Medicare Advantage Plans Cleared To Go Beyond Medical Coverage — Even Groceries

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Air conditioners for people with asthma, healthy groceries, rides to medical appointments and home-delivered meals may be among the new benefits added to Medicare Advantage coverage when new federal rules take effect next year.

On Monday, the Centers for Medicare & Medicaid Services (CMS) expandedhow it defines the “primarily health-related” benefits that insurers are allowed to include in their Medicare Advantage policies. And insurers would include these extras on top of providing the benefits traditional Medicare offers.

“Medicare Advantage beneficiaries will have more supplemental benefits making it easier for them to lead healthier, more independent lives,” said CMS Administrator Seema Verma.

Of the 61 million people enrolled in Medicare last year, 20 million have opted for Medicare Advantage, a privately run alternative to the traditional government program. Advantage plans limit members to a network of providers. Similar restrictions may apply to the new benefits.

Many Medicare Advantage plans already offer some health benefits not covered by traditional Medicare, such as eyeglasses, hearing aids, dental care and gym memberships. But the new rules, which the industry sought, will expand that significantly to items and services that may not be directly considered medical treatment.

CMS said the insurers will be permitted to provide care and devices that prevent or treat illness or injuries, compensate for physical impairments, address the psychological effects of illness or injuries, or reduce emergency medical care.

Although insurers are still in the early stages of designing their 2019 policies, some companies have ideas about what they might include. In addition to transportation to doctors’ offices or better food options, some health insurance experts said additional benefits could include simple modifications in beneficiaries’ homes, such as installing grab bars in the bathroom, or aides to help with daily activities, including dressing, eating and other personal care needs.

“This will allow us to build off the existing benefits that we already have in place that are focused more on prevention of avoidable injuries or exacerbation of existing health conditions,” said Alicia Kelley, director of Medicare sales for Capital District Physicians’ Health Plan, a nonprofit serving 43,000 members in 24 upstate New York counties.

Even though a physician’s order or prescription is not necessary, the new benefits must be “medically appropriate” and recommended by a licensed health care provider, according to the new rules.

Many beneficiaries have been attracted to Medicare Advantage because of its extra benefits and the limit on out-of-pocket expenses. However, CMS also cautioned that new supplemental benefits should not be items provided as an inducement to enroll.

How Will a Ban on Plastic Straws Affect You?

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From Malibu to London, cities around the world are banning the use of plastic straws in an effort to reduce the amount of plastic garbage that piles up on our beaches and swirls around in our oceans. This is good news for the environment, but could pose hardships for people with disabilities like quadriplegia and cerebral palsy who rely on straws in order to enjoy their drinks.

“I think a lot of people feel overwhelmed by the magnitude of the plastic problem,” said Diana Lofflin, the founder of Strawfree.org, an activist organization based in San Diego, to the New York Times.“Giving up plastic straws is a small step, and an easy thing for people to get started on. From there, we can move on to larger projects.”

It’s not just cities embracing the ban, as Scotland plans to be straw-free by 2019 and Taiwan by 2020. A growing list of restaurants aren’t waiting for laws, but are voluntarily withholding plastic straws. To see which establishments no longer offer straws in your area, visit Thelastplasticstraw.org.

Straws are necessary for many people with limited hand function or who have difficulty swallowing, and this rush to eliminate straws is creating access problems. “The anti-plastic straw debate has enraged me because it has been one-sided,” said the United Kingdom’s Baroness Tanni Grey-Thompson, who has spina bifida, to the BBC. “No one has consulted disabled people. A significant number of us rely on the humble plastic straw to be able to drink a glass of water, wine or a cup of coffee.”

With that in mind, we are consulting you. How will the movement to ban plastic straws affect you? Will you change your straw usage, or have you already changed it? If you’ve changed it, what are you using instead?

Medicaid Continues to Help Schools Help Children

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School superintendents confirm Medicaid’s key role in schools, especially for children with disabilities. In a recent survey of 1,000 superintendents, 57 percent of districts reported that they’d have trouble meeting special education mandates without Medicaid funding. That’s just one of the ways that Medicaid helps schools and children. Without Medicaid funding to cover health care costs for Medicaid-eligible children, many schools would have to cut positions and programs, not just in health care but in general education as well.

