, Microsoft has focused on developing devices aimed at monitoring chronic conditions, and Apple’s patents have focused on making iPhones’ ability to capture and use biometric data in more ways.

Amazon, according to EY’s research has not filed any health care patentsyet. But their announced partnership with
Berkshire Hathaway
and JP Morgan coupled with the company’s secretive drug delivery team, 1492, represents yet another threat to health care incumbents.

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Gathering Health Care Insights from Data About People’s Daily Lives

Vincent Tsui for HBR

While the healthcare industry becomes increasingly adept at applying clinical and claims data to improve care, it has largely ignored other data sources that provide the greatest opportunity to positively impact health and cost at scale. The dependence on this limited data set originates in the system’s orientation toward “sick care” — treating illness. To radically improve health care, we need to apply consumer demographic and lifestyle data in ways that help the health care industry shift its focus from providing sick care to partnering with people (rather than “patients”) to help them stay well.

The government and private sector have dedicated enormous capital and energy to building electronic health record and claims systems to automate and record sick-care transactions. This digitization supports consistent quality of care and payment accuracy, but the data is primarily retrospective – it tells a story of what has been. To most effectively predict future health and how a person will interact with health resources, the health care industry must learn to integrate selected consumer data with medical and claims data.

Insight Center

To understand the relationship between consumers’ demographic data, daily-living choices, health and interactions with the health care system, we created a proprietary database drawn from multiple private and public sources that represents 275 million consumers across America. The data includes disparate demographic and lifestyle information such as income, home ownership, household composition, buying patterns, voting history, transportation choices, social networking activity and physical activity as measured by tracking devices. It also includes clinical, claims and health-resources use data made available through our partnerships with client providers and insurers. We have identified approximately 800 variables that are indicators of consumer behavior and intent that robustly and meaningfully supplement existing clinical and claims data.

Our machine learning algorithms and models combine these data and learn from each combination of data points analyzed. For example, we might analyze the relationship between a diagnosis, income level and commuting methods to identify predictable patterns. Through this sort of data-crunching, we generate a new set of predictive models every ten seconds. These models illuminate the behavioral contributors to health and allow us to identify the interventions and messages that will have the greatest impact in shaping consumers’ behavior to improve health.

We have found, for instance, that household composition and voting history can be leading indicators for emergency room usage. Childless or only-child households are more likely to use the ER inappropriately, which suggests educational interventions and incentives that could reduce such use. Our predictive models can also reveal which health engagement channels will be most effective for a given individual — text, automated voice, email, mail, phone, coaching or a combination approach. (Just for fun, we used the model to determine that Philadelphia Eagles fans are more likely to join condition-management programs if contacted by text than by email.)

In one case, by combining key consumer attributes including socioeconomic status, voting history, education level, medication adherence rates and demographics with a national health plan client’s data, we generated a 16% increase in medical cost savings and a 10 percent improvement in care-management program engagement. This was achieved by identifying individuals who were both at elevated risk of being readmitted to the hospital within 30 days and who would likely be receptive to outreach and respond well to a care management program.

In another case, we determined the likelihood of an individual not recertifying, but still eligible for, a Medicaid program. Our predictive models successfully identified the top 25% who were 1.8 times more likely to not recertify and the optimal outreach channels for engaging them (automated voice and live agent calls). This targeted and coordinated outreach resulted in a 39% decrease in recertification failure rate compared to the control group.

Another way we’re putting predictive models to work is to fill the gaps in cases where clinical data is unavailable or inadequate. One payer client, for example, had a dearth of information for a largely overlooked population segment. The analysis of lifestyle and demographic information revealed that 14 percent of those consumers were likely to be obese and/or diabetic and would be receptive to targeted interventions, giving the client a head start on engaging that population.

Failing to take consumer data into account is to ignore the most powerful change-agents in health care — consumers themselves. Clinical data and expertise are vital, but the only way the healthcare industry will fundamentally improve care is to understand consumers at an individual level – by leveraging information about every aspect of their lives — to create personalized interventions that ultimately drive behavior change and improve outcomes.

