Finding the Best Drug Rehab Center in California

Addiction is always bad. Whether you are addicted to a certain activity or a certain substance, your addiction always has a potency to devastate your life. Some people have everything in their life lost because they are addicted to such activities as gambling and gaming or because they are addicted to such substances as alcohol, prescription drugs or illegal drugs. For this reason, whenever you love doing or consuming something, you have to be able to control your passion so that you are not become addicted to that thing.

If you are inevitably become addict, there is nothing that you can do to rescue yourself except being strong and persistent to withdraw from your addiction. After you address your problem and you are aware that in order to recover you have to be strong and persistent, you can start looking for a reliable rehabilitation center where you can get your addiction treated. If you are a drug abuser, bay area drug rehab center can be a drug rehab center that you can rely on. In this drug rehab center, you will not reside in a secluded facility that is gloomy and unattractive. This drug rehab center’s facility is not an old asylum for desperate patients and ruthless doctors, but a home-like facility surrounded by beautiful environment and clean air. Most stages of your treatment in this drug rehab center are recreational. You hike nearby hills, stroll around nearby parks, and enjoy various recreational activities that can make you forget about your suffering. As a result, you will not suffer your withdrawal symptoms very much because everything that you get there is more than enough to get those symptoms alleviated.

In order to get an access to this drug rehab center, you can either go to its center in California in person or visit its website. On its website, you can read everything that you wish to know about the center and you can decide whether it is the right place for you to get your addiction removed.

Doctors to See in Washington DC

One of the most common things about seeing a doctor is waiting in line for hours and as soon as you enter their office you find yourself out of the room in less than ten minutes. Not worth the wait at times and even further you still have no idea what is wrong with your health. This is certainly very painful for those of you who don’t always have time to wait around and many errands need to be taken care of. Many who have experienced this have refrained from seeing a doctor unless they are very ill. If you happen to be one of the many that feel this way then it is time for you to look closer and open your eyes wide. Here you are to be introduced to a team that is recommended as the friendliest yet professional health practice in all of Washington DC. They are known as the doctors Washington DC.

With a doctor DC you are not only to be welcomed to an amazing interior and designed office but the building itself offers that soothing feeling you can deny. A soothing ambiance and atmosphere that goes perfectly well with everything around it, makes the waiting experience nothing like the ordinary. This is yet just the beginning, with an arrangement of an appointment that is provided online you can simply step into the office and consult just like that. No more waiting in line for hours and stepping out empty handed. This team of doctors understand perfectly that the health issues that you may be going through are very personal hence the importance of providing a thorough understanding for you to know too. The more you understand the more likely your recovery. A personal approach is not always likely to happen in any doctor’s office, hence be surprised by how much they care that you are getting better.

Last but not least the fact that you are provided with a full team of physician Washington DC that you can choose from yourself. This is a great feature that not all clinics are capable of providing. Now that you are able to make a move forward and fight the fear of seeing a doctor, you are about to experience a once in a lifetime event of seeing a doctor that actually cares. The team will be happy to take your call in person as your sense of security matters the most to them. As they say, all that starts well shall definitely end well.

Health Insurance Company Response to High Risk Patients

Today’s Managing Health Care Costs Indicator is 25%

Click image to enlarge. Source above

Today’s NY Times has an article focused on high risk patients – who in the under-65 population represent about 1% of patients, and 25% of all medical costs – over $100,000 per year. Full Report Here (Registration Required)

The concentration of the cost of care is an important observation – the bottom 50% of Americans represent about 3% of total medical costs – so interventions to lower the cost of care for these least expensive health plan members are bound to be unsuccessful. This is also why programs to convince Americans to go see the doctor raise costs.   (Good Op-Ed on this topic from Dartmouth University today, too).

