Data Shows Affordable Care Act Helped Seniors

By White House
Press Office 

New data shows Affordable Care Act helped Seniors save $8.9 billion on prescription drugs nationwide

In total, Seniors in Maryland saved $129,642,297 on their prescription drug costs since Affordable Care Act was enacted

WASHINGTON, D.C. -- Seniors and people with disabilities with Medicare prescription drug plan coverage saved $8.9 billion to date on their prescription drugs thanks to the Affordable Care Act, according to new data released today by the Centers for Medicare & Medicaid Services (CMS).  In Maryland, 45,932 seniors and people with disabilities saved $42,084,486, or an average of $916 per beneficiary, during the first 10 months of 2013. Overall, seniors in Maryland have saved $129,642,297 since passage of the Affordable Care Act. At the same time, these seniors will be free to use more of their Social Security benefit cost of living adjustment on what they choose because the Medicare Part B premium will not increase in 2014, thanks to the health care law’s successful efforts to keep cost growth low.

Since the Affordable Care Act was enacted, more than 7.3 million seniors and people with disabilities who reached the donut hole in their Medicare Part D (Medicare Prescription Drug Coverage) plans have saved $8.9 billion on their prescription drugs, an average of $1,209 per person since the program began.  During the first 10 months of 2013, nearly 3.4 million people nationwide who reached the coverage gap -- known as the “donut hole” -- this year have saved $2.9 billion, an average of $866 per beneficiary. These figures are higher than at this same point last year, when 2.8 million beneficiaries had saved $1.8 billion for an average of $677 per beneficiary.

“Protecting seniors from the dreaded donut hole and high prescription drug costs is an important Affordable Care Act reform that Medicare beneficiaries have come to depend on,” said CMS Administrator Marilyn Tavenner. “Today’s data shows that the law is already helping millions of seniors save billions of dollars off their needed medications.”

For many people enrolled in Medicare Part D, the Medicare “donut hole” is the gap in the Medicare prescription drug benefit before catastrophic coverage for prescriptions takes effect. Without Affordable Care Act assistance, Medicare beneficiaries would pay out-of-pocket for the entire cost of prescription drugs once they hit the donut hole, until they reach catastrophic coverage. But under the discount program in the Affordable Care Act, in 2010, anyone with a Medicare prescription drug plan who reached the prescription drug donut hole got a $250 rebate. In 2011, beneficiaries who landed in the donut hole began receiving discounts on covered brand-name drugs and savings on generic drugs. Next year, Medicare Part D participants who fall into the donut hole will receive savings of about 53 percent on the cost of brand name drugs and 28 percent on the cost of generic drugs. These savings and Medicare coverage will gradually increase until 2020, when the donut hole will be closed.

News on the continued savings on prescription drugs comes on the heels of new information showing historically low levels of growth in Medicare spending. For example:

CMS recently announced that the Medicare’s Part B premium will not increase in 2014, and that the last five years have been among the slowest periods of average Part B premium growth in the program’s history.

The Part B deductible will also not increase, having decreased in 2014.  The Part B premium and deductible for 2014 are 15 percent below what was projected in 2010, the year the Affordable Care Act was enacted.

Also as a result of the Affordable Care Act, Medicare Advantage and Prescription Drug Plans remain stable and strong. Earlier this year, CMS announced that the average Medicare Advantage (MA) premium in 2014 is projected to be $32.60. CMS also estimated that the average basic Medicare prescription drug plan premium in 2014 is projected to be $31 per month, holding steady for 4 years in a row. The deductible for standard Part D plans will decline by $15 in 2014, to $310. Since the passage of the Affordable Care Act, average MA premiums are down by 9.8 percent.

Since enactment of the Affordable Care Act, the life of the Medicare trust fund has been extended by nearly ten years, till 2026.

For state-by-state information on savings in the donut hole, please visit: http://downloads.cms.gov/files/SummaryChart2010_October_2013.pdf

For more information about Medicare’s prescription drug benefits, please visit:  http://www.medicare.gov/part-d/.

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Concussion Test for State High School Athletes

By ZACK WARD
Capital News Service

ANNAPOLIS - This fall, about 10,250 student-athletes had baseline concussion testing in Montgomery County, where mandatory testing was introduced this year, continuing a trend of Maryland school systems taking youth concussions more seriously.

The test being used, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), began at the suggestion of the Pittsburgh Steelers’ front office in 2002 and has spread across the entire NFL, as well as the NHL, MLB and much of the NCAA. 

Now, it has even spread to lower levels of competition. In addition to Montgomery County, Anne Arundel and Charles Counties are in their second years of ImPACT testing, while Howard County has been doing it since 2007.

