John Colbert

February 19, 2019

Trends Archives

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

February 19, 2019

Trends Archives

By Susan N. Hanrahan, ASAHP President

In my message in the November 2017 issue, I indicated that I will be asking some of you to send a photo and answer a series of “fun” questions to be shared with our membership so that we can continue our collegiality through our newsletter. The 10th of many profiles and the second in 2019 is presented as follows:

Name and Title: Gregory Frazer, Dean and Professor, Covey College of Allied Health Professions

Place of birth: Evansville, Indiana

University: University of South Alabama

How long have you been in your position? 3rd year at USA; 19th year as a dean

What is the value of ASAHP? ASAHP is the preeminent organization for peer administrators and educators that enables collaboration and sharing among those committed to educational and professional excellence.

Your philosophy on education in seven words: Skills and knowledge enable opportunity, achievement and success.

If I could teach in another field, which one and why? Medicine because I have witnessed the dramatic impact of the delivery of care all over the world.

Before I retire I want to: Establish an international learning opportunity in every program I’m responsible for.

In college, I was known for: Being the fraternity social chairman.

What music is playing in my car/office? Luther Vandross

The last book I read for fun was: ”Honoring the Trust” by William Massy

My favorite trip was: Machu Picchu

If I could travel anywhere it would be: Santorini, Greece

Four people I’d take to coffee or have a glass of wine with: Confucius, Rosa Parks, President Obama, and Herb Kelleher

The best advice I ever received was: “Never forget where you came from and those who helped you be where you are today”

My hobby is: Racquetball

My passion is: Photography

My pet peeve is: Dirty car

A perfect day is: Professionally, its graduation. Personally, a sunny day on the beach with family and friends.

Cats or dogs? DOGS

E-book or hardback? Hardback

Beach or mountains? Beach

I wish I could: Share my passion for my work with all of my colleagues.

Only my friends know I: See what a challenge golf is to play.

My favorite saying is: “Fair is a playground term” as in “this policy isn’t fair.”

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THE PERIODIC TABLE OF ELEMENTS

John Colbert

February 19, 2019

Trends Archives

En route to becoming a health professional, the academic preparation of many students will involve enrolling in a course in chemistry. A typical classroom usually features a wall display of the Periodic Table of Elements. Its presence is the result of the work of Dmitri Mendeleev who published it 150 years ago. A show of remarkable prescience on his part, one of its impressive characteristics was the inclusion of gaps waiting to be filled by new elements yet to be discovered that are based on properties he predicted. When initially formulated, the Table contained only 63 elements. Currently, there are 118 of them.

Most elements are found in nature (the number is subject to debate) while others were discovered in laboratories and nuclear accelerators. It is possible that some students enrolled in chemistry offerings at the University of California, Berkeley may have a deeper appreciation of the discovery process because 16 elements were synthesized or discovered on that campus, including Berkelium, Californium, Lawrencium, which honors Professor Ernest Lawrence who invented the cyclotron, and Seaborgium after Berkeley professor Glenn Seaborg.

This brief history of achievements in the physical sciences may serve as a segue into developments that occur in the sphere of health care. Public policy continues to be dominated by discussions regarding how best to achieve accessibility, affordability, and accountability in the provision of health care services. Just as chemical elements are grouped together in the Periodic Table on the basis of shared common properties, it is possible to examine comparable proposals aimed at enhancing accessibility, for example, while recognizing that significant gaps continue to occur between the provision of health care and the attainment of improved health status at both individual and community levels.

One definition of chemistry holds that it is concerned with the transformation of substances and all the energies associated with these transformations. Health care can be transformative either by preventing disease or by halting ill health in its tracks. The term mutability has some relevance in this regard. Race and ethnicity represent an immutable human characteristic. Age is another one, for an 80-year old patient cannot be transformed into a 20-year old individual. Unfortunately, interventions in health care that produce salubrious outcomes for members of one racial/ethnic or age group do not always prove to be as effective with other groups.

Social determinants hugely affect who gains and who loses in the acquisition of high quality health care services. While portions of human existence may be mutable in theory, it remains insurmountably challenging to overcome the effects of poverty, discrimination, joblessness, insufficient formal education, a low level of health literacy, loneliness, and residence in turbulent neighborhoods ravaged by pollution and violence. Such conditions often prove to be highly refractory to generating positive alterations, but change they must if the aims of health care are to be realized. Meanwhile, an understanding both of chemistry and health may be enriched by reading The Periodic Table by Primo Levi, an author who composed a poetic link between the disparate worlds of physical and human nature.

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PHYSICAL THERAPY AND OCCUPATIONAL THERAPY GUIDELINES

John Colbert

January 22, 2019

Trends Archives

Page four of this newsletter provides information about health reform from the perspective of legislation and regulations that follow the enactment of laws. Since many policy guidelines also are formulated to improve health care by clarifying legislative intent, they may be considered useful aspects of health reform. As described in a manuscript published in the January 2019 issue of the journal Archives of Physical Medicine and Rehabilitation, the objective of a study was to determine if there was a change in the number of outpatient physical therapy (PT) and occupational therapy (OT) visits for Medicare beneficiaries, and in the number of beneficiaries receiving extended courses of >12 therapy visits, after the Jimmo vs Sebelius settlement.

Medicare Part-B helps to cover outpatient physician, PT, OT, speech therapy, and home health services. Policy is designed to cover rehabilitation services that require the skill of a PT or OT to restore function, or when no improvement is expected, to slow deterioration and maintain current levels of functioning. Beneficiaries are able to receive outpatient OT and PT services until a monetary threshold, or cap is reached. If the cap is met, and treatment is medically necessary to further improvement or to prevent a worsening of function, Medicare guidelines state that reimbursement of care can continue. Historically, however, this process was not always followed.

Coverage determination is delegated to Medicare administrative contractors (MACs) who make local decisions to ensure that therapy is medically necessary. Policy manuals developed to help interpret regulations became more restrictive and in some cases contradicted federal regulations. Beneficiaries were being denied access to and payment for therapy if their chronic conditions precluded improvement. Regional local coverage decision manuals for outpatient PT incorrectly noted that coverage depended on the “expectation that the patient’s condition will improve significantly in a reasonable and generally predictable period of time.” If there was no expectation that the condition would improve and there was no measurable change in function, MACs would deny coverage.

