Monday 31 August 2015

Medibank and Calvary resolve health insurance dispute at 11th hour

Medibank Private customers will be free to use hospitals run by Calvary Health Care following a last minute resolution to a dispute that would have ended the agreement between Australia’s largest private health fund and the chain on Monday.

Negotiations between the fund and the Catholic-affiliated hospital chain broke down in July after Medibank declared that it would no longer pay for 165 “highly preventable adverse events” and unplanned hospital readmissions within 28 days saying the crackdown would help eliminate mistakes.

“We had reached an agreement that will deliver enhanced clinical safety, quality care and affordability for members and patients,” both parties said upon signing a new three-year agreement. “It is good for both our organisations and all other stakeholders, be they staff or doctors.”

At the height of the dispute Medibank took out full-page newspaper advertisements to counter what it terms misleading and misinformed statements from Calvary.

“Unfortunately, unlike [other private hospitals] Calvary believes health insurers should pay for mistakes which can be prevented, like falls and pressure sores, even though they happen in their hospitals,” it said in advertisement.

Last week it offered to introduce an independent clinical review process to clarify situations where responsibility for adverse events was unclear.

Although neither party will reveal the terms of the new agreement it is likely to put pressure on other hospitals to adopt the rules Medibank was proposing.

Consumers Health Forum chief executive Leanne Wells said the secrecy was “not good enough”.

“Consumers pay thousands of dollars a year in health insurance premiums and the health fund involved is a publicly listed for-profit company.”

“For all members know, Calvary may have weakened and agreed to 160 or the 165 claims – hardly a big win for consumers because differential costs will still fall to consumers. Basically Medibank private members don’t know what they don’t know.”

Had the agreement not been signed, Medibank would have continued to pay for treatment at Calvary Hospitals, but the hospitals would have been free to charge patients extra where it felt it had not been paid enough.

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Are we prepared to pay taxes for health?

Just when the Government thinks it has a small bit of financial leeway, a hefty additional bill for the health services drops. It calls to mind the old millionaire businessman’s summation of “a few hundred million here and a few hundred million there… and suddenly you’re talking big money”.

The surprise about this really should be that anyone is surprised at all. We have been told for several months now that the Government has some €1.5bn to spare in the Budget next October.

Everyone assumes that this will be used by the Coalition parties to ensure they can win back power in the forthcoming general election. After seven years of doing far more for less, the people are understandably weary and would welcome the encouragement of even modest tax cuts.

But enter the Health Service Executive bosses with their 2016 Budget blueprint. The big picture looks like this: the 2015 health spend is €500m over what was provided; just matching current service levels in 2016 will cost another €650m; and then you must factor in addressing pressing deficiencies like substandard care facilities for the elderly and the other problems which have been unearthed by investigations conducted by the Health Information and Quality Authority (Hiqa).

The projected 2016 extra demand could be as high as €1.9bn, suggesting tax increases rather than cuts might be the more realistic option. It is a sobering thought and it should provoke a more measured adult debate.

Most people will agree our health services have fundamental problems which undermine the good work done by our healthcare professionals every day. We know that part of the problem is that we sometimes get bad value for money. But we also know that our services are, in fact, underfunded. So, it is time we asked: are we prepared to pay more taxes to fund a better health service?

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GST needed for health services, not federal income tax cuts, South Australian Treasurer argues

GST revenue must not be seen by the Federal Government as a way to offer income tax cuts, the South Australian Government says.

“It’s a breach of the agreement between the Premier and the Prime Minister,” South Australian Treasurer Tom Koutsantonis told 891 ABC Adelaide.

The SA Government said it would not agree to any rise in the GST which then let the Federal Government retreat further on funding its health responsibilities.

“There have been dramatic shortfalls in health and education funding on the basis of the Federal Government’s first budget, where they cut $80 billion of health and education funding over the next 10 years,” Mr Koutsantonis said.

What Treasurer [Joe] Hockey and Finance Minister [Matthias] Cormann are now attempting to do is hijack this debate to fund their own source-revenue tax cuts.

“We’ve got to find money to fill this gap and we’re having a conversation now about the GST.

“What Treasurer [Joe] Hockey and Finance Minister [Matthias] Cormann are now attempting to do is hijack this debate to fund their own source-revenue tax cuts.”

