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Not all health outcomes are issues of personal choice and genetics. Social determinants — the conditions into which we’re born, live, work, and play — have a huge effect on our health. This is especially true in our workplace, where stress and group habits can significantly undermine health at an individual, family and community level.

In fact, a 2015 study on work stressors and health outcomes for Behavioral Science & Policy found that job insecurity increases the odds of reporting poor health by about 50 percent, with high job demands raising the odds of having a physician-diagnosed illness by 35 percent Researchers also found that long work hours increase mortality by almost 20 percent. None of these numbers bode well for the overall health of a workplace population, which can lead to revenue loss through employee turnover, sick-time coverage, and claims.

Clearly, there’s a serious need to address and treat social determinants, not just through workplace culture but healthcare as well. But how do we take action on these issues when the current, reactive healthcare system itself can be a major obstacle?

Over 40 percent of Americans put off doctor visits due to concerns about cost. The average appointment only lasts around 15 minutes. That means the majority of patients are seeing their providers very rarely — and only briefly when they do. If patients aren’t seeing their providers regularly and are only going to urgent care or an emergency room when the situation seems serious enough to warrant the price of a visit, then “sick care” becomes the standard. Social determinants of health aren’t even on the radar.

The good news is that we have the means to solve the problem. Not only is primary care the perfect tool to address people’s whole health — the symptoms they present and the underlying causes that comprise so much of who they are — but a useful way to further understand, predict, and prevent the negative effects of social determinants in the workplace.

Primary care as the frontline in combating social determinants at work

Providers in the current, reactive sick care system are hard-pressed to get to know their patients or understand the social factors that are impacting their health. These short visits take a toll on provider-patient relationships, so providers can’t serve as they were trained to do and patients are more likely to leave with a prescription instead of the help they really need to change critical behaviors and situations.

When modeled correctly, removing time, cost and accessibility barriers via employer-funded care centers, primary care can become what it was always meant to be, and the perfect strategy to address social determinants in the workplace and beyond. Especially when the emphasis is on empathetic listening as a means to build stronger and more involved provider-patient relationships – where the primary care provider is the patient’s first and most important stop for healthcare, providers are able to delve more deeply into symptoms, concerns, and any contributing workplace social factors.

Add to that, a centralized primary care model lets employees receive the majority of their healthcare in one place with a single team that they know and trust. This results in less “sick care as healthcare” and more proactive, engaged employees who are more likely to visit their provider and manage their own health rather than waiting for the next expensive trip to the urgent care clinic or emergency room. And with knowledgeable professionals trained in empathetic listening to help guide behavioral change, patients are better equipped to make choices that minimize the effects of negative social determinants, both at work and outside of it.

Finally, the most effective primary care model includes embedded health coaches trained in behavior change methods, the facilitation of workplace health councils to take on suggestions for further improvement of services and delivery, and care coordination for specialist treatment when necessary.Primary care fights negative social determinants exactly where they occur

Working in an office exposes employees to historically unhealthy social determinants like unhampered access to sugar-laden sodas and snack foods from vending machines, secondhand smoke during breaks, sedentary habits, and psychosocial stressors that can include long work hours and high-performance demands.

Despite spending nearly 17.8 percent of GDP on healthcare, patient outcomes in the US are often much worse than in other highly developed high-income countries. This staggering figure reflects a huge gap in addressing non-clinical factors like social determinants of health.

An effective working model of primary care is a perfect tool for leveraging both healthcare and behavior change in a population, like an office or shared workspace, to improve health at scale right where it matters most.

Since social determinants affect particular groups of people in a community, it only makes sense that addressing them takes a community effort. By using empathetic listening to connect more fully with patients about their workplace environments and stressors, and implementing primary care to counteract social determinants of health in the workplace, better habits spread and health improves via 1:1 and community effects: provider to patient, peer to peer, employers to employees, and employees to their families.