The robust and publicly-available Medicare claims database has been studied extensively – but many of the conclusions from the over 65 population are not applicable to the younger cohort insured through employer-based plans

-       Medicare beneficiaries are highly likely to be readmitted to the hospital (almost 20% in 30 days). Readmission rates are much lower  in the non-Medicare population (5-8%) , and many of these readmissions are planned, like followup inpatient chemotherapy.
-       Medicare spends a quarter of its dollars on patients in the last 6 months of life.   Commercial plans actually spend a very small portion of their claims on end of life care, since death is much less common in this population
-       Medicare beneficiaries stay with that insurance plan for the remainder of their lives, while commercial health plans “churn” membership at a rate of 15% or more a year

Care management interventions should not assume that the commercial population is akin to the Medicare populations.

Health plans have hired platoons of nurses to do outbound calls to high-risk beneficiaries– and they charge employers large fees to perform this work.    However, most of the evidence of efficacy of this intervention is highly anecdotal. From Reed Abelson’s article:

When Wendy Meath, a 59-year-old with diabetes, was hospitalized a year ago, she was identified by HealthPartners as someone who needed help to control her disease. She had been admitted for kidney stones, one of many possible complications of diabetes. Although she had insurance through her husband, she was unemployed.

Since leaving the hospital, where she was admitted for 12 days for a series of complications from the surgery to remove the stones, Ms. Meath has been in regular contact with one of HealthPartners’ nurses, who serves as a case manager. The nurse calls at least once a month and checks in after she goes to the doctor for any developments. The health plan also assigned a social worker to help her with the cost of medications and other obstacles that were preventing her from taking better care of herself. “It makes me feel like I’m not alone,” Ms. Meath said.
“They’re trying to prevent the big things from happening, which is great,” she said.

But the iron-clad evidence of the effectiveness of this intervention is still lacking.

Health plans tend to cite compelling anecdotes – but here’s what we should look at to assess efficacy of these programs

a. What intervention is in place?    Are the elements evidence-based?  Is there a measurement plan?

a.     How many of the targeted high risk members actually participate?  Many health plan programs have half or more targeted members refuse to participate.   That sharply limits potential effectiveness

a.     Are there changes in clinical course due to the intervention?
b.     Are there beneficial financial outcomes as a result?

There are two major problems with the outcome evaluations I’ve seen – most of which have focused on only program participants.  

The first is regression to the mean.  The likelihood that Wendy Meath will be hospitalized again over the next year is low.  This doesn’t mean that the intervention has been successful – it’s what you’d expect in the year following such an admission.

The second problem is selection bias. The half of patients who eagerly participate in the intervention are fundamentally different than those who refuse.  Even efforts to do “propensity matching,” to try to adjust for known differences between participants and nonparticipants, aren’t effective for adjusting for these differences.

We should only attribute cost savings to these programs if there are cost savings over the entire population.  Further, we should only find claims of success believable if enough members were engaged to credibly lead to the claimed cost savings.

I believe that high risk programs performed in the provider realm are likely to get more patient engagement – and could lead to more success in preventing bad outcomes and lowering costs.    Health plan leverage in the future might have more to do with payment reform than with hiring legions of remote nurses.

Of course, we will have to measure that too!

Perceptions of the Affordable Care Act

Today’s Managing Health Care Costs Indicator is 44%

Click on image to enlarge.   Source 

The Kaiser Family Foundation does periodic tracking surveys, asking Americans for their opinion of the Affordable Care Act.  The January survey showed that 44% of the public regard the bill unfavorably, while 37% regard the bill favorably. 

KFF explored the percent of nonelderly who would benefit from the ACA by PUMA (Public Use Microdata Areas – a bit larger than zip codes).    Interestingly, Republican congressional districts got substantially more benefit than Democratic congressional districts. 

On average, an estimated 17% of the non-elderly population nationwide would benefit from the Medicaid expansion and tax credits. In parts of Florida, New Mexico, Texas, Louisiana, and California, 36-40% of population could benefit.  In areas of Massachusetts, Hawaii, New York, and Connecticut – states that generally have high levels of employer-provided health insurance or have already implemented reforms to make insurance more accessible and affordable – 2-4% of the non-elderly could benefit from the coverage expansions in the ACA.