A week ago, Mr Hockey said it was time for some relief for Australians who were being pushed into higher income tax brackets and the Government would go to the next federal election with a tax cut proposal.

“I have no problem with the Federal Government addressing bracket creep – they should – but they should [do] it through their own budget means,” the SA Treasurer said.

“[Mr Hockey and Mr Cormann] have said previously that the GST is a states tax and it goes to fund state-based activity.

“If they want to fund income tax cuts, and they should, they should do that themselves.”

Mr Koutsantonis said South Australia’s budget position was strengthening, at a time when he had outlined a range of state tax cuts.

“We’ve done that in SA, cut tax dramatically [and] we’re on track to deliver a budget surplus this financial year,” he said.

“We are trying to do what we can to try and get our health system under control without compromising service, so we have announced the closing of the Repatriation Hospital.

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Reporting mental health issues costs soldiers their job or sidelines them, Senate Inquiry told

REPORTING a mental health issue was a “career killer” for members of the Australian Defence Force, a Senate Inquiry into the mental health of serving personnel has been told.

Representatives from peak organisations including Soldier On and the Alliance of Defence Service Organisatons told Senators that troops had actually lost their jobs or been sidelined after flagging mental health problems.

According to Noel McLaughlan from the Royal Australian Armoured Corps Corporation, an Army Major who reported a “flash back” and sought treatment was issued with a “show cause” as to why he shouldn’t be sacked.

“People will not talk about this in the military, they wait until they get out,” he said.

“The stigma needs to be taken away and [mental illness] needs to be treated like a physical injury.”

Soldier On chief executive and Afghanistan veteran John Bale said there was a long way to go within the defence forces because there was a belief that warriors should not feel these feelings.

He said the only way to eliminate the stigma attached to mental health was via education.

“It doesn’t exist within the ADF,” he said.

The fourth generation war veteran said there was still a long way to go in terms of the level of transitional support required for veterans leaving the military.

St John of God Hospital CEO David Burns with John Bale, CEO of Soldier On, opening a new

St John of God Hospital CEO David Burns with John Bale, CEO of Soldier On, opening a new gym provided by Soldier On at the hospital in Richmond, NSW. Source: News Corp Australia

Mr Bale said the defence force recognised the problem but did not take the time to deal with it.

“We are the people achieving better awareness of mental health,” he said.

Despite the strong criticism of the defence approach, the ADF’s own submission painted a rosy picture of an enlightened employer doing everything it could to support mentally ill troops.

“We aim to be responsive to the specific needs of the ADF population and their families,” it said.

“This includes assisting them to build and maintain their mental fitness at all stages of their career and as required, to assist them to access effective and timely treatment no matter what the cause or source of their illness or injury.”

The submission was not supported by any of the witnesses at the hearing with most saying it was often impossible for families to even get onto a base let alone seek help for their loved one.

Mr Bale said education about mental health should be conducted “off base” and heavily focused on families.

“Families are reluctant to endanger the member’s career,” Mr Bale said.

Robert Macdonald from the Australian Families of the Military Research and Support Foundation said families were deliberately kept out of the loop.

He said the breakdown of the family unit was a major contributor to suicide.

The husband of this Queensland family attempted suicide four weeks ago by taking a cockta

The husband of this Queensland family attempted suicide four weeks ago by taking a cocktail of prescription drugs and alcohol. Picture: Jamie Hanson Source: News Corp Australia

“Families are usually the first to know something is wrong.”

The foundation said the system for dealing with the mental health of serving troops and veterans was dysfunctional and characterised by “silos within silos”.

For example Mr Macdonald said it was amazing that there was no accurate record of suicides among defence members and veterans.

The Foundation said it sincerely hoped that the Senate Inquiry did not result in changes that merely turned the system around without removing its complexities.

Sine 2009 Defence has spent $146 million on mental health services and support.

Its submission said that to break down mental health stigma and reduce barriers to care there could be no hierarchy of mental illness such as those caused by operational service versus those from non-operational causes.

Any veteran or serving member who feels they need help should contact the RSL, Soldier On, Mates 4 Mates, the Australian Defence Force Assistance Trust or Lifeline — either online or on 13 11 14.