In this type of system, even small changes can have a lasting impact. The City of Kirkland, for example, saw over 80 percent employee engagement and a 23 percent increase in primary care after incorporating a healthcare model that included an onsite primary care center. One of the smallest changes they made (initiated by one of their own employees) was to remove candy dishes from public areas. Coupled with behavior change health coaching, advocated and supported by a primary care team, several employees lost a significant amount of weight (50 lbs in one case) and became much healthier. Primary care improves workplace population health and social determinants into the future

With access to informatics based on previous years’ healthcare claims (including disease burden and predictive analysis), providers have the visibility and context necessary to anticipate health risks and engage employees proactively.

Primary care also allows for better targeting of negative social factors through claims data analysis, which is more effective than siloed “wellness” programs that provide mixed results and no evidence of reduced healthcare costs. Notable trends or patterns in claims data can help employers fine-tune workplace health initiatives, including onsite education or additional services to complement primary care — like health coaching and behavior change — to support patients even further in combating the effects of social determinants to their own health. When offered the exact kind of help they need, combined with empathetic listening and professional guidance to help them succeed, patients are more likely to take action on their own health journey and meet their goals. Progress and outcomes data can then be collected and more easily tracked, for further proof of primary care’s life-changing (and life-saving) effect on populations.

As the compiled data increases and the needs of the population become more predictable, the primary care team is able to further improve the healthcare experience by increasing efficiency in the system. Staff is able to create better appointment templates, stock the most frequently prescribed medications, adjust resources to meet population needs, and provide better risk identification and insight into the impact of social factors on community health.

The results are compelling. Employers utilizing a successful primary care model have saved up to 25 percent on overall healthcare costs in the first year alone. Moving away from the sick care toward primary care is not only a more efficient way to address social determinants of health in the workplace but a more budget-friendly one as well.

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Microsoft and SilverCloud collaboration to leverage AI for mental health

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The treatment of mental health conditions appears to have received a boost with a recently announced research collaboration between digital mental health company SilverCloud Health and Microsoft Research. The partnership was designed to further step up the former’s online offering with artificial intelligence.

A little background: During the past 18 months, the two have worked in tandem on research that marries Microsoft’s machine learning and AI technologies with SilverCloud, which specializes in the digital delivery of evidence-based mental healthcare to improve outcomes.

Ken Cahill, CEO of Boston based SilverCloud, said the technology enables “very tailored support” to each patient; meaning “more responsive and reactive care.” He called that process a “big departure” from existing digital delivery that’s generic or a one-size-fits-all approach and doesn’t accommodate for factors such as behavior, engagement, and effectiveness.

SilverCloud’s digital mental health platform is globally deployed in routine clinical care providing coverage to 65 million people, Cahill noted. Since 2012, more than one million hours of therapy have been delivered.

“Our (model) encourages patients to be more active (in the care) instead of a backseat spectator. We’re all individuals with unique challenges and underlying issues,” noted Cahill. He added that the goal of the AI collaboration with Microsoft is to provide personalized mental health care which will hopfeully improve mental healthcare outcomes globally.

Artificial intelligence necessarily evokes the feeling of machines doing the work that humans did, so Cahill emphasized that SilverCloud views itself as “an extender – not a clinician replacer.”

In other words, “we’re working with Microsoft on ensuring what we deliver is responsive, in context and appropriate for that end user.” He said that if you contemplate a user’s journey today, they’re accessing what’s often “generic care, that might be at the wrong intensity or severity level.” Conversely, “we’re delivering care much more in context and appropriate for each user.”

It seems abundantly important to contemplate the impact of the condition on the population. In a given year, around one in five adults in the U.S. — or 18.5 percent — experiences mental illness, according to the National Alliance of Mental Health.

The National Institute of Mental Health estimates that there were 11.2 million adults at least 18 years of age in the U.S. with serious mental illness in 2017 – accounting for 4.5 percent of all adults in the country.