After the Jimmo settlement was reached, Part B Medicare beneficiaries were likely to receive about one additional therapy visit per year. An estimate is that at a minimum, the settlement will increase utilization by about 12 million visits per year. Patient therapies help minimize functional decline, avoidable hospitalizations and nursing home admissions, which may result in lower costs.

Return to Dec 2018 - Jan 2019 trends

DETECTING BS IN HEALTH CARE

John Colbert

January 22, 2019

Trends Archives

Given its noticeable abundance, it is likely that even individuals who are barely sensate realize that quite a bit of BS exists in this world, even in health care. Fortunately, Lawton Burns and Mark Pauly from the Department of Health Care Management at The Wharton School University of Pennsylvania have arrived on the scene with a timely remedy in the form of a detection tool to offset a variety of preposterous claims that clutter up the landscape. Their position is buttressed by a belief that in the past several months, they have observed several notable signs of deceptive, misleading, unsubstantiated, and foolish statements that they call “BS” in the health care industry (e.g., fraudulently marketed products, ridiculous assertions of ways to reduce health care costs by huge percentages, and purported wonders that are supposed to occur as a result of business mergers).

A starting point is to ask the question, why does this kind of behavior occur? While flat-out dishonesty for short term financial gains is an obvious answer, a more common explanation is the need to say something positive when there is nothing positive to say. The two researchers present their Top 10 BS candidates, in both pictures and words. Each picture is presented untitled and without text, thereby inviting readers to discern what the BS message is and engage them in the BS detection process. Then, they offer an explanation of what the picture conveys, which aims at helping readers to become more skilled “BS Hunters.” They also note that they reserve the option to expound further since there is a likelihood of the danger of wading into even more BS in the future. (Link to special report)

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

January 22, 2019

Trends Archives

Faculty Attitudes On Academic Technology
Inside Higher Ed’s 7th annual Survey of Faculty Attitudes on Technology aims to understand how professors and digital learning leaders view online learning and other aspects of academic technology. A new report presents findings from a quantitative survey research study that Gallup conducted on behalf of Inside Higher Ed. Some findings are: The proportion of faculty members who have taught online courses continues to increase. Currently, 44% report having taught an online course, up from 30% in 2013. Meanwhile, 38% have taught a hybrid or blended course that has elements of face-to-face and online teaching. The vast majority of instructors who have taught online courses, 89%, say they have been involved in the design of those courses. More than 7 in 10 faculty members who have taught online courses say the experience has taught them skills that have improved their teaching. Most commonly, they say their online teaching has caused them to think more critically about how to engage students with course content and to make better use of multimedia content. The report can be obtained here.

State Strategies For Establishing Connections To Health Care for Justice-Involved Populations: The Central Role Of Medicaid
Prior to the Affordable Care Act, most individuals leaving prison or jail weren't eligible for Medicaid, since coverage generally wasn't available to childless adults. With Medicaid expansion taking hold in more states, health coverage is becoming more available for those upon release from incarceration facilities. With coverage as a foundation, states are seeking to address the complex health and social issues many of these individuals face, including opioid addiction, mental illness, and barriers to stable housing and employment. In a new Commonwealth Fund report, experts with Manatt Health explore the latest developments in comprehensive primary care for adults leaving jail or prison and the role Medicaid can play in financing and supporting the most effective practices. In a number of states, "in-reach" services are helping inmates establish relationships with providers prior to release, identifying health conditions, and setting up community-based care. The report can be obtained here.

Public Health Trends Plaguing The U.S. Population
The United Health Foundation released its annual population health report, documenting a number of concerning public health trends that have continued to plague the U.S. population. The rate of obesity in the U.S. increased by 5% from 2017 to 2018, which equates to one in three Americans being affected by the disease. The increasing prevalence of obesity coincides with a greater number of deaths due to cardiovascular disease (112,403) and other chronic diseases. Mental and behavioral health issues also have been on the rise, as feelings of mental distress were self-reported 7% more often than in 2016. Rising behavioral health issues are exacerbated by the barrier of access to care. Currently, 124 million Americans live in areas where there are shortages of formal mental health care. The report notes various other disparities in health that can be attributed to social determinants of health. It can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

January 22, 2019

Trends Archives

Lower Wages And Benefits Of Female Health Care Workers
According to a report appearing in the January 2019 issue of the American Journal of Public Health, a study carried out by researchers at Massachusetts General Hospital (MGH) and the Perelman School of Medicine at the University of Pennsylvania finds that low wages and poor benefits leave many female health care workers living below the poverty line. Projecting the survey's results across the entire U.S. population suggests that 5% of all women health care workers, including 10.6% of Black and 8.6% of Latina women health care workers, live in poverty. Overall, 1.7 million women health care workers and their children lived below the poverty line in 2017, accounting for nearly 5% of all individuals living in poverty in the U.S. The researchers also found surprisingly high numbers of female health care workers surveyed lack health insurance. Overall, 7% , projected to represent more than 1 million women nationwide, were uninsured, including more than 10% of Black and Latina women employed in health care.

Physical Therapy In Relation To Opioid Usage
According to a study by researchers at the Stanford University School of Medicine and the Duke University School of Medicine published on December 14, 2018 in JAMA Network Open that was based on an analysis of private health insurance claims for care and prescriptions between 2007 and 2015, patients who underwent physical therapy soon after being diagnosed with pain in the shoulder, low back, or knee were approximately 7 to 16% less likely to use opioids in subsequent months. For patients with shoulder, back, or knee pain who did use opioids, early physical therapy was associated with a 5 to 10 % reduction in how much of the drug they used, the study found. Amid national concern about the overuse of opioids and encouragement from the Centers for Disease Control and Prevention, and other groups to deploy alternatives when possible, the findings provide evidence that physical therapy can be a useful, nonpharmacologic approach for managing severe musculoskeletal pain.

HEALTH TECHNOLOGY CORNER

Robotic Activity Support System For Elderly Patients With Dementia
A robot created by Washington State University (WSU) scientists could help elderly patients with dementia and other limitations to live independently in their own homes by performing basic and instrumental activities of daily living (ADLs). The Robot Activity Support System, or RAS, represents a collaboration between a smart home and a mobile robot. It functions by using sensors embedded in a WSU smart home to determine where its residents are, what they are doing, and when they need assistance with daily activities. RAS combines the convenience of a mobile robot with the activity detection technology of a WSU smart home to provide assistance in the moment, as the need for help is detected. A description of the project appears in advance in the May 2019 issue of the journal Cognitive Systems Research. Technologies that automatically assist with activity of daily living may relieve some of the strain on the health care system as well as caregivers, allowing individuals to remain functionally independent and age in place.