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How to Get Health Care Like the 1%

Saturday 29 August 2015

Health IT Business News Roundup for the Week of August 28, 2015

M&A, Financial Reports and Funding

Xerox will acquire RSA Medical, a provider of technology-based health risk management services, for an undisclosed sum…Inovalon, a provider of health care analytics services, has acquired consulting firm Avalere Health for $140 million…Cardon Outreach, a provider of integrated revenue cycle management services, will merge with Diversified Healthcare Resources, a provider of hospital eligibility and enrollment services.

ZocDoc, an online physician appointment scheduling tool, has raised $130 million in a funding round with participation from undisclosed investors…SkinVision, a mobile dermatology application, has raised $3.4 million in a funding round with participation from multiple investors…DynoSense, a provider of health scanner technology, has raised $9.4 million in a Series A funding round with participation from undisclosed investors.

Contracts

Vantage Oncology, a network of cancer treatment facilities, has selected Wellcentive’s quality reporting and population health management tools…John Muir Health in California has selectedZipnosis’ online diagnostic platform…Availity, a real-time health information network, has selectedAmendola Communications’ public relations and content marketing services…Memorial Hermann Health System in Texas has selected CynergisTek’s health information privacy and security tools…Denver Health, Rockford Health System in Illinois and George Washington Medical Faculty Associates in Washington, D.C., have selected Hyland’s enterprise content management software.

Alameda County Emergency Medical Services and the City of Alameda Fire Department in California have selected Beyond Lucid Technologies’ EHR and interoperability platform…Cookeville Medical Center in Tennessee has selected Allscripts’ chronic care management tool…the Department of Veterans Affairs has selected Systems Made Simple andEpic to overhaul its medical appointment scheduling system…Capitol Health Network in California has selected Sutherland Healthcare Solutions’ population health management services.

Product Development and Marketing

Theranos has integrated its lab testing services with Practice Fusion’s EHR system; RadNet has integrated its diagnostic imaging services with Practice Fusion’s EHR system…Hospira will integrate its infusion pump data into Cerner’s EHR system…Axway has integrated its business-to-business and application program interface management services with OneHealthPort’s health information exchange…CVS Health has partnered with telehealth firms American Well, Doctor on Demand and Teladoc to develop new remote care services.

Personnel

Lisa McVey, former CIO at McKesson, has been named vice president of technology and operations at BioIQ, a health IT vendor…Justin Brookman, former head of the Center for Democracy and Technology’s consumer privacy project, has been named policy director of theFederal Trade Commission’s Office of Technology Research and Investigation…Carol Steltenkamp, CMIO at UK Healthcare, has been named chair of the Healthcare Information and Management Systems Society board of managers; Christian Lovis, head of University Hospitals of Geneva’s division of medical information sciences, has been named vice chair of the HIMSS board of managers.

Dan Strong — former CFO of Control4, a provider of automation systems — has been named CFO of Health Catalyst, a provider of health data warehousing and analytics services…Anthony Tardugno, former senior vice president and CIO at AvMed Health Plan in Florida, has been named vice president and chief information and security officer at Blue Cross and Blue Shield of Louisiana.

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MEDICA HEALTH IT FORUM reflects forward-looking trends in the field of health IT

Collecting and linking data offer great opportunities – ethical and legal challenges represent the downside

New possibilities of digitalizing processes continually enhance the “hunger for data” of various players. What is generally valid is also valid with reference to health and patient data. What benefits do new technologies bring – and what risks? And how can digital processes that generate additional data end up serving the growing need for patient safety? Those are topics at the MEDICA HEALTH IT FORUM held during MEDICA 2015. The world’s largest medical trade fair will be held from November 16 – 19, 2015 at the fairgrounds in Düsseldorf, Germany – with new show days (Monday to Thursday) and will feature about 4,800 exhibitors from around the globe. Collecting data is a method of choice to disclose problems with, for example, medical devices more quickly. In this connection, the ongoing work on the European Medical Device Regulation is a reaction to the worldwide scandal surrounding substandard breast implants by a French manufacturer. A new obligation that entails providing clear and individual identification markings on medical devices should become an integral part of these measures. This obligation to provide standardized identification is also being negotiated as a module of the free-trade agreement, “Transatlantic Trade and Investment Partnership” (TTIP). Currently, at least the U.S. is the forerunner concerning this. Their regulatory authority, the FDA, is already stipulating Unique Device Identification (UDI) to a certain extent. Matching international regulations is not much far ahead.