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$40-a-month baby health app free for some DC moms

WASHINGTON — Pacify, a D.C.-based app that gives pregnant women and new mothers 24/7, instant access to nurses, nutritionists and lactation consultants, makes the app free to low-income women in the District.

Since the partnership with the D.C. Department of Health Women, Infants and Children program launched in June 2016, more than 500 D.C. residents who qualify for help through the federally funded Women, Infants and Children program have signed up for access to the service, and have made more than 1,500 video calls to Pacify’s network of board-certified lactation consultants alone.

Subscription to the Pacify app is $40 a month.

The app displays three simple buttons: Nurse, Pediatric Nutritionist and Lactation Consultant. A tap of a button connects the user to experts in each field and the response time — usually a FaceTime-like video conversation — averages 30 seconds or less.

New mothers have lots of questions, and Google can’t replace a real-time conversation with a health care expert, the company says.

If new moms have questions about the consistency of foods, they can press the pediatric nutrition button, Pacify’s Melanie Silverman told WTOP.

“And as things go on, lactation experience changes, a fever may pop up so they can press the nurse line, and it is this kind of beautiful, one-stop for pediatric care,” Silverman said.

Access is unlimited.

The network of experts are paid for their time by Pacify, and it is based on an on-demand Uber model.

“They turn their phones on when they want to work. It is really neat on the provider side, because they may work part-time and want to take some extra hours on weekends, or holidays,” Silverman said.

Silverman acknowledged the $40 a month fee sounds expensive at first blush, but pointed out it is both a time saver — no need to make an appointment, bundle up the baby and pay a visit to a pediatrician’s office — and it quickly addresses less serious medical conditions expectant women, new mothers and their babies experience.

Most interactions occur outside of regular business hours.

Silverman said $40 is actually pretty inexpensive, considering the service the app provides.

“You look at apps that are free or 99 cents, and you look at this and it’s $40 a month, but I want to put this in perspective,” she said. “When a lactation consultant comes into somebody’s home it is $150 to $250 an hour. When you put an app on somebody’s phone for $40 a month for 24/7 care, it’s a bargain.”

The Pacify app is also being offered as an employee benefit by some employers, and Silverman says a lot of people are “baby gifting” it to expecting friends and family members.

Pacify also serves mothers through contracts with Medicaid Managed Care companies, state departments of health and breast pump manufacturers.

Like WTOP on Facebook and follow @WTOP on Twitter to engage in conversation about this article and others.

© 2018 WTOP. All Rights Reserved.

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Bids to Curb Health Care Costs Offer Little More Than Talk

It started as a bipartisan attempt to curb soaring health care premiums.

But Congress’ effort to stabilize the nation’s insurance markets is faltering amid escalating demands by each party and erratic positions by President Donald Trump. Democrats want bigger federal subsidies for consumers under President Barack Obama’s health care law while Republicans, still fighting that statute, aim to relax its coverage requirements and win abortion restrictions.

The bickering could collapse the whole effort, with each side blaming the other when next year’s expected higher insurance rates are announced — just weeks before Election Day, on Nov. 6.

Last week, Sen. Patty Murray of Washington, a lead Democratic negotiator, called GOP demands on abortion limitations “a complete nonstarter.” A spokeswoman for Rep. Ryan Costello, R-Pa., sponsor of the House GOP package, said if Democrats want to oppose the effort “by playing abortion politics, then shame on them.”

Top News Photos: 5 Dead in New York City Helicopter Crash

[NATL] Top News Photos of the Week

Some Democrats think they’d reap political gains if the talks collapse since polls show the health care statute is widely popular and the public would largely fault Republicans if consumer costs spiral skyward.

“Either Republicans help stabilize the market or they own these premium and deductible increases,” said Rep. Kurt Schrader, D-Ore. “And I’d be glad to help crucify them if they don’t want to do something very reasonable.”

The effort forces Republicans to choose between trying to avert bad news about premiums shortly before elections or standing by their opposition to anything that could be viewed as propping up “Obamacare.”

Trump hasn’t clarified things for his party. In a single day last October, he bounced from praising one bipartisan plan as “a very good solution” to labeling it “bailouts to insurance companies.”