NAMI showed that broken down by demographic group, the annual prevalence of the condition among U.S. adults looks like this:

  • Non-Hispanic Asian: 14.7 percent
  • Non-Hispanic white: 20.4 percent
  • Non-Hispanic black or African-American: 16.2 percent
  • Non-Hispanic mixed/multiracial: 26.8 percent
  • Hispanic or Latino: 16.9 percent
  • Lesbian, Gay or Bisexual: 37.4 percent

Even in the glare of all that, however, NPR.org, reported that mental health coverage was being short-shifted by health insurers. In 2015, behavioral care was several times more likely to be provided out-of-network than medical or surgical care. Statistics vary significantly from state to state, the report showed. Forty-five percent of office visits for behavioral health care were out of network in New Jersey; 63 percent in Washington D.C., Milliman stated. Alarmingly, a study published in 2016, at $201 billion, mental disorders paced the list of the costliest conditions in the U.S. in 2013.

Against this backdrop, there are several digital health efforts being addressed toward mental health, among which is the Microsoft-SilverCloud collaboration. Artificial intelligence can help to speed up the understanding and delivery of more personalized mental healthcare. This, in turn, can lead to early interventions that can then improve clinical outcomes.

Cahill, however, was very careful to explain that patient privacy would be safeguarded.

“We’re only looking to utilizing machine learning and the content to ensure the right support for the clinician and coaches by giving them better access to appropriate tools at the right time, while always ensuring privacy.”

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Reata to seek approval for Friedreich’s ataxia drug on positive Phase II results

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Shares of a small biotech company skyrocketed Tuesday following the release of positive data from its registration-directed Phase II study of a fatal genetic disorder that causes muscle weakness.

Irving, Texas-based Reata Pharmaceuticals rose 60 percent on the Nasdaq Tuesday morning and remained up 57.5 percent through the afternoon after the company announced positive results from the registrational second part of its Phase II MOXIe trial of the drug omaveloxolone in patients with Friedreich’s ataxia.

The company said that patients treated with the drug at 150mg per day showed a statistically significant, placebo-corrected 2.40-point improvement on the modified Friedreich’s Ataxia Rating Scale, or mFARS after 48 weeks of treatment. The company plans to submit regulatory filings to seek approval in the U.S. and in other countries.

FA, also abbreviated FRDA, affects about 1-in-40,000 people and is the most common inherited ataxia – or loss of control of the limbs – in Europe, the Middle East, South Asia and North Africa, according to the National Organization for Rare Disorders. Ataxia results in an unsteady gait and poor control of fine movements of the limbs, along with slurred speech and difficulty swallowing. Patients with FA ultimately progress from needing walking aids to requiring a wheelchair. Most patients are diagnosed before the age of 25, though late-onset FA can affect people between the ages of 26 and 39, and very late-onset FA can appear after age 40.

“Based on the results reported today for omaveloxolone, we are hopeful that our community will finally have its first approved therapy that can slow this relentlessly progressive disease,” Friedreich’s Ataxia Research Alliance President Ronald Bartek said in a statement. “We are extremely proud of, and grateful for, the FA community, including all those who have participated in this clinical trial and in the natural history study important in designing the trial.”

The news comes five days after Reata said it had reacquired from Chicago-based drugmaker AbbVie worldwide rights to omaveloxolone and other drugs belonging to its class, known as Nrf2 activators, along with ex-U.S. rights to the drug bardoxolone. Reata is paying AbbVie $330 million to the rights for bardoxolone, which includes a $75 million upfront payment this year and installments paid next year and in 2021, plus low single-digit tiered royalties from worldwide sales of omaveloxolone and other Nrf2 activators. The ClinicalTrials.gov page for MOXIe lists AbbVie and the Friedreich’s Ataxia Research Alliance as collaborators.

Another company, Barcelona, Spain-based Minoryx Therapeutics, is running a 36-patient, placebo-controlled Phase II study of its own drug for FA, MIN-102, which it launched in March of this year and which is scheduled to reach initial completion next March.