The following has been planned: Every individual device should be identified with an individual number and this number should be saved in a database that is accessible at a European level. There, all implants should be recorded along with their type, serial number, date and place of use, anonymous patient data and any possible incidents associated with them. Thereby, each medical device should be electronically readable. Although, it is anticipated to only initially require linear bar codes or “data matrices”. After all, scanning medical devices marked in this manner could help hospitals and manufacturers to optimize procurement processes from the acceptance of goods at the warehouse all the way to their usage, as well as simplify their documentation and classification. But what about patient safety? According to the current status of legislation, the “radio frequency technology” (RFID) has only been provided as an additional option in the future. Professor Christian Dierks, lawyer at the law office, Dierks + Bohle, says: “Medical devices with a UDI can also be used for a further collection of data within the scope of clinical routine.” Completely recording this data will be started in a different way. “Imagine that an individual with a femoral head implant could measure the amount of stress on his femoral head by means of an app.” A hip prosthesis with integrated sensors capable of wireless data transmission had already been conceived by the Fraunhofer Institute around two years ago. Prof. Dierks said that he was expecting the regulation to go into effect next year. He pointed out that, when it is announced, a European regulation would also apply for all EU nations. Currently, collecting data for use in the field of patient safety is also being pushed forward, not only on a technical, but also a legislative level. The MEDICA HEALTH IT FORUM will also shed light on the details concerning the European role with regard to German health services.

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Island Health partners with private contractor to reduce surgical wait times

Wait times for surgeries on Vancouver Island could be significantly reduced if the region’s health authority moves ahead with contracting operating room space from a Calgary-based private surgical provider.

According to Interior Health, this third-party clinic could allow for up to 55,000 day surgeries over a five-year period.

Norm Peters, executive director for surgical services at Island Health, told All Points West host Robyn Burns that they are weeks away from finalizing a deal with Surgical Centres Inc.

“We have a growing population in Canada, and B.C., and Vancouver Island in particular,” he said.

“We’re just responding to what we’ve seen is growing demand.”

Focus on day surgeries

Peters stressed that the health authority is only contracting out the space — and that all surgeries would be done by Island Health staff.

‘We would treat those additional operating rooms like our own operating rooms,” he said.

“We would be doing the booking for the cases. We would be assigning the operating room time to the various surgical divisions and their surgeons would be going there to perform the cases, as well as the Island Health anesthesiologist.”

Island Health is negotiating this contract with Surgical Centres Inc. after the health authority issued a request for proposals in April.

The RFP said the authority was looking for a surgical services partner to perform between 3,000 and 4,000 day surgeries per year over a five-year contract term, as well as up to 4,000 colonoscopy procedures on the southern part of the Island and up to 3,000 on the central part of the Island.

“The primary focus of the clinic is going to be on day care procedures, so those are cases where you would come to either Vancouver General or Royal Jubilee and the case would be done during the day and you would be discharged home.”

Not a move to privatization

Peters said surgery wait times have exceeded the average benchmark of 26 weeks, and hopes this move will allow the authority to improve.

“By moving day cases from the hospital to the surgery clinic, we can then use that operating room time to provide those more complicated procedures, such as total-joint replacement, and improve our wait times for people waiting for total joints.”

Responding to criticism about surgeons leaving the public system to work at a private company, Peters said he is not concerned.

“The surgeons are not actually leaving the public system. They will still continue to be credentialed and privileged to perform surgeries at Island Health, and that’s a requirement to go work at the surgery clinic,” he said.

“We will use the wait list to manage access to this space. People will not jump the queue and pay privately like you would see in the United States. So this is actually a continuation of the public system by using a third-party to provide operating room space.”

Peters said the location of the clinic is still being finalized, and said the hope is that it will open in spring 2016.

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Top-notch community health care emerges in New Orleans from Hurricane Katrina’s rubble

Big Chief Theodore Emile “Bo” Dollis, a musician and one of New Orleans’ legendary Mardi Gras Indians, spent the last years of his life struggling with the effects of a stroke and failing kidneys that forced him onto dialysis for nearly a decade. But unlike most people without health insurance, he got top-notch care at the New Orleans Musicians’ Clinic until his death this past January at age 71.