The Individuals with Disabilities Education Act (IDEA) requires that children with disabilities have access to public education in the least restrictive environment based on their individual needs, which for some children means getting the health care services, like speech and physical therapy, they need to get an effective education. Federal IDEA funding isn’t adequate to meet the special education needs of children with disabilities, but IDEA requires schools to prioritize special education over general education. Medicaid helps schools fulfill IDEA requirements by reimbursing schools for health care services they provide to Medicaid-eligible children. Moreover, Medicaid helps mitigate potential cuts to schools’ general education budgets to pay for their special education programs. Without Medicaid, the survey revealed, 29 percent of districts would have to cut general education positions and programs.

Rural communities overwhelmed with hepatitis see few options

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Narcotic opioids heroin, fentanyl and carfentanil were responsible for more than 64,000 drug overdose deaths in 2016 and the drug crisis continues to grow across the country. In Ohio people are dying from accidental opioid overdose deaths more often than from car accidents, with an estimated 14 dying each day. As the rate of drug use increases in rural Ohio, the number of life-threatening MRSA (Methicillin-resistant Staphylococcus aureus) and chronic hepatitis C infections are on the rise among people who use shared needles.

Stephanie Ottesen arrived at the Clinton County Memorial Hospital emergency department overwhelmed with pain in 2015.

“I thought, because I had been using a little bit of meth, but I was mostly a heroin addict, I had been staying up for days and I thought it was related to that meth and I just needed sleep. But then I had to take my jacket off at the hospital and the nurses saw my arm and I had open sores on my arm,” said Ottesen.

The open sores, near her wrist, remained covered most of the time. Ottesen said she was trying to hide the infection and described how it was caused by using shared syringes when she injected heroin or methamphetamine with her friends in her hometown of Blanchester.

“They knew right away that it was MRSA and rushed me in for treatment,” said Ottesen.

She spent hours in the emergency department. She learned that the multi-drug resistant MRSA had spread into the valves around her heart. Ottesen was placed into a Warren County nursing home for three months and said she was treated with a strong antibiotic, vancomycin, to kill the MRSA bacteria. Ottesen said she thought she was going to die from the MRSA infection but over time the antibiotic healed her heart.

She will always be a carrier for MRSA and will have to cope with having permanent skin abscesses and high blood pressure. Losing a piece of the skin on her arm from MRSA was traumatic, she said, and it wasn’t the last time she would rush to the emergency department to be seen for overwhelming pain.

Additional tests during her stay at the nursing home confirmed the MRSA infection was co-morbid with the hepatitis C virus, Ottesen said. Hepatitis C is transmitted primarily through contact with blood and using shared needles when injecting drugs. Recent research has shown that the hepatitis C virus can also survive outside of the body on surfaces for three weeks, with some research reportedly showing that it can remain active for six weeks. Hepatitis C infections increased 1,000 percent nationally in the period between 2011-15, the Centers for Disease Control and Prevention (CDC) reports, and the CDC attributed the growth to the opioid crisis in counties across the country.

“I was having pain in my back near my liver. I couldn’t walk. I went back to the hospital and the hospital did a CAT scan — they called me back saying there was a spot on my liver,” said Ottesen.

Ottesen said she was surprised by how suddenly the permanent damage set in once she had become infected with the pathogens. Left untreated, hepatitis C becomes a chronic disease that can possibly cause liver cancer or the kidneys to shut down.

abies Who Are Given Antacids Are More Likely to Develop Allergies

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Infants who are given antacids like Zantac or Pepcid are more likely to develop childhood allergies, perhaps because these drugs may alter their gut bacteria, a new large study suggests.

Early use of antibiotics also raised the chances of allergies in the study of nearly 800,000 children.

Researchers combed the health records of kids born between 2001 and 2013 and covered by Tricare, an insurance program for active duty and retired military personnel and their families. A surprising 9 percent of the babies received antacids, reflecting the popularity of treating reflux in infancy.

Over four years, more than half of all the children developed allergies to foods or medications, rashes, asthma, hay fever or other allergic diseases. The study couldn’t prove causes, but the connection with antacids and antibiotics was striking.

For children who received an antacid during their first six months, the chances of developing a food allergy doubled; the chances of developing a severe allergic reaction called anaphylaxis or hay fever were about 50 percent higher. For babies who received antibiotics, the chances doubled for asthma and were at least 50 percent higher for hay fever and anaphylaxis.

The results were published Monday in JAMA Pediatrics.

“These medicines are considered generally harmless and something to try with fussy babies who spit up a lot,” said lead researcher Dr. Edward Mitre of the Uniformed Services University in Bethesda, Maryland. “We should be a little more cautious prescribing these medicines.”