Research On Roundworms May Lead To Motor Function Improvement In Humans
As animals and humans age, motor functions progressively deteriorate. Millimeter-long roundworms called nematodes exhibit aging patterns remarkably similar to those of other animals and they live only about three weeks, making them an ideal model system for studying aging. A report on January 2, 2019 indicated that research from the University of Michigan Life Sciences Institute has uncovered a cause of declining motor function and increased frailty in tiny aging worms and a way to slow it down. The findings, published that day in Science Advances, identify a molecule that can be targeted to improve motor function and indicate that similar pathways may be at play in aging mammals as well. Age-dependent motor activity decline is a prominent feature of normal aging. Motor deficits represent one of the main risk factors for falling in elderly humans, which leads to injury and mortality. It would be beneficial to delay or slow motor aging to improve the quality of life and, ideally, to extend a life span, which has remained a challenge. Using C. elegans as a model, targeting aging motor neurons can slow motor aging and promote longevity.

Return to Dec 2018 - Jan 2019 trends

DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

January 22, 2019

Trends Archives

Similar to legislative and regulatory initiatives pertaining to health reform that are described on the previous page of this newsletter, higher education also is affected by events that occur in those two arenas. A most important piece of legislation in need of concerted action is reauthorization of the Higher Education Act. Last reauthorized in 2008, since 2013 it has been sustained by a series of short-term continuing resolutions (CRs). Whether this important task will be completed in 2019 is uncertain.

One way of assessing what may unfold involving higher education is to chart the activities of key officials when they appear in public to make presentations. Secretary of Education Betsy DeVos on December 19, 2018 met with leaders of the American Council of Education (ACE) at that organization’s headquarters to discuss higher education policy. She used accreditation as an example of how to approach the current educational system. She requested her listeners to rethink which parts of the Department’s accreditation regulations and guidance are related directly to educational quality and student experience, and which parts are ambiguous, repetitious, or unnecessarily burdensome. She also asked how the Department could clarify the roles and responsibilities of each entity within the higher education “triad,” consisting of the federal government (which has a focus on administrative and fiscal integrity of student financial aid programs), state governments (which issue licenses to academic institutions), and accreditation organizations (which assure acceptable levels of quality in teaching and learning).

Rethinking Higher Education

As part of her remarks, the Secretary released the document “Rethinking Higher Education,” which identifies the following goals:

It is time to challenge our past practices, assumptions, and expectations about what “college” is, what it should be, and how it should operate.
It is time to restore institutional autonomy and respect for an institution’s unique mission.
It is time to value the unique goals and challenges that each student brings to the postsecondary experience.
It is time to include in our assessment of institutions the contributions that each school makes to help its students’ success.
It is time to streamline regulations so as to avoid government intrusion.
It is time to promote innovation.
It is time to allow new entrants to educational delivery and reject efforts to maintain the status quo.

Rethinking Higher Education: Accreditation

A second document also was released that outlines some of the following goals:

Restore “substantial compliance” as the standard for recognition.
Restore the regulatory triad by more clearly defining the roles and responsibilities of accreditors, the states, and the Department in oversight of Title IV participating institutions of higher education.
Increase academic and career mobility for students by eliminating artificial boundaries between institutions due to credential levels an institution offers or the agency that accredits the institution or its programs.
Provide greater flexibility for institutions to engage in innovative educational practices and meet local and national workforce needs.
Within the confines of law, protect institutional autonomy, honor individual campus missions, and afford schools the opportunity to build campus communities based on shared values.
Reward institutional value-added, not student selectivity.
Modify “substantive change” requirements to provide greater flexibility to institutions to innovate and respond to the needs of students and employers.
Streamline and clarify the Department’s accreditor recognition process.
Encourage and enable accreditors to support innovative practices, grant limited accreditation to experimental pedagogies, provide support to accreditors when they take adverse actions, and allow sanctions that do not mandate “all or nothing” access to Title IV.

Return to Dec 2018 - Jan 2019 trends

HEALTH REFORM DEVELOPMENTS

John Colbert

January 22, 2019

Trends Archives

It does not amount to the least bit of hyperbole to suggest that a great many pieces of legislation that are enacted into law might conveniently be subtitled: The Attorneys, Accountants, and Lobbyists Relief Act (fill in the year of enactment). The Patient Protection and Affordable Care Act of 2010 (commonly referred to as either the ACA or Obamacare) fits this description perfectly. To cite just one example, in February last year, 20 attorneys general filed a lawsuit claiming that the 2017 Tax Cut law and the Jobs Act’s reduction of the individual responsibility tax penalty to zero, in effect made the ACA’s individual mandate unconstitutional. Proceeding from that line of reasoning, it means that the entire ACA was invalid because of the disappearance of the tax penalty. In December of 2018, a federal court judge in Texas agreed with this argument, entering a judgment that if it is upheld, the entire ACA would become invalidated. What comes as no surprise is that supporters of the Affordable Care Act have mounted their opposition to this ruling. Democratic attorneys general in 17 states have intervened to defend the entirety of the health reform law.

Apart from this specific example, it is worth noting that once it became apparent that Republicans in Congress in 2017 were unable to repeal and replace the ACA, since then the Trump Administration has used its powers to issue several regulations and guiding principles aimed at crippling the law. Opponents have responded by unleashing countersuits to prevent or delay these administrative actions. Thus, it is safe to assume that the future appears to remain quite bright when it comes to the financial health of many law firms and advocacy groups since additional litigation already can be detected hovering on the near horizon.

Administration Initiative To Create Association Health Plans Faces Challenges
One Trump Administration regulatory initiative is aimed at creating Association Health Plans that do not have to comply with either ACA individual or small-group requirements, In June 2018, the Labor Department finalized a rule to expand the ability of employers, including sole proprietors without common law employees, to join together and offer health coverage through Association Health Plans. These short-term limited duration vehicles can be in effect for one year and also be subject to renewal for as many as 36 months while continuing to be exempt from the Affordable Care Act’s consumer protections. Opponents have reacted in New York and other states by bringing a lawsuit to challenge the health plan rule on the basis that it violates the ACA, the Employee Retirement Income Security Act (ERISA) of 1974 that regulates group health plans, and the Administrative Procedures Act. Oral arguments in federal district court for the District of Columbia were scheduled to begin in January 2019.