“I don’t know if my husband would have survived as long as he did without the Musicians’ Clinic,” says his widow, Laurita “Big Queen Rita” Dollis. “That’s because he got everything he needed – X-rays, blood work, referrals to specialists – without any stress and didn’t have to wait hours in the emergency room just to see a doctor.”

The clinic on a leafy street in the city’s Garden District is part of one of the great success stories to emerge from the rubble of post-Katrina New Orleans, experts say. Now the clinic is one of a network of more than 70 community-based medical clinics in the Big Easy, up from just a handful before the storm.

Following the catastrophic hurricane, health care administrators and providers strategized to make their public health system more resilient in a disaster, and focused on improving patient delivery to the city’s indigent population—a change that studies since have shown is remarkably better for patients.

“In the aftermath of Katrina, few could have predicted that the next 10 years would bring a profound transformation to the health system here in New Orleans,” says Charlotte Parent, director of the New Orleans Health Department.

New Orleans’ ranking in county health assessments by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute has improved for three consecutive years. The uninsured rate tumbled from 25% before the storm to about 16.9% in 2013, due to the Greater New Orleans Community Health Connection (GNOCHC), a joint federal and state program that provides insurance to the poor.

Things certainly didn’t look promising right after storm, which flattened the city and triggered the collapse of the public health system. The breach of the city’s levees and flooding that overtook 80% of the city shuttered 13 of 16 acute care hospitals, including Charity and University Hospitals, two fabled public facilities that had long served the poor. The storm also displaced thousands of health care providers, from nurses and doctors to specialists. Those medical professionals who stayed faced serious shortages of laboratory facilities, hospital beds and pharmacies.

“We lost everything—our offices, our staff, even our bank accounts were frozen,” Bethany Bultman, the musicians’ clinic’s executive director, said.

Public health officials saw an opportunity to replace an antiquated system that had forced the city’s poor and uninsured residents to rely on public hospitals located in the city’s central core, such as “Big Charity,” or go to hospital emergency rooms when their untreated conditions escalated out of control. Before the storm, it often took months to get an appointment at the hospital and even then, many patients waited hours to see a doctor. Often, treatable ailments festered into into life-threatening ills.

“Bring a book because you’d spend the whole day there even if your appointment was at 8:30 in the morning,”  Dollis recalls.  “And you didn’t know which doctor you might see – which meant that you’d have to tell the same story all over again. That’s why so many people ended up in the emergency room, because they didn’t want to go through all that.”

Health officials, faced with near total destruction, sought to rebuild the health system from the ground up by making health care and preventive services more accessible for the city’s poor and uninsured residents. To meet initial demand in the months right after Katrina, health officials set up 18 impromptu street clinics in New Orleans’ poorer neighborhoods. The “clinics” were the barest of bare bones, operating in tents in front of police stations and the casino, in abandoned department stores and supermarkets, in church basements and rectories, and in school dormitories. Doctors and nurses practiced medicine at card tables, and stored medication and vaccines in ice chests.

“Prior to Katrina, there was no network of community primary care centers and you’d hear story after tragic story of generations of people, even pregnant women, who relied on the ER as their only source of care,” says Dr. Diane Rittenhouse, a family doctor and health policy analyst at UC San Francisco who evaluated efforts to improve health care in New Orleans after Katrina.

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Nigerian health tourist racks up £145k NHS bill – and hospital won’t chase it up

Friday 28 August 2015

Digital Health Center Coming To Denver

Healthcare partnership has acquired a full city block of land in Denver’s RiNo area.

Catalyst Health-Tech Innovation, a healthcare partnership, has announced plans for a 300,000 square-foot digital health center in Denver’s River North, or RiNo, area. “Catalyst HTI will bring together private enterprise (startups to Fortune 20), government, academic, and non­profit organizations with healthcare providers and payers to accelerate innovation and drive real, lasting change for the healthcare industry and our nation,” entrepreneur Mike Biselli said in a press statement.

The goal is to transform Denver into a Digital Health mecca with the new facility being constructed in phases. Phase I, slated to begin construction in mid-2016, will be 180,000 square feet including over 10,000 square feet of retail as well as an events venue. The completed Catalyst HTI development will be over 300,000 square feet.