Photo: FotografiaBasica, Getty Images



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Think ‘Medicare For All’ is the only Democratic health plan? Think Again

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Sen. Elizabeth Warren (D-MA) speaks to the media in the spin room following the first night of the Democratic presidential debate on June 26, 2019 in Miami, Florida. 

If you tuned in for the first five nights of the Democratic presidential debates, you might think “Medicare for All” and providing universal care are the only health care ideas Democrats have.

With four months to go before the Feb. 3 Iowa caucuses, proposals on issues like the opioid epidemic have attracted less attention.

That is because big-ticket policy ideas ? like enrolling all U.S. residents into a Medicare-style program and eliminating private insurance ? can help candidates stand out in the eyes of voters during a primary, said Robert Blendon, a professor of health policy and political analysis at Harvard University and director of the Harvard Opinion Research Program.

But Blendon said he has not seen polling suggesting voters have an appetite for another major health care debate. Voters are more concerned with how much they have to pay for medical care, like prescription drugs ? “very practical, pocketbook issues,” he said.

“So it’s just my belief that whoever wins is going to have to switch back to pocketbook issues,” Blendon said of the eventual Democratic nominee.

A new poll echoes that. Democratic voters are eager to hear more from the candidates about other health care issues, according to a Kaiser Family Foundation poll released Tuesday. The results show 58 percent of Democrats and Democratic-leaning independents believe the candidates are not spending enough time talking about women’s health, including access to reproductive health services, for instance. And more than half said the candidates were spending too little time discussing surprise medical bills and ways to lower the costs people pay for care. (KHN is an editorially independent program of the foundation.)

The next Democratic presidential debate on Oct. 15 will give 12 of the candidates a fresh chance to talk about their ideas beyond sprawling health care reform. Let us walk you through a few proposals they have championed, plus what President Donald Trump is offering.

Sanders’ Plan To Cancel Medical Debt

Sen. Bernie Sanders of Vermont rolled out a sweeping proposal last month to overhaul medical debt collection with a headline-catching promise: to wipe clean the roughly $81 billion Americans owe in past-due medical debt.

And the issue is ubiquitous since polls show voters are deeply concerned about their out-of-pocket costs. Raymond Kluender, an assistant professor at Harvard Business School who researches medical debt, said about 20 percent of households have medical bills in collections.

Kluender said Sanders’ plan targets debt that is rarely repaid anyway, noting that only about 8 percent of what is sent to collection agencies is ever repaid. Although some limited research suggests debt forgiveness may have mental health benefits, Kluender said, the effect Sanders’ move would have “is hard to know.”

Here are highlights of Sanders’ proposal:

Empower the federal government to negotiate, then pay off past-due medical bills that have been reported to the credit agencies. To calculate how much that debt is, the Sanders campaign points to a 2018 study that showed 1 in every 6 Americans has a past-due medical bill on their credit report, with debt totaling about $81 billion.
Curb “abusive and harassing” debt collection tactics, including enforcing statutes of limitation that generally run from three to six years, depending on the state; limiting how often debt collectors can contact those who owe; requiring debt collectors to verify whether the information they have is accurate before attempting to collect; restricting the seizures of assets and garnishing of wages.
Task the Internal Revenue Service with examining nonprofit hospitals to ensure they meet the “charitable care standards” for facilities with nonprofit tax status.
Reform the bankruptcy court system to help those in debt.

Biden’s Plan To Curb Gun Violence

Former Vice President Joe Biden announced a plan this month to reduce gun violence, an issue that has become a must for most Democratic voters.

In addition to outlining his proposal to ban the manufacture and sale of assault weapons and require universal background checks, Biden took the opportunity to talk about his legislative history on guns: In 1993, he helped pass the law that established the background check system, and in 1994, he helped secure the 10-year assault weapons ban that has since lapsed.

He also drew attention to his newer ideas to change the system, including a push toward transitioning to “smart guns.”

But Biden’s plan does not go as far as that of some of his opponents ? including Sen. Cory Booker (N.J.), who would require a license to own a firearm.