THE COMPLEX INTERPLAY BETWEEN CHRONIC INFLAMMATION, THE MICROBIOME, AND CANCER

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Cancer is a multifaceted condition, in which a senescent cell begins dividing in an irregular manner due to various factors such as DNA damage, growth factors and inflammation. Inflammation is not typically discussed as carcinogenic; however, a significant percentage of cancers arise from chronic microbial infections and damage brought on by chronic inflammation. 

A hallmark cancer-inducing microbe is Helicobacter pylori and its causation of peptic ulcers and potentially gastric cancer. 

This review discusses the recent developments in understanding microbes in health and disease and their potential role in the progression of cancer. 

To date, microbes can be linked to almost every cancer, including colon, pancreatic, gastric, and even prostate. We discuss the known mechanisms by which these microbes can induce cancer growth and development and how inflammatory cells may contribute to cancer progression. 

We also discuss new treatments that target the chronic inflammatory conditions and their associated cancers, and the impact microbes have on treatment success. Finally, we examine common dietary misconceptions in relation to microbes and cancer and how to avoid getting caught up in the misinterpretation and over inflation of the results.

Alzheimer's Stigma May Stymie Research

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Widespread stigma related to Alzheimer's disease (AD) may act as a barrier against individuals' seeking early risk-assessment, treatment, or participating in research relating to the condition, a survey study confirmed.

The researchers asked 317 randomly selected U.S. adults in the general population to review a fictional case vignette of a man with mild AD dementia and complete a survey. In adjusted analyses, 55.3% of respondents said they would expect the patient with mild-stage AD to be discriminated against by employers and excluded from medical decision-making, reported Shana D. Stites, PsyD, MA, MS, of the University of Pennsylvania, and colleagues.

Just under half of respondents expected the patient's health insurance to be limited due to either data in his medical record (46.6%), brain imaging results (45.6%) or genetic testing (44.7%), according to the study in Alzheimer's & Dementia.

"We found that concerns about discrimination and overly harsh judgments about the severity of symptoms were most prevalent," Stites said in a statement from the Alzheimer's Association.

When informed the condition of the person would worsen over time, negative perceptions jumped substantially, with 78.4% of respondents anticipating on-the-job discrimination and nearly 75% assuming the person would be excluded from medical decision-making. Furthermore, when taking into account this worsening prognosis, most respondents expected the patient's health insurance to be limited due to medical record data (65.7%) or brain imaging results (62.7%).

Stem Cell Treatment Stabilizes Disease and Reduces Disability in Multiple Sclerosis

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The first ever international large scale randomised trial into autologous haematopoietic stem cell transplantation (AHSCT) in relapsing remitting multiple sclerosis (MS) has shown that the treatment stabilised the disease and improved disability in people who had experienced two or more relapses in the year before joining the trial.

During the trial, researchers recruited 110 people with relapsing remitting MS and frequent relapses on convention drug therapy.

Key findings:

  • 110 people with active, relapsing, remitting MS despite being treated with disease modifying drugs were randomised to receive either the best available drug treatment or AHSCT.
  • During the treatment follow up period, disability improved significantly after AHSCT.
  • The EDSS score of patients receiving the transplantation improved from an average of 3.5 to 2.4, which is unprecedented in MS treatment trials. This contrasted significantly with those receiving standard drug treatment whose EDSS scores declined from an average score of 3.3 to 3.9.
  • Within a year of joining the trial, only one patient in the transplant arm of the trial suffered a relapse compared to 39 relapses observed in the drug treatment arm.
  • With a mean follow up of three years, treatment failure measured by disability progression was six per cent in the HSCT arm and 60 per cent in drug treatment arm.
  • 30 people who were originally randomly allocated into the drug treatment arm of the trial were moved over to the transplant arm during the trial period after they had a decline in their EDSS scores. After AHSCT their scores improved from 5.2 to 2.6.
  • No person in the AHSCT arm suffered any significant side effects.

AHSCT is an intensive treatment which essentially rebuilds a patient’s immune system using stem cells harvested from their own blood and bone marrow to reset it to a point before it caused MS. After having their stem cells harvested and frozen, the patient is then given a high dose of chemotherapy before the stem cells are thawed and re-infused into the patient’s blood to reboot their immune system. It is currently only suitable for patients with the relapsing remitting form of the disease who have failed to respond to standard treatments and who have lived with the disease for ten years or less.

