Health and Disability

The researchers say evidence indicates that burnout leads to poor care, physician turnover and a decline in the overall quality of the health care system. In the 2011 survey 45 percent of physicians met the burnout criteria, with highest rates occurring in the "front lines" -- general internal medicine, family medicine and emergency medicine. In 2014, 54 percent of responding physicians had at least one symptom of burnout. Satisfaction with work-life balance also declined. The survey results were based on 6,880 physicians across the United States, a 19 percent response rate, as well as a population based sample of 5313 working U.S. adults in other fields.

In a snapshot:

• Physician burnout is up 10 percent over the last three years
• Burnout rates are up across almost all specialties
• No overall increase in physician work hours was reported
• No increase in rates of depression was observed among physicians

Researchers say the problem of physician burnout is largely a system issue and that health care organizations have a shared responsibility in addressing the problem. They say more needs to be done by healthcare organizations to help physicians by improving the efficiency of the practice environment, reducing clerical burden, and providing physicians greater flexibility and control over work.

This website supports plans and providers in their efforts to deliver more integrated, coordinated care to Medicare-Medicaid enrollees, specifically in the context of intellectual and developmental disabilities (I/DD), physical disabilities, and serious mental illness (SMI). Please choose from the toolbar above or the links provided here to explore our resources by stakeholder, individual, or concept. You may also search theResource Library above for a full listing of resources on this website.

Included on this website are:

• Assessment Tools
• Concept Guides
• Educational Webinars
• Topic-Specific Briefs

Resources for Integrated Care works to aid stakeholders such as:

• State Medicaid agencies
• Health plans
• Long-term services and support providers
• Behavioral health providers

Chronic Pain Treatment should focus on improving function and quality of life.

In the commentary, Ballantyne and Sullivan discuss the growing influence of the basic pain scale (patients' self-reported rating of their pain on a scale of 0-10). For many patients with chronic pain, "especially those who have developed opioid dependence, maintaining low pain scores requires taking continuous or escalating doses of opioids at the expense of worsening function and quality of life." Instead, according to Ballantyne and Sullivan, treatment should focus on helping patients improve their ability to function at work and at home, shifting the focus from pain to moving on with their lives. This shift will require embracing multimodal therapies that encompass behavioral, physical, and integrated medical approaches.

Ballantyne and Sullivan clarify that use of the pain scale for measuring acute or post-surgery pain, as well as for end-of-life pain, is distinct from its use for chronic pain. "When pain is chronic, its intensity isn't a simple measure of something that can be easily fixed," they write. Instead, multiple measures of the complex causes and consequences of pain, including associated depression and anxiety, are needed for effective treatment. "For this purpose, nothing is more revealing than a conversation between a patient and a clinician, which allows the patient to be heard and the clinician to appreciate the patient's experiences and offer empathy, encouragement, mentorship, and hope."

Drawing on his personal interactions with families touched by brain injury and breakthrough findings in the neuroscience literature, Dr. Fins compared the MCS to a flickering lightbulb: neural circuits are intact, but like the lightbulb, but they aren’t always “on.” Occasional reports of seemingly conscious behaviors, such as tracking moving objects with their eyes or reaching for a nearby cup, give hope to families of MCS patients, but these physical actions are not always reliably reproduced.

However, much of what doctors once perceived as wishful thinking from families actually has been supported by multiple neuroscience methodologies. Diffusion tensor imaging (DTI), a brain scan sensitive to white matter structure that researchers use to study connectivity, was used with early MCS patients to reveal the surprising plasticity due to the formation of new connections between old neurons. Furthermore, a breakthrough functional imaging study published in 2006 by Adrian Owen and colleagues showed integrative reactions in the brain of a young women who, behaviorally, was believed to be in a PVS. When the woman was given verbal instructions inside the scanner to imagine herself playing tennis and walking through her home, Owen observed activation in motor and spatial regions of her brain, respectively, which was consistent with brain activity in healthy controls.

Taking into account this experimental evidence about the minimally conscious brain, Fins argued that patients face the challenge of having “dynamic brains in a static healthcare system.” As scientists and physicians learn more about the remarkable cognitive abilities of MCS patients, there is a growing obligation for neuroscience to help these persons, otherwise sequestered from the broader human community, communicate with the outside world. To address the challenges of MCS, Fins advocates for the use of neuroimaging as a neuroprosthetic communication tool; the administration of drugs that can alter brain states and speed the recovery of MCS patients; and the application of thalamic deep brain stimulation as a therapeutic intervention.

It is worthwhile to give patients expensive new drugs that can cure their hepatitis C much earlier than some insurers are now willing to pay for them, according to a UC San Francisco study that models the effects of treating the disease early versus late in its development.

Researchers said they were surprised by the findings, since the drugs can cost up to $100,000 for a full course of treatment. But when they factored in the long-term medical cost of delaying treatment for hepatitis C, they found the savings, in combination with improvements in the quality of patients' lives, were enough under current standards to justify using them even at early stages of liver fibrosis. Researchers said the drugs were therefore cost effective.

Cost effectiveness is a measure of broad social benefit that health economists use to make decisions about whether medical treatments are warranted. The researchers said the balance was tipped in favor of the drugs because the hepatitis C virus can cause so much damage. Hepatitis C is one of the leading causes of liver cancer, liver transplants and liver-related death, yet the drugs can prevent much of that with an early cure. Moreover, even if costly hepatitis C treatments are delayed, they eventually will be given to many patients once the infection causes enough damage to their livers.

About 3.2 million people have hepatitis C in the United States. The vast majority were infected by blood transfusions before testing of blood donors became available in 1992. Today, most people get infected from injecting drugs.

Left unchecked, hepatitis C causes varying degrees of liver fibrosis in a majority of those infected, and causescirrhosis in 20 to 30 percent. This damage is classified in five stages of increasing severity, from zero to four. Using sofosbuvir-ledipasvir, which is sold as Harvoni, and is one several new drugs for hepatitis C, researchers compared the costs of treating patients at all stages of fibrosis, zero through four, with the cost of waiting until stages three or four, which is when some patients are usually treated.

UnitedHealth is certainly a big fish in the insurance industry, but they’re a rather small one in the marketplace pond. They opted not participate in the first open enrollment period and subsequently lost out on the opportunity to make a first impression when millions of Americans logged on and purchased quality, affordable health insurance, some for the first time in their lives. The late entry, and perhaps plans offered, has contributed to UnitedHealth representing roughly 5.5 percent of the nearly 10 million Americans purchasing coverage through marketplaces.

And while UnitedHealth may be struggling to find the right recipe to provide attractive benefits and entice consumers to purchase their plans over ones they’ve had in the past, other larger players, such as Kaiser Permanente and Aetna, have shown no indication of slowing down.

One would hope that UnitedHealth would stay in the marketplaces, and even build on their current expansion plans for 2017 and beyond. But at this time, UnitedHealth’s small footprint in the markets fails to make their comments a broader indication of the health of the marketplaces as a whole.