Transgender Protections And Religious/Moral Objections To Contraception Coverage
Increased attention is being paid by policymakers to the issue of whether the health care needs of transgender individuals are being addressed satisfactorily. One concern is whether current regulations provide adequate protection from discrimination against transgender patients by insurance companies and health care providers. Federal courts have weighed in on this matter in the past and can be expected to continue doing so in the future. Mandated benefits under the ACA sometimes trigger opposition for moral and religious reasons. Contraception coverage offers an example whenever religious groups are compelled to provide this benefit because doing so may conflict with core spiritual beliefs.

Pursuing The Realization Of Health Care Priorities In Congress
Major differences exist between Democrats and Republicans in Congress, and despite that each party enjoys a majority in only one chamber, it still may be possible to achieve bipartisan agreement on certain issues that could be enacted into law. An example is lowering the cost of prescription drugs. President Trump also has signaled his desire to see constructive action taken in that regard. Recent years have involved a series of proposed buy-outs and mergers among drug companies, insurance firms, and health care providers. Through its oversight powers, committees in Congress may be able to work in an effective bipartisan way to determine if such transactions have the potential either to weaken competition or have a negative impact on health care consumers and taxpayers. Fixing a maldistribution of health resources in the form of an insufficient supply of clinicians and health care facilities in rural areas is a chronic problem that also should be of interest to legislators from both political parties.

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FEDERAL BUDGET AND THE OPERA

John Colbert

January 22, 2019

Trends Archives

An inability to reach agreement on federal budget priorities resulted in a partial government shutdown to mark the start of the year 2019. The current shutdown occurred because of an inability to reach agreement on how much should be spent and for what purposes to increase security measures along the nation’s southern border with Mexico. This 21st stoppage in the past 43 years conjures up thoughts about how efforts to produce a budget each fiscal year can assume qualities of an operatic nature. As an illustration, divas and divos from both major political parties are accustomed each year to performing dramatic roles involving the equivalent of singing enthusiastic arias that reflect their distress at pet projects being denied adequate funding.

History shines some light on the nature of the basic problem. Only on four occasions since 1977 has Congress been able to pass all 12 appropriations bills on time before a new fiscal year begins on October 1. Another 16 years have been characterized by an inability to pass a single bill on time. The usual remedy is to enact short-term continuing resolutions (CRs) to enable the government to continue operating, but as the present situation exemplifies, even that approach has not been possible on 21 different occasions.

It also is worth acknowledging that squabbles over the federal budget are restricted to only one-fourth of total spending. Referred to as discretionary expenditures, amounts have to be debated and agreed upon for purposes, such as aid to education, the military, National Institutes of Health, and the provision of agricultural subsidies. The remaining three-fourths of the budget essentially is on automatic pilot where spending is allocated among major entitlement programs, including Social Security and Medicare. Once individuals qualify to become recipients, their benefits must be paid as regularly as clockwork. Given the steady numerical and proportional growth in the segment of the population age 65 and older, the provision of adequate support for such programs will continue to pose significant future challenges.

Apart from funding, individual members of Congress either singly or in combination will introduce a large number of bills in 2019. Committees and subcommittees will conduct hearings and also carry out oversight activities of the executive branch. The educational community has been waiting patiently since 2013 for reauthorization of the Higher Education Act (HEA). This major piece of legislation that became law in 1965 last was reauthorized in 2008. Whether agreement can be reached on producing a reauthorization this year remains to be seen.

Both chambers are off to a quick start proposing other legislative action.

Senate:
S.3—stabilize the individual insurance market, make insurance coverage more affordable, lower prescription drug prices, and improve Medicaid.
S.12—improve access to health care through expanded health savings accounts.

House:
H.R. 64—intensify stem cell research showing evidence of substantial clinical benefit to patients, and for other purposes.
H.R. 83—repeal the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.

Now that Democrats are the majority in the House of Representatives, considerable interest is being expressed in moving toward a single payer system. Expanding Medicare eligibility to a wider segment of the U.S. population would be a step in that direction.

Return to Dec 2018 - Jan 2019 trends

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

January 22, 2019

Trends Archives

By Susan N. Hanrahan, ASAHP President

In my message in the November 2017 issue, I indicated that I will be asking some of you to send a photo and answer a series of “fun” questions to be shared with our membership so that we can continue our collegiality through our newsletter. The 9th of many profiles and the first in 2019 is presented as follows:

Name and Title: Brooke Hallowell, Dean of Health Sciences and Rehabilitation Studies

University: Springfield College

How long have you been in your position? 1 year

If I could teach in another field, which one and why? Counseling/coaching/hypnotism. To be at the heart of empowering people to be their best, authentic selves, thus enhancing their roles as vehicles of service to others.

Before I retire I want to: Start doing a lot of the things I dream of doing after I retire.

In college, I was known for: Being president of our university orchestra.

What music is playing in my car/office? Francis Cabrel

My favorite trip was: In southern India, with my daughter

If I could travel anywhere it would be: Fiji

The best advice I ever received was: Put on your own oxygen mask before assisting others.

My hobby is: Improv acting, arm wrestling, sculpting, collaborative storytelling

My passion is: Hanging out with older people and babies.

Beach or mountains? Both! Why choose?

Only my friends know I: Am a certified heavy equipment operator and an arm-wrestling pro.

My favorite saying is: Choose the joy!

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CALLING UNCLE SAM AND ALEXA

John Colbert

January 22, 2019

Trends Archives

Federal programs that include Medicare and Medicaid, along with technology developments in the private sector such as Alexa are two sets of forces that represent enormous influences on the health care domain. Apart from furnishing health services and paying for them, parallel activities by other government entities play essential roles in generating innovations (e.g., National Institutes of Health) and ensuring safety of new health products (e.g., Food and Drug Administration).

The Medicare Board of Trustees reported on June 5, 2018 that in 2017, Medicare covered 58.4 million individuals, 49.5 million aged 65 and older, and 8.9 million who are disabled. Total expenditures in 2017 were $710.2 billion and total income was $705.1 billion. Medicaid is the nation’s public health insurance program for individuals with low income. It covers more than 70 million Americans, including many with complex and costly needs for care. The program accounts for one in six dollars spent on health care in the United States and more than half of all spending for long-term services and supports. Plus, it drives state budgets and is the largest source of federal revenues to states.