Signs indicate insurance prices will likely continue upward. Without federal action, premiums are expected to rise in every state by up to 32 percent next year and by a cumulative 90 percent or more through 2021, according to a report released last week by Covered California, the state agency overseeing California’s health care exchange.

Ominously for the GOP, the study found that 14 of the 17 states that risk potentially “catastrophic” three-year rate increases of 90 percent or more backed Trump in the 2016 elections.

‘Keep America Great!’: Trump Unveils 2020 Slogan at Pa. Rally

[NATL-PHI] 'Keep America Great!' Trump Unveils 2020 Slogan

President Donald Trump announced his 2020 re-election slogan, chanting “Keep America Great!” in front of a Pennsylvania crowd Saturday. Trump also discussed congressional redistricting.

(Published Sunday, March 11, 2018)

To try containing those increases, lawmakers crafted two bipartisan bills last year.

One by Sens. Susan Collins, R-Maine, and Bill Nelson, D-Fla., would provide billions to states for reinsurance. The funds would help insurers afford covering some of the sickest, costliest customers.

Another by Murray and Sen. Lamar Alexander, R-Tenn., would revive federal payments to carriers to subsidize discounts they give lower-earning consumers for costs like deductibles and copayments. Trump halted the subsidies in October as part of his effort to upend Obama’s law after federal courts said Congress hadn’t properly approved the money.

Obama’s statute requires insurers to provide those cost reductions, which last year cost the government $7 billion to help around 6 million people. Insurers boosted premiums to make up the difference.

Complicating what Congress might do, Trump’s halt of those subsidies to insurers has had an unanticipated, positive impact for low-income consumers.

Because of how most state regulators let carriers raise premiums, federal tax credits that help lower-income customers buy coverage grew so robustly that many were better off than before. Reviving the subsidies could actually increase out-of-pocket costs for at least 1.6 million people, the liberal Center on Budget and Policy Priorities says.

Chuck Todd Responds to President Trump’s Vulgar Jab

[NATL-DC] Chuck Todd Responds to President Trump's Vulgar Jab

At a campaign stop in western Pennsylvania, President Donald Trump described “Meet the Press’” Chuck Todd using a vulgar phrase. Todd tells News4′s Adam Tuss that it’s challenging to parents when the president uses vulgarities.

(Published Sunday, March 11, 2018)

In other changes since last fall, the new GOP tax law has erased the tax penalties enforcing the “Obamacare” individual mandate, which requires most people to buy coverage. Trump has also proposed making it easier for insurers to sell policies that last less than a year and have fewer consumer protections than Obama’s statute imposes, like required coverage for people with pre-existing conditions.

Citing those blows to Obama’s law, Democrats say the tax credits that help millions pay premiums need to be more generous and cover more people. They want to restore spending that’s used to encourage people to buy coverage and block Trump from allowing the sale of low-cost, low-coverage plans.

Republicans have their own demands.

A White House memo says any effort to strengthen markets must have language that “ensures all federal dollars are life-protected” — a reference to restrictions on using the programs to finance abortions.

AshLee Strong, spokeswoman for House Speaker Paul Ryan, R-Wis., said last week that the effort to stabilize insurance markets must heed the GOP’s long-imposed legal bar against using federal funds for nearly all abortions.

“That is not negotiable for House Republicans,” Strong said.

White House: No North Korea Meeting Without ‘Concrete Actions’

[NATL] White House: No North Korea Meeting Without 'Concrete Actions'

White House Press Secretary Sarach Huckabee Sanders said that the United States has made “zero concessions” in agreeing to meet with North Korea. She spoke to reporters from the White House on Friday afternoon.

(Published Friday, March 9, 2018)

The White House memo also demanded that insurers be allowed to charge older customers higher premiums than Obama’s law permits and get more leeway to renew short-term, low-coverage policies.

An agreement would likely be included in a government-wide spending bill Congress wants to finish by March 23. It’s probably the year’s last must-pass measure, so proposals left behind will face difficulties becoming law.


Associated Press writers Ricardo Alonso-Zaldivar and Jill Colvin contributed to this report.


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