Click image to enlarge.  Source

Harold Pollack had a thoughtful essay in The Incidental Economist, debunking some of the right wing press which misstates conclusions from Jonathan Gruber who evaluated impact of the ACA in Wisconsin, Minnesota and Colorado.   He concluded with a question:

Millions of people will join health insurance exchanges. Most will be relatively healthy. They will see certain relatively small and immediate things, such as contraceptive coverage and clinical preventive services. They will not (yet) experience chronic illness and thus the resulting interactions with their insurerWill they perceive and value the improved actuarial value of this insurance? Two years ahead of time, it is impossible to answer this basic question.

I don't feel sanguine about this.  The fact that Gruber and others show that on the average households will be better off doesn’t mean that the Affordable Care Act will be popular.  Distribution of benefits from the ACA and our understanding of behavioral economics gives us some reasons to worry

1.     The Affordable Care Act includes defines essential coverage, which will prevent insurers from selling policies that would not cover preventive care.   Many people won’t realize that the preventive care wasn’t covered before (especially if they had HMO policies which traditionally cover such services.) Most employer policies cover preventive care already.  
2.     Medicare cuts in future hospital reimbursement increases are necessary – and there is no credible health care reform plan that does not include such cuts.  However, these cuts will be blamed every time a hospital has a layoff  - and might be highlighted whenever a patient has access difficulty.  This is a framing problem – the ACA will be compared with what we had before 2010 – not what we would have had instead.
3.     The ACA’s prohibition against underwriting for kids and against excluding preexisting illnesses will provide much-needed new benefits to a very small number of people.   Most of those with employer-based insurance already have this.  Many who had previously purchased defective coverage – which would not have protected them if they had a major illness – value their current low premium, which will increase under the ACA.   They will in the future have an insurance plan that is a  “Chevy” rather than a Yugo with a defective engine block – but they didn't realize their old policy was defective if they were in good health.  They liked the low premium for the Yugo though!
4.     The ACA only allows a three-fold difference between the price of coverage for the oldest vs. the youngest health plan beneficiaries.  This means that there will be substantial subsidization of the old by the young.  That might seem politically good (middle age people vote in higher numbers than the young).  However, people hate losses much more than they like gains.  Therefore, the “losers” in the new system will be much more unhappy than the “winners” will be gleeful.
5.     We tend to like what we already have (“Endowment Effect,”) and many people will lose their current policies. They might get better policies – but still change is unpopular.
6.     We also tend to like choices.   While there will be more choices in health insurance exchanges (assuming that each state has a functional exchange) than the current choices available to individuals and small groups – there are mandates now which limit individual choice.
7.     2012 had relatively low rates of health care premium inflation. If that inflation rate is higher in 2013 or 2014, many will blame the ACA – even if actuaries know that the incremental requirements are responsible for only a tiny portion of overall health care premium inflation.

There are a few concepts from behavioral economics to suggest how the Obama administration should approach the political conundrum of gaining more public support for the ACA

1.     Discounting: Be sure to show the benefits as soon as possible.  We discount too much in our minds -  so a benefit in the distant future is like no benefit at all.  2014 seems like an eternity away right now, and the uncertainty around the Supreme Court challenge makes this problem worse.  (The KFF survey showed that the majority of Americans think the Supreme Court will find the individual mandate unconstitutional).  Coverage of young adults on their parents’ policies was an excellent idea.
2.     “Availability”.  We really like stories – much more than facts or statistics.  Therefore, we need more stories about families with hemophiliac kids no longer facing ruin because of lifetime limits, and families covered for dramatically less than they had to spend prior to health care reform.
3.     We overestimate the chances of small-likelihood events – which is why we gamble and play the lottery. It’s also why we worry about being killed in  a plane crash. (Cars kill over 40,000 per year; in the average year the deaths from civilian air crashes with scheduled carriers is less than a dozen).  The Affordable Care Act would protect Americans from terrible outcomes from rare events.   We need to hear more about this.

The Affordable Care Act will be good for the average family – and over time should be quite good for our economy.   But many will continue to doubt the overall benefits of the ACA – and we need an effective political campaign to show its benefits.

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