Amazon Echo and Dot devices are improving patients’ lives by enabling those who are bedridden and unable to reach a wall thermostat to regulate room temperature. When issuing commands to a device, the software can be rearranged to accommodate whatever words a patient is capable of using to perform various household tasks and set medication reminders. An Alexa app called Marvee can translate voice snippets into text messages and deliver them to pre-specified contacts. Meanwhile, Amazon has filed a patent for the Alexa voice assistant to recognize coughs or colds. That firm also has been exploring options that would allow it to mine medical records to diagnose patients and it has been exploring the possibilities of testing patients for disease at home.

Technology developments impinge on the government both directly and indirectly. For example, the Apple Watch can generate data as a consumer health tracker. The company touts the ability of this device to detect atrial fibrillation, although evidence is gathering that it does so less accurately for users below the age of 55. Efforts currently are underway to determine if private Medicare plans are interested in subsidizing the watch for beneficiaries.

As devices of this nature collect consumer and patient health information, concerns are raised about how adequately current policies protect privacy. Congress could play a useful role by clarifying the amount of authority and ownership patients have over their own records, and the extent to which patient information can be held by a health system. Steady advances in germline gene editing and artificial intelligence also call into question whether existing policies suffice to ensure that patients are protected from possible harm. A congressional in-house think tank, the Office of Technology Assessment (OTA), was disbanded in 1995. As legislators increasingly are called upon to deal with technology issues, restoring the OTA may be warranted as a means of assisting them to perform satisfactorily.

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NAVIGATING THE HEALTH FRONTIER

John Colbert

November 26, 2018

Trends Archives

A deeper understanding of consumers’ decision-making processes can equip health care providers to retain and engage them effectively as well as attract new ones. The Deloitte Center for Health Solutions recently surveyed 4,530 U.S. consumers to assess their attitudes, behaviors, and preferences when making decisions about health insurance, health care, and well-being. A segmentation analysis of data, focusing on health care attitudinal and behavior questions rather than demography, offered a richer understanding of consumers than analysis focused solely on demographic factors.

The analysis categorized individuals into four distinct groups that reflect their differences in preferences for managing their health and interacting with various providers. Given its changing and sometimes unknown landscape, the U.S. health care system draws parallels with the Wild West of the 19th century. Personalities of individuals from the American frontier during that time period used to describe the results of segmentation are as follows:

Trailblazers (tech-savvy, self-directed, engaged in wellness, willing to share data)
Prospectors (rely on recommendations from friends/family, use providers as trusted advisors, willing to use technology)
Homesteaders (reserved, cautious traditionalists)
Bystanders (complacent, tech-reluctant, resistant to change, unengaged)

The analysis shows that each group not only has unique needs and expectations, but navigates the health care system differently. Segmentation findings can help tailor more effective interactions with consumers.

Return to November 2018 trends

CELEBRATING ALLIED HEALTH WEEK AT DES MOINES UNIVERSITY

John Colbert

November 26, 2018

Trends Archives

Members of Des Moines University Health Leaders and UnityPoint Clinic staff came together to celebrate Allied Health Week on November 8.

As part of 2018 Allied Health Week on November 4-10, the Des Moines University Health Leaders, an interprofessional student club, brought to campus members of UnityPoint Clinic’s recruitment staff on November 8. They held mock interviews with more than 30 physical therapy, physician assistant, and osteopathic medical students to help them hone their interviewing skills and resumés. The UnityPoint team also gave a presentation on general tips for constructing a strong resumé, the process that occurs from applying for a position to landing an interview, how to come prepared, and insights on contract negotiations. Additional events involved hosting a noon event for students to learn about each program on campus and networking on another evening that week.

Return to November 2018 trends

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

November 26, 2018

Trends Archives

Separate & Unequal Public Colleges
America’s selective public colleges should be among the great equalizers in U.S. society. Funded primarily by taxpayers and carrying a relatively low price tag, these colleges are meant to be engines of opportunity for all. In reality, however, the doors of these institutions are open wider to White students than to their Black and Latino peers, according to a report from Georgetown University’s Center on Education and the Workforce. Whites have almost two-thirds (64%) of the seats in selective public colleges even though they make up barely half (54%) of the nation’s college-age population. Blacks and Latinos are making unprecedented gains in college-going, but the vast majority of Black and Latino students enroll in overcrowded and underfunded open-access colleges, primarily community colleges. Consequently, fewer Black and Latino students receive a bachelor’s degree. Selective public colleges reflect the Latino college-age population (18-to-24-year-olds) in just one state: Florida. Meanwhile, other states are far from parity. In California, 48% of the college-age population is Latino, but only 25% of students in selective public colleges are Latino. Blacks are not proportionately represented in selective public colleges in any state. Certain states are egregiously unbalanced, e.g., in Alabama, 32 of every 100 college-age residents are Black, but only seven of every 100 students at the state’s selective public colleges are Black. The report can be obtained here.

Access To High School Courses That Help Prepare Students For College
Students in relatively poor and small schools had less access to high school courses that help prepare them for college, according to an analysis of Department of Education data for school year 2015-16 (the most recent available) by the Government Accountability Office (GAO). While most public high schools, regardless of poverty level, offered courses like algebra and biology, disparities in access were associated with school poverty level for more advanced courses like calculus, physics, and those that may allow students to earn college credit, like Advanced Placement (AP) courses. High-poverty schools were less likely to offer the math and science courses that most public 4-year colleges expect students to take in high school, according to GAO's analysis of college websites. Regression analysis also showed that smaller schools and certain types of schools, like charter schools, are less likely to offer the college preparatory math or science courses that many colleges look for during the admissions process. The report can be obtained here.

Understanding Disparities In Access To Genomic Medicine
Genomic medicine has the potential to improve the quality of health and health care by allowing clinicians to tailor prevention and treatment strategies individually to their patients. Recent research breakthroughs, technological advances, and the decreasing cost of DNA sequencing have led to wider adoption of genomic medicine in health systems. It is not clear, however, if genetic/genomic services will reach all communities within the population both now and in the near future because of a significant gap in knowledge regarding potential health care disparities in genomic medicine and precision health. The National Academies of Science, Engineering, and Medicine hosted a public workshop on June 27, 2018 that explored disparities in access that exist across different communities (e.g., in medically underserved areas and populations, across different racial/ethnic groups, and socioeconomic levels). Discussions included exploring barriers to accessing genomic/genetic services, the role of health systems in delivering equitable access, and innovative solutions and models of success in reducing health care disparities related to genomic medicine. Workshop proceedings can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

November 26, 2018

Trends Archives

Use Of Yoga, Meditation, And Chiropractors Among U.S. Adults: 2012-2017
A report from the National Center for Health Statistics (NCHS) in November 2018 examines changes over time in the percentage of adults who used yoga, meditation, and chiropractors in the past 12 months, as well as variation by sex, age, race, and Hispanic origin. Among adults aged 18 and over, increases were seen from 2012 to 2017 in the use of yoga, meditation, and chiropractors. Yoga was the most commonly used complementary health approach among U.S. adults in 2012 (9.5%) and 2017 (14.3%). In 2017, women were more likely to use yoga, meditation, and chiropractors in the past 12 months compared with men. Non-Hispanic white adults were more likely to use yoga, meditation, and chiropractors compared with Hispanic and non-Hispanic black adults. In 2012, seeing a chiropractor was as popular as yoga, followed by meditation, but in 2017, meditation became the 2nd most-used approach ahead of chiropractic.