Amy Knappen, Chief Creative Officer at Righttime Medical Care headquartered in Crofton, said that many high schools around the country are using ImPACT. Knappen is also the program advisor of Righttime affiliated HeadFirst Sports Injury and Concussion Care, which has eight locations in Maryland that offer ImPACT testing.

Knappen said ImPACT was created because the Steelers wanted to “prove in black and white what was actually measurable for a concussion,” so they turned to the University of Pittsburgh Medical Center, which came up with the test.

Dr. Gerard Gioia, director of the Safe Concussion Outcome Recovery & Education (SCORE) Program at the Children’s National Medical Center in Washington, D.C., said the model of baseline testing has been around for about 20 or 25 years.

The ImPACT tests have come with their fair share of complications, but to Knappen, Howard County is the most on top of its game.

“It is mandated [in Howard County] before you try out for a sport that you have to have your pre-participation sports physical and the ImPACT test.” Knappen said.

“For Montgomery County, they just brought trainers in this year. They did a line item in their budget to accommodate for ImPACT testing. That first year is always historically very tumultuous, trying to get it up and running,” she said.

Montgomery County is spending $99,140 to give the ImPACT test to student-athletes, according to Dana Tofig, the director of public information for Montgomery County Public Schools.

ImPACT is designed to test memory skills, both verbal and visual, as well as reaction time and attentional skills. The first section shows the athlete words on a computer screen and then later asks them to look at a new set of words and determine which ones were in the original set and which were not. The same process is then followed for shapes, to account for the visual memory portion. Later in the test, athletes are asked to press a key if they see one color and another key for a different color to test reaction times.

For all of these sections, it’s not a red flag if an athlete’s score isn’t perfect. Knappen said sometimes results that are extremely good correlate to the type of sport or position the athlete plays. For example, a hockey goalie might score above average in the reaction section.

The point of the baseline test is to see where an athlete stands under perfectly normal conditions, when they have not been impaired by a concussion. Student-athletes then take a follow up test if they sustain a head injury. Doctors compare the results to the baseline to determine when the athlete is safe to return to competition.

In Montgomery County, about 60 retests have been given this fall, a figure that accounts for some athletes who have taken the test more than twice, according to Tofig.

“I definitely think there is a benefit to baseline testing as long as the testing is done well,” said Dr. Stacy Suskauer, director of Brain Rehabilitation Programs at the Kennedy Krieger Institute in Baltimore. “It is not always done well. We’ve been told about student-athletes who have taken the test at home while they’re watching TV and not really paying attention.”

It is for that reason that HeadFirst strives to provide athletes with a quiet test-taking space, free of distraction. While the assessment may not be perfect, Knappen said the test is smarter than any student trying to sandbag it.

“There was anecdotally a lot of talk about athletes coming in and deliberately trying to do poorly on the test so that they would have a lower baseline,” Knappen said. “And therefore, if and when they sustained a concussion, they would not have to try as hard to get back to baseline.

“But the test is like playing chess on a computer … It knows when you’re trying to throw it and it will kick out an invalid response,” Knappen said. “We get those from time to time, there’s no doubt about it.”

More imperfections include the fact that taking the test too many times can can create what Knappen calls a “familiarization process,” where it becomes too easy for the athlete, and the fact that it is difficult to mandate for every sport.

Although all athletes were tested in Montgomery County this fall, other school systems might test football players, but not other athletes. For example, girl’s soccer players in Anne Arundel County weren’t tested last year, despite their sport being the second leading cause of sports-related head injuries in the United States.

In addition, Dr. Kevin Crutchfield, who works for LifeBridge Health and is the independent neurological consultant for the Baltimore Ravens, stressed that ImPACT tests do not diagnose concussions.

“It’s good to know some type of baseline function, but it has extreme limits as well,” Crutchfield said. “You’re only looking at certain functions that the brain does and see if they become dysfunctional after some type of event. But there are other things that cause dysfunction of those functions other than a brain injury. 

“The test is sensitive in picking up that there might be some kind of problem after the initial test was taken. But is it a concussion? And that’s where the issue comes up. It is not specific enough,” Crutchfield said.

However, Gioia remains hopeful that working to improve baseline testing is worth the effort.

“If the information is made available to clinicians who know how to use it, it can be one of the more important tools that we use,” Gioia said.

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Professor Combats Obesity with Better Math

By KATE ANDRIES
Capital News Service 

COLLEGE PARK - A Northwestern University professor is taking a stab at making activity recording apps on smartphones more accurate—by employing more sophisticated math.

Apps like Moves or Argus that track exercise and movement are more popular than ever, but don’t capture data all that accurately in certain situations.

Most movement-tracking apps lose a bit of accuracy when the smartphone is carried in a bag or a pocket. Konrad Kording, an associate professor at Northwestern University, and colleagues have developed a more accurate algorithm for activity recording apps.