Here is what Biden has said he would do on gun control:

Ban the manufacture and sale of assault weapons and high-capacity magazines, and otherwise regulate and buy back existing weapons.
Require background checks for all sales, and close certain loopholes, including those that allow people with mental health issues and hate crime convictions to have firearms.
Reward states that set up firearm licensing programs, require owners to safely store their weapons, and crack down on “straw purchasers” who buy firearms for those who cannot pass a background check.

Buttigieg’s Plan To Strengthen Mental Health Care

Mayor Pete Buttigieg of South Bend, Ind., introduced a wide-ranging, $300 billion proposal in August to improve treatment for mental health and substance abuse.

Few disagree on the need to increase access to mental health care in the United States, making the issue one that is unlikely to move voters on its own, Blendon said. But Buttigieg’s plan stands out for tripling the investments proposed by other Democratic candidates, including Massachusetts Sen. Elizabeth Warren.

True to his mayoral roots, Buttigieg adopts a locally driven approach. Among other strategies in his 19-page plan, he would give communities “most affected” by mental illness and addiction $10 billion annually for 10 years to address prevention and care.

His campaign claims the plan would enable about 10 million more people to access care over the first four years of the program. Here are some ways Buttigieg said he would do that:

Enforce mental health parity in coverage, including under Medicare and Medicaid.
Expand access to addiction treatments, including by deregulating buprenorphine, a medication-assisted treatment proven effective for opioid use disorder.
Reduce related incarceration, in part by decriminalizing all drug possession and expunging past convictions.
Hold drug companies “accountable” for their role in the opioid epidemic, including by supporting state-level lawsuits.
“Combat the epidemic of social isolation and loneliness,” including through a national service program that would pair older and younger Americans.

Warren’s Plan To End The Opioid Crisis

Warren unveiled an aggressive plan to combat the nationwide opioid epidemic last spring, proposing to spread $100 billion across the country to help state, local and tribal governments respond to the crisis.

And unlike Buttigieg and his $300 billion mental health and addiction plan, Warren outlined how she would pay for it ? with a tax on the richest 75,000 families.

“This crisis has been driven by greed, pure and simple,” she wrote in a Medium post detailing her plan.

Here is some of what her plan would do:

Prioritize and allocate money for public health departments, first responders and others in “front-line” communities.
Give states incentives to cover addiction services through state Medicaid programs.
Expand surveillance, research and access to treatment, including naloxone, the overdose reversal drug.

Trump’s Efforts On Medicare, Public Health And Drug Price

President Donald Trump caused a stir this year when he declared the Republican Party would become “the party of health care” and suggested he was working on another proposal to replace the Affordable Care Act.

But he has said little on the subject since then, and a Washington Post report last month said the White House has abandoned that effort in favor of damage control should the 5th Circuit Court of Appeals strike down the Affordable Care Act.

Instead, the Trump administration has picked up on a series of often disparate health issues, including changes to how the government pays for care, investments in public health crises and steps intended to pressure drugmakers to lower prices.

One of his latest moves came on Oct. 3, when Trump signed an executive order making a variety of changes to Medicare, including expanding the private Medicare Advantage plans available to seniors and changing the enrollment process. He took the opportunity to pan the progressive push toward a single-payer health care system as “socialist,” framing his changes as protections for seniors.

In addition to an ambitious plan to end HIV/AIDS introduced in February, the Trump administration unveiled a kidney care initiative in July that adjusts payment incentives to encourage preventive care, home dialysis and transplants. And last month, the administration said it was preparing to ban the sale of flavored e-cigarettes amid a public health scare over vaping and concerns about widespread use among teens.

And after promising to lower drug prices, Trump has struggled to make changes amid disagreements with the pharmaceutical industry and even fellow Republicans.

The administration has tasked the Department of Health and Human Services to work on other policies, including requiring hospitals to disclose prices and laying out a framework to allow, for the first time, the legal importation of prescription drugs from overseas.

Photo: Drew Angerer, Getty Images



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