Increasing Medication Adherence Could Improve Care And Save Health Care Costs
Non-adherence to medication represents a major problem that limits the effectiveness of treatment and adds to the burden of illness and cost of health care. About half of all patients do not take their medication as prescribed, according to a September 2018 report from the National Council for Behavioral Health’s Medical Director Institute. Estimates indicate that medication non-adherence costs the health care delivery system $100 billion to $300 billion annually due to more frequent use of high-cost services, additional prescriptions to offset non-adherence, and interventions to address relapses. The report discusses medication non-adherence in chronic conditions, mental health, and substance use disorders, and offers some possible solutions. If many of these solutions were to be adopted by 2025, a projection is made that the health system would save $2 billion a year from reduced hospital costs alone. Apart from improving communication between patients and providers, some more high-tech solutions include apps and robots.

HEALTH TECHNOLOGY CORNER

Robotic Arm May Help To Rehabilitate Chronic Stroke Victims’ Communication Deficits
Apropos of the article about silos in Health Silo Disruption and Eradication of this issue of TRENDS, treatment in one domain (motor function) may benefit performance in another untreated domain (communication) in individuals with acquired aphasia, the loss of ability to understand or express speech. Research published in Frontiers in Neurology on October 22, 2018 shows that robotic arm rehabilitation in chronic stroke patients with aphasia may promote speech and language function recovery. The rehabilitation in this study targeted the right arm since study participants each had suffered a left hemisphere stroke leading to a deficit in motor function on their right side. The research team observed small, but consistent improvement on measures assessing speech articulation and overall language processing in aphasia. It is believed some treatment approaches may encourage plasticity and reorganization that can span multiple domains. Although this initial finding should be interpreted cautiously, it remains exciting to consider the possibility that stroke rehabilitation in one domain would improve performance in another domain.

Obesity Provides Unexpected Enhancement Of Anticancer Medications
Obesity is associated with increased mortality and reduced longevity, but counter-intuitive findings occasionally suggest evidence of an obesity paradox. An article published in the journal Nature Medicine on November 16, 2018 indicates that overweight patients sometimes respond better than other patients to powerful drugs that harness the immune system to fight tumors. Called checkpoint inhibitors, the drugs block the activation of PD-1, a protein on the surface of immune sentinels called T cells. The body naturally triggers PD-1 to dampen immune responses, but tumors also can stimulate PD-1 to protect themselves. Lifting this molecular “brake” allows the T cells to attack the cancer cells. PD-1 inhibitors have caused untreatable tumors to vanish for years in patients with melanoma, lung cancer, and some other cancer types. Although there is heightened immune dysfunction and tumor progression, there also is greater anti-tumor efficacy and survival after checkpoint blockade that targets some pathways activated in obesity.

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DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

November 26, 2018

Trends Archives

The potential impact on health policy that might result from Democrats becoming the majority in the U.S. House of Representatives as a result of the mid-term elections earlier this month is described in Election Results to Ponder of this issue of TRENDS. The current page extends the discussion to consider how the education sphere also might be affected during the next two years. For example, Betsy DeVos, Secretary of the Department of Education, has been the target of steady criticism by Democrats since her appointment. One reason is her efforts to undo regulations from the Obama-era aimed at holding colleges accountable for the federal-loan debt of their students. She now can expect to be the object of tougher scrutiny by House Democrats.

Regulations proposed on November 16, 2018 that can determine how colleges handle cases of sexual misconduct under Title IX, the federal law meant to ensure gender equity on campuses, are destined to generate spirited opposition. Similarly, efforts by the Department to modify various regulations that deal with accreditation are destined to create a similar level of opposition. Meanwhile, an all-important Higher Education Act (HEA) continues to await reauthorization. Emboldened by their recent gains in the House of Representatives, combined with the prospect that they also might reacquire control of both the Senate and the White House in 2020, may provide an incentive for Democrats to wait until then to reauthorize the HEA. That way, they would be in a more advantageous position to produce legislation in line with their policy objectives.

Proposed Regulations On Title IX Campus Sexual Assault
The U.S. Department of Education on November 16 issued a long-awaited notice of proposed rulemaking (NPRM) to specify additional regulations to implement Title IX of the Education Amendments of 1972. The NPRM procedure is required by the federal Administrative Act, except in limited cases of emergency rulemaking, to provide the public with an opportunity to review, consider, and comment on draft regulations before they are finalized. Upon release of the proposed rule, opponents instantly began to express concerns that it will reduce the obligation of academic institutions to investigate complaints of sexual misconduct and decrease the likelihood that they will respond to the issue of sexual misconduct seriously. Another objection is that unlike previous federal policy, institutions would be responsible only for investigating misconduct that occurred within programs sanctioned by a college, thereby reducing protections for students assaulted or harassed off-campus. Equally contentious is a provision that would require colleges to allow for cross-examination of students in campus proceedings, but not allow the parties themselves to interact. Once published in the Federal Register, the rule enters a 60-day public notice and comment period.

Allowing The Department Of Education And The Internal Revenue Service To Share Student Data
An example of bipartisanship on display in the Senate following the recent election was the introduction of S. 3611 on November 13, 2018 to amend the Internal Revenue Code of 1986 and the Higher Education Act of 1965 to facilitate the disclosure of tax return information to carry out the 1965 Act, and for other purposes. The bill, co-sponsored by Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) of the Committee on Health, Education Labor & Pensions (HELP), is cited as the Faster Access to Federal Student Aid (FAFSA) Act of 2018. This proposed legislation would amend the Internal Revenue Code, which currently prohibits the IRS from sharing taxpayer data with the Department of Education, to allow the IRS to disclose tax return information to department officials "determining eligibility for, and amount of, Federal student financial aid."