The algorithm allows apps to predict the location of a smartphone throughout the day—be it on a belt, in a bag, or in your hand—which increases the accuracy of health tracking apps.

“We wanted to see how well activity recognition could tolerate what people did in their everyday life,” Kording said. While the algorithm wouldn’t be integrated in current app technology in the immediate future, it should help improve the accuracy of these health monitoring apps.

Kording’s research is a part of the Center for Behavioral Intervention Technologies (CBITs) at Northwestern University. Opened in 2011, researchers at CBITs work to develop apps for a variety of tech platforms, including smartphones, websites, text messages, even virtual reality.

While a more accurate app may aid in the fight against inactivity and obesity, it is just a small step.

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Your Phone is Talking Behind Your Back -- to Your Doctor

By KATE ANDRIES
Capital News Service 

COLLEGE PARK -  Your phone knows everything about you—how much you walk, talk and what level of Candy Crush you’re stuck on—but soon it could be spilling secrets to your doctor.

More and more physicians are prescribing apps that help track their patients’ illnesses through information collected by their smartphones.

“[The trend] just seems to be exploding,” said Seth S. Martin, a Pollin cardiovascular prevention fellow at Johns Hopkins Hospital in Baltimore. “With the widespread use now of smartphones, it’s a really exciting opportunity to help people live healthier lives.”

Apps like Ginger.io and those developed by the Center for Behavioral Intervention Technologies (CBITs) at Northwestern University collect data through smartphones and web activity and relay that information to healthcare providers—without the patient needing to lift a finger. This, they argue, enriches the healthcare process by integrating technology and primary care.

This is most apparent with the app Ginger.io, which is currently invite only—it’s being tested in larger hospital systems before it expands to the public—and deals with a small number of specific diseases like diabetes and ulcerative colitis.

According to their website, Ginger.io “works in the background to collect data about your movement, call, and texting patterns. Once the application has gathered enough data to understand your behavior patterns, we will provide you with health insights and alerts.”

These alerts range from condition-specific health tips to insights into the patient’s own health patterns.

“It forms an automated diary of your life,” said Anmol Madan, co-founder and CEO of Ginger.io. “The idea is to provide support to patients and families.”

By collecting two forms of data—nicknamed passive and active—Ginger.io attempts to paint as full of a picture as possible from the data collected by a person’s phone. The app asks patients to fill out condition-specific surveys about their symptoms and well being (this is active data) while also collecting information from the sensors in the phone regarding calling and texting patterns as well location data (this is passive data.)

This data is then sent to a patient’s primary care physician.  They use the collected data to monitor a patient’s day-to-day behavior, flare-ups and unusual patterns in communication—are you making longer calls? Maybe not moving around as much as normal?

This allows for faster and more accurate intervention should a health condition head south.

Similar to Ginger.io, CBITs works to develop apps for smartphones, websites, text messages and even virtual reality.

“There’s so many things that technology makes available to us,” said Jennifer Duffecy, associate director of intervention development at CBITs.

Many of the apps in development at CBITs involve mental health—especially making sure people with mental illnesses stay on their medication. One described by Duffecy dealt specifically with antidepressants.

Patients often feel no immediate effects when starting an SSRI—a common anti-depressant that changes the balance of serotonin levels in the brain—and stop taking it.

The app from CBITs tracks whether or not the patient took their medication—adding an accountability aspect—while also tracking any side-effects felt by the patient.

While their focus is mainly on mental health, Duffecy said, other research has looked at apps for insomnia, chronic pain, cancer survivorship and various transplants.

CBITs is also developing an app specifically to monitor and improve veterans’ ability to cope with stress. The app is specifically tailored to veterans with serious mental illnesses who seek care in community-based mental health agencies.

“The most effective way to use [health tracking apps] is to integrate these systems with others—linking information in real time with feedback that is designed by the patient’s physician or a specialist. But doing this in a very reputable and patient friendly manner,” Martin said.

Martin and colleagues at Johns Hopkins University plan to begin a study later this year that uses smartphone apps and bluetooth data to monitor patients.

However, in the deluge of health-tracking apps available, few have undergone any moderation to ensure the validity and reliability of the science behind the app, Martin said. Few studies have been conducted that analyzed the effectiveness of apps like Ginger.io that employ total integration of technology and primary care.

“Hopefully the clinic of the future will be very much app-based,” Martin said. “There will be some optimal combination of app-based, home based care with actual face-to-face clinic visits. [But] right now it’s way, way too early to make any definitive statements.”

Most important, Duffacy noted, is the need to ensure that people who download any health related apps actually integrate the technology into their everyday life.

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