The impetus for the project comes because Biselli saw a great need to reimagine healthcare. “Healthcare in the U.S. is truly in a crisis. It’s going to trend to a $5 trillion problem,” he told the Denver Post. “The problem is so big, we need a cooperative health environment.”

Enter Catalyst Health-Technology Innovation, a joint project between developer Koelbel and Co., entrepreneur Biselli, and Larry Burgess, whose family owns the land where the new Catalyst will be located.

Colorado is already home to 127 digital health startups, according to Jeffrey Nathanson, CEO of Prime Health, with many of them less than a year old making Denver a prime area for this new venture. “We have a huge and growing tech community, and there is a large, installed healthcare industry,” Nathanson told the Denver Post.

Biselli, who sits on Prime’s board, explained, “If you are passionate about reimagining healthcare, you have a seat at our table.”

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Sullivan Institute Opens Care Coordination, Health IT Use Survey

The Louis W. Sullivan Institute for Healthcare Innovation is requesting stakeholder feedback on potential care coordination shortfalls with a new online survey.  The survey hopes to gather information on potential gaps in population health management and individual patient care, such as missed screenings, poor medication adherence, access to services, and chronic disease management.

The poll also plans to gather information on how providers are leveraging health IT tools such as EHRs, health information exchange, population health management software, and big data analytics, to gather patient data and assess their needs.

Care coordination and population health management

“The survey will gather information from healthcare stakeholders to understand how both providers and payers are addressing gaps in care through health information technology and data exchange,” said Devin Jopp, EdD, president and CEO of WEDI. “It serves as an opportunity for us to look at areas where automation could make a significant difference in improving patient care.”

Participating providers will have the opportunity to share their opinions on the effectiveness of currently available health IT applications for emerging competencies such as predictive analytics, risk stratification, health data interoperability, and evidence-based clinical decision support.

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Top Health IT Purchases for the Week of Aug. 24

New contract signings that health information technology vendors announced during the week of August 24 include:

* Temple University Health System in Philadelphia has a seven-year contract with GE Healthcare to modernize its radiology systems. The contract includes financial incentives for both parties with the goal of achieving $39 million in operational savings over the life of the contract.

* Western New York health information exchange HEALTHeLINK welcomed Chautauqua County Health Department, Jamestown Medical Imaging, Garden Gate Health Care, Five Star Family Clinic, Niagara County Department of Mental Health, Schoellkopf Health Center, Tuscarora Health Center and YJH Medical.

* Cookeville (Tenn.) Medical Center, an existing client of Allscripts, bought chronic care management software.

* Meridian Health in New Jersey picked up labor management software from Avantas to optimize processes across six hospitals.

* Alameda County Emergency Medical Services and the City of Alameda Fire Department in northern California have deployed a patient care records platform from Beyond Lucid Technologies. Functions include health information exchange, longitudinal charting, telemedicine, visit scheduling, dispatch and analytics.

* Missouri Delta Medical Center in Sikeston, Mo., bought patient access, registration and scheduling software from PatientMatters, along with patient payment services, to improve receivables.

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Predictive Analytics, NLP Flag Psychosis with 100% Accuracy

A predictive analytics algorithm that leverages natural language processing was able to predict the onset of psychosis in high-risk youths with 100 percent accuracy, says a study published inSchizophrenia this month.  Using machine learning techniques, researchers analyzed the speech patterns of thirty-four patients in the proof-of-concept exploration, which aimed to extend predictive big data analytics capabilities to the subjective area of psychiatry.

“The capacity of psychiatry to diagnose and treat serious mental illness has been hampered by the absence of objective clinical tests of the type routinely used in other fields of medicine,” write the study authors, who hail from a variety of organizations including Columbia University in New York, the Universidad de Buenos Aires, and IBM’s Computational Biology Center.

Predictive analytics and natural language processing

“Although recent years have seen substantial advances in understanding of the neurobiology of mental illness, these developments have yet to yield markers that reliably differentiate psychiatric health from illness at the level of the individual patient.”

“Whereas clinical neuroscience has focused on the brain in mental illness, computer science has, in parallel, developed increasingly sophisticated automated approaches to characterize and predict human behavior.”

In both psychology and psychiatry, speech is a primary tool for diagnosis and treatment.  Patients experiencing episodes of psychosis often lose coherence in their speech as thought disorders take hold.  The authors hypothesized that applying natural language processing techniques to the complex speech patterns of these high risk patients may be able to predict the loss of organized expression and subsequent development of psychosis before a human interviewer could pick up on the shift.