The results, have been hailed as “hugely encouraging” by researchers Professor Basil Sharrack and Professor John Snowden from Sheffield’s Royal Hallamshire Hospital, the sole UK site involved in this landmark trial which is being led by Dr Richard Burt, of North Western University in Chicago. The trial has closed to any further patient recruitment.

How Social Media Can Reveal Overlooked Drug Reactions

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When Allison Ruddick was diagnosed with stage 3 colorectal cancer in October 2014, she turned to the world of hashtags.

After her initial diagnosis it wasn't clear if the cancer had metastasized, so she was in for a nerve-wracking wait, she says. She wanted outside advice. "But they don't really give you a handbook, so you search kind of anywhere for answers," Ruddick says. "Social media was one of the first places I went."

Under the hashtags #colorectalcancer and #nevertooyoung on Facebook, Twitter and Instagram, other patients were sharing a fuller picture of their experience with cancer treatments.

Later she found even more advice on specialized message boards. Patients posted everything from the details of their surgeries to the ice packs they liked best as they recovered. "These weren't things that my doctor could tell me, and as much as I appreciate their expertise, it's also really limited by the fact that they've never really experienced any of this themselves," Ruddick says.

Partly because of that experience gap, doctors and drug companies are keen to learn from online communities, too. They're analyzing social networks to get a faster, wider look into how patients react to drugs, sometimes picking up information about side effects that clinical trials missed.

The rule of three

Stanford University dermatologist Bernice Kwong specializes in skin conditions that tag along with cancer treatments. In her practice and on patient message boards, she's constantly on the lookout for symptoms that could be drug reactions.

In January 2017, a patient came to Kwong's office with an unusual complaint. "I've noticed that when I work out, I just get really hot," he told Kwong. "I don't sweat anymore, and I used to sweat so much." He was taking a drug called Tarceva, or erlotinib, that's used against lung cancer.

At first, Kwong thought the problem might be hormonal. But soon after, two more of her patients at Stanford on the same drug reported that they'd also stopped sweating. "Anytime something hits three, I think, OK, I gotta look into this a little bit more," she says.

But she hadn't seen any reports before of a lack of sweating — hypohidrosis — as a side effect for Tarceva. Her sample size of three patients was small. She'd need more data to figure things out.

From talking with patients and perusing online forums, Kwong knew people discussed their treatments and side effects online. In fact, hundreds of thousands of people participate in support groups and communities she'd looked at on the website Inspire. She partnered with the site with the idea that its trove of patient reports could connect more dots between hypohidrosis and Tarceva.

Healthy! Capital Counties: Registration is now open for the 2018 focus groups!

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We need your help recruiting participants for the following Healthy! Capital Counties focus groups! The following dates have been scheduled:

Chronic Disease (have a chronic disease and be low income/unemployed/uninsured/Medicaid/ Medicare/food stamps/food bank/WIC): April 5 6:00-8:00pm at the Greater Lansing Housing Coalition in Lansing

Persons of Color (identify as a person of color and be low income/unemployed/uninsured/ Medicaid/Medicare/food stamps/food bank/WIC): April 5 6:00-8:00pm at the Allen Neighborhood Center in Lansing

Special Needs/Disabilities/Substance Abuse: April 10 6:00-8:00pm at Peckham in Lansing

Eaton County (low income/unemployed/uninsured/Medicaid/Medicare/food stamps/food bank/WIC): April 11, 6:00-8:00pm at Union Street Center in Eaton Rapids


Clinton County (low income/unemployed/uninsured/Medicaid/Medicare/food stamps/food bank/WIC): April 24, 6:00-8:00pm at the Clinton County District Courthouse in Saint Johns

We need the assistance of your partner organizations to help us recruit participants for all of the groups, especially the Clinton County and Persons of Color focus groups!  Recruitment fliers are available to be posted in appropriate locations or distributed, and are available on our website athttps://www.healthycapitalcounties.org/focus-groups.html.

Any potential participants will be contacted to confirm their place in the focus group. Please let me know if you have any questions. 

Thanks again to our valuable community partners for your continued assistance in helping us to determine, together, the health needs of the communities in Clinton, Eaton, and Ingham counties. 

Sincerely,

Susan Peters, DVM, MPH
Health Analyst, Barry-Eaton District Health Department
speters@bedhd.org
Phone: (517) 541-2652

on behalf of the Healthy! Capital Counties staff