Reauthorization Of The Higher Education Act (HEA)
The takeover of the House of Representatives by Democrats can be expected to reduce the likelihood of having a Republican version of HEA reauthorization, the Promoting Real Opportunity, Success, And Prosperity Through Education Reform (PROSPER) Act (H.R. 4508), become law. That proposed legislation has attracted wide criticism by higher education lobbying groups, along with various student and veteran organizations. Instead, it is likely that Democrats will strive to have their version, the Aim Higher Act (H.R. 6543), become the basis for reauthorizing the HEA. if an when that opportunity arises.

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HEALTH REFORM DEVELOPMENTS

John Colbert

November 26, 2018

Trends Archives

The ability to access high quality health care services is a necessary, but not sufficient means of improving the health status of individuals. Race, ethnicity, health literacy, nutritious dietary patterns, being physically fit, the opportunity to live in safe neighborhoods, and the availability of jobs that provide a satisfactory level of income are among the many key factors that have an impact on health. Government programs, such as Medicare have strict limits defined statutorily that determine the scope of services that can be offered to beneficiaries. As discussed below, a recent speech on November 14, 2018 at the Hatch Foundation for Civility and Solutions in Washington, DC by Alex Azar, Secretary of the Department of Health and Human Services (HHS), provides a possible way of expanding services to include a greater emphasis on addressing social determinants of health.

Also, not only do technology developments play a major role in contributing to a constant rate of growth in the cost of health care, they complement efforts to enhance service quality. Telehealth, artificial intelligence (AI), and machine learning are key items as described below.

Addressing Social Determinants Of Health In The U.S. Through Medicare Advantage
HHS Secretary Alex Azar on November 14 stated that the department he oversees is logically positioned to think of healthcare as broad and interconnected with other needs. "Social determinants would be important to HHS even if all we did was healthcare services, but at HHS, we cover health and human services, all under one roof. In our very name and structure, we are set up to think about all the needs of vulnerable Americans, not just their healthcare needs. But what if we went beyond connections and referrals? What if we provided solutions for the whole person, including addressing housing, nutrition and other social needs? What if we gave organizations more flexibility so they could pay a beneficiary’s rent if they were in unstable housing, or make sure that a diabetic had access to, and could afford, nutritious food?” One of the best ways to do so is through Medicare Advantage, which is Part C of the Medicare program. Beginning next year, plans under Part C will be allowed to pay for a wider array of health-related benefits, such as transportation and home health visits.

Telemedicine Usage Increases In Medicare
A report sent to Congress on November 16, 2018 by the Centers for Medicare & Medicaid Services (CMS) describes an increase in telemedicine usage of about 50% in fee-for-service Medicare from 2014 to 2016. Telehealth is emerging as a tool with the potential to improve access to care, potentially reduce costs, and enhance patient satisfaction. Medicare and other telehealth services are being used currently for a range of services in rural communities, allowing patients to connect directly with health care providers and support these providers with clinical decision-making. Moreover, telestroke services connect neurologists to rural patients and providers to provide remote diagnoses and treatment recommendations. Research indicates that telepsychiatry can reduce disparities in access to psychiatric care. When delivered remotely, psychiatric care increases the chances that individuals living in rural communities will be able to access professionals who are culturally and linguistically competent.

Bioethics Influence On Artificial Intelligence and Machine Learning
According to an essay in the September/October 2018 issue of The Hastings Center Report, artificial intelligence (AI) and machine learning have the potential to revolutionize the delivery of health care. AI systems generate conclusions by applying complex algorithms to enormous data sets by replacing human reasoning with rote‐like analysis. Machine learning “trains” or “teaches” the algorithm so that it can “learn” and eventually perform its given tasks automatically. Empirical research has demonstrated that the latest generation of AI and machine learning applications not only can identity at‐risk patients, but even achieve better diagnostic performance than expert physicians can. An example of why it is important to develop ethical frameworks that can support novel technologies has to do with the possibility that schizophrenia is over diagnosed in black patients. For a decision model to make correct predictions about the diagnosis or prognosis of these individuals seeking mental health care, factors such as their social history, their access to providers or hospitals, and the quality of hospitals available to this patient population play an important role. If a machine learning‐based decision support system continually is exposed to this ailment in black patients without appropriate context, then the algorithm will wrongly “teach” the decision system that schizophrenia is common in these patients.

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ELECTION RESULTS TO PONDER

John Colbert

November 26, 2018

Trends Archives

Elections that occur in the middle of a presidential term may provide useful insights regarding directions in which voters prefer to have some corrective measures implemented. Typically, the party that occupies the White House experiences mid-term losses in both congressional and state contests. The year 2018 was no exception insofar as Democrats in Congress regained having a majority in the House of Representatives. Much of what they may hope to achieve will be tempered to a certain extent, however, by the fact that not only will Republicans maintain control of the Senate for the next two years, they will do so with more members than they had prior to the election.

Health was the number one issue for many individuals casting ballots throughout the U.S. Democrats running for office campaigned on promises to protect key provisions of the Affordable Care Act, such as defending protections for patients with pre-existing conditions and preventing future Republican efforts to repeal the ACA. Members of the G.O.P emphasized the risk of heightened fiscal dangers that will occur if either Medicare for All legislation or any single-payer health insurance variation aimed at making health care available at little or no cost for patients ever is enacted.

One policy area of concern may lend itself to some bipartisan agreement. Key members of the Democratic party and President Trump have expressed interest in curbing pharmaceutical price increases. Generally, Republicans tend to oppose government action to set or influence prices. Yet, it would come as no surprise if House Democrats try to require direct government negotiation of Medicare Part D drug reimbursement policy. Democrats also can be expected to be more aggressive when it comes to investigating drug manufacturers suspected of being responsible for initiating price increases of their products. The pharmaceutical industry may not be alone, however, in attracting greater congressional scrutiny. An example involves what is called “surprise bills” that may arise unexpectedly after patients are discharged from hospitals. This issue also has some potential to attract bipartisan support in search of a remedy.

Marijuana legislation usually generates more attention at the state rather than the federal level, but the topic remains of interest to Democrats on Capitol Hill. Republican Pete Sessions of Texas was defeated earlier this month after serving as Chairman of the important House Rules Committee. While in that position, he was able to block proposals from being considered on the House floor, such as allowing states to develop their own approaches to marijuana regulation. His departure may signal increased efforts in that chamber to advance marijuana policy reform measures.

Apart from what occurs in Washington, DC significant actions will continue to occur at the state level. Michigan will move forward in legalizing adult recreational marijuana use, while a medical marijuana ballot measure was approved in Missouri. Voters in Idaho, Nebraska, and Utah approved ballot referenda to expand their Medicaid program coverage under the Affordable Care Act. Newly elected governors in Kansas, Maine, and Wisconsin can be expected to take action to expand their respective Medicaid programs.

Meanwhile, whatever unfolds in the coming two years will serve as an important prelude to identifying key debatable propositions that will manifest themselves in the next election scheduled for 2020.

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PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

November 26, 2018

Trends Archives

By Susan N. Hanrahan, ASAHP President

I am not sure we had a spring or fall in the Mid-South because we went from winter to summer and now have gone from summer to winter. Climate change has seemed to eliminate two of my favorite seasons. Good grief!

Want to thank everyone who attended our Annual Conference in St Pete. We had some great speakers (plenary, poster and platform), beautiful venue (despite the high humidity during the storm) and good celebrations. Our evaluation feedback supported that. We were also given some ideas for our Charleston conference next year (Oct 16 -18) and planning has already begun.

A couple of things I want to share. We are working to enhance our website so that information on committees and task forces is more robust and that links to our Regional Deans groups are available. Even though the deans groups are not “officially” part of ASAHP, they are an avenue for deans across the US to get together outside of our annual conference to discuss and brainstorm on items of mutual interest.

Our International Task Force has completed some preliminary work in better understanding the need for health workers (predominately rehab) internationally and a desire for education and certification for those individuals. Originally it seemed that a “country by country” approach would be needed but the committee has opted for an ‘economies of scale’ model. We have put together a small group to establish the process for standard setting and to use this conceptual framework to develop a set of standards that defines the expected competencies of a rehab health worker.

Once complete, they can be sent globally for peer review. Individual countries can choose to adopt these standards for certification of their rehab health workers. That will be part one. We are partnering, and have entered into a non-disclosure agreement, with the Commission on Graduates of Foreign Nursing Schools (CGFNS) who knows all about process. Rich Oliver (ASAHP) and Julia Dutka (CGFNS) will be co-chairing the group along with ASAHP members Fevzi Akinci, Duquesne University, Katherine Beissner, SUNY Upstate, and David Henzi, UT San Antonio. This is a substantive first step.

One of our most valued assets in the Association is the Journal of Allied Health. We have formed a task force led by Greg Frazer, University of South Alabama, with members Jon Williamson, UT Southwestern, and Bonnie Van Lunen, Old Dominion University, to look at the journal itself for new opportunities while keeping in the back of their minds, succession planning. Our current Editor, Tom Elwood, has been so vital to our operations for so many years. We rely on him heavily and often forget about doing specific planning around the journal itself. If you have thoughts about the journal, please share those with Greg or myself.

Lastly, the Board has selected Phyllis King, University of Wisconsin, Milwaukee as its President-Elect for 2019. Phyllis most recently led the Leadership Development Program for ASAHP, currently serves on the Board of Directors and has been an active member of ASAHP for many years. I look forward to my continued work with Phyllis. Many more things to share but please know that if you have ideas about the Association or want us to put you to work, let me know at hanrahan@astate.edu. Happy ALL holidays between now and next year!!!

Susan Hanrahan, President

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HEALTH SILO DISRUPTION AND ERADICATION

John Colbert

November 26, 2018

Trends Archives

A lamentation expressed over the decades is that the health domain is dysfunctional to some degree because of the existence of silos that separate clinical services and the health professionals who provide them. One example will suffice to illustrate the nature of the problem. A patient can be referred to a practitioner in a different profession. That visit will be characterized by having to devote 10-15 minutes filling out a form on paper to register information about current medications in use, recent hospitalization episodes, allergies, and family history of particular diseases. A physical examination and the administration of some laboratory-based tests may follow, but there is no guarantee that any of this critical information subsequently will reach all relevant providers furnishing care for that patient.

A lack of interoperability is a dominant concern. Although efforts are underway to share information, no effective mechanism exists to establish a repository to house clinical data and ensure that it properly can be distributed to health professionals involved in patient care. Thus, it should be evident that efforts are necessary to make improvements that can occur on both an intramural and an extramural basis.

From an Intramural perspective, advances have been made through initiatives in interprofessional education to enable students from different health professions to learn about the unique contributions that personnel from other fields contribute to the betterment of both individual and population health status. Depending on the kind of employment undertaken upon completion of academic preparation, it is inevitable that some jobs will entail a mix of practitioners from a broad spectrum of disciplines. For instance, a neonatal intensive care unit (NICU) may provide care for an infant with a gestational age of 22-24 weeks who weighs only one pound. Cardiology, nursing, respiratory therapy, nutrition, and physical therapy are among the professions involved whose representatives must work together in a seamless manner to provide the most effective team-oriented care required.

The Extramural sphere is a region where health professionals stand to benefit from research and discoveries that emerge from totally different fields. For example, investigators in polymer chemistry and macromolecular science and engineering are studying the use of bio-inspired materials to develop products that mimic the adaptable skin of a sea cucumber for potential use in creating a worm-like robot to deliver a stent or remove plaque by crawling through a blood vessel.

Actuarial science personnel are using predictive analytics to figure out how to employ big data to direct patients to higher quality, lower cost providers. Computer scientists at Sandia National Laboratories are working to improve this nation’s biosurveillance system that alerts authorities to disease outbreaks by mimicking the human immune system. The November 2018 issue of the International Journal of Molecular Sciences discusses how the marine environment creates opportunities for acquiring new substances with anti-cancer activity. Overall, perhaps an unlimited number of resources are in a position to be exploited, but only if health professionals are willing to embrace the challenge of attempting to disrupt and eradicate the artificial boundaries that separate a vast multiplicity of disciplines.

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More Articles from TRENDS February 2019

THE PERIODIC TABLE OF ELEMENTS

OPEN SEASON FOR LEGISLATION

HEALTH REFORM DEVELOPMENTS

DEVELOPMENTS IN HIGHER EDUCATION

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

IDENTIFICATION, EVALUATION, AND COMPARISON OF HEALTH DEVICES

PUTTING PATIENTS FIRST AND DISPARITIES RESEARCH

More Articles from TRENDS February 2019