The study examined a small group of help-seeking patients, aged 14 to 27, who were fluent in English.  The patients participated in open-ended, narrative interviews every three months for two and a half years, which were transcribed by an independent service.  The transcripts were then parsed through a natural language processing system that used “a novel combination of semantic coherence and syntactic assays as predictors of psychosis transition,” the researchers explain.

Five out of the 34 participants in the study were known to develop psychosis within two and a half years of the initial evaluation period, as measured by separate clinically accepted criteria.  The combination of predictive analytics and natural language processing used in the study correctly identified all five members of this patient group, and the results were validated with additional null hypothesis testing.

While the authors note that the very small sample size may have resulted in a higher accuracy rate than might be apparent in a larger patient cohort, the study does illustrate the potential for predictive analytics to aid the early diagnosis of psychiatric patients.

“First, reliable identification of individuals likely to progress to schizophrenia would greatly facilitate targeted early intervention,” the authors write. “Second, automated speech assessment, if further validated, could provide previously unavailable information for clinicians on which to base treatment and prognostic decisions, effectively functioning as a ‘laboratory test’ for psychiatry. The ease of speech recording makes this approach particularly suitable for clinical applications.”

“As a direct, objective measure, automated speech analysis could thus provide important information to complement existing methods for patient assessment,” the study concludes. “Finally, these findings support the use of advanced computational methods to characterize complex human behaviors such as speech in both normal and pathological states.”

“Computerized analysis of complex human behaviors such as speech may present an opportunity to move psychiatry beyond reliance on self-report and clinical observation toward more objective measures of health and illness in the individual patient.”

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How Retail Health Clinics Impact Population Health Management

Retail health clinics have seen a surge over the past decade, bringing major changes to the healthcare industry, particularly in the realm of providing low-cost, quality care to patients at a very local level. Recently, retail health clinics have increased their scope of influence into population health management, implementing strategies to increase medication adherence and serve chronically ill patients.

HealthITAnalytics.com spoke with Peter Goldbach, MD, Chief Medical Officer of RediClinic and Health Dialog, regarding the relationship between retail health clinics and population health management.

“Retail clinics make good healthcare more accessible as well as affordable for a broad group of Americans, which means people get the care they need a return to health faster,” he says. “Perhaps more importantly, people are getting the care they need in the right setting. That means problems like strep throat don’t find their way to the ER, and this cost avoidance is good for patients and our healthcare system at large.”

Although retail health clinics are not typically associated with population health management, nor was that their intended purpose, Goldbach maintains that retail clinics have nonetheless played a pivotal role in improving health by increasing the availability of quality care and offering easily accessible services, such as immunizations.

“You might be shopping in a grocery store or in your pharmacy and realize that now you can get your necessary immunizations there, and get your kids immunized,” Goldbach says. “As a result of that convenient care, more and more people are receiving necessary immunizations, so that’s a really good thing from a population health perspective.”

However, retail clinics’ roles in population health management goes beyond immunizing people against this year’s flu virus.  Retail health clinics are also playing integral roles in caring for chronically ill patients and coaching them in chronic disease management, according to Goldbach.

Retail health clinics are in a unique position where their location and resulting convenience allows them to interact with patients and increase patient engagement. It’s that patient engagement that allows retail health clinics to increase the services they provide and manage population health.

“From the very beginning, it was minor urgent care, and then they started offering employment and school physicals, immunizations, travel medicine, and we at RediClinic offer a medically supervised weight loss program that you can access both in the clinic in your neighborhood and online,” Goldbach says. “So the scope of services is increasing.”

Goldbach looks ahead to the future, where he anticipates the integration of the retail health clinic and the patient-centered medical home as a means of population health management and chronic disease management.

“We’re going to be moving toward a provision of chronic care because if you think about a lot of what’s been written about chronic care and how we’re looking to improve it and keep care coordinated, a lot of that centers on patient-centered medical homes,” he says.

The largest stride retail health clinics make with population health, however, is one with accountable care organizations (ACOs). Goldbach says that ACOs are beginning to recognize retail health clinics as drivers for expanded and cost-effective primary care, and from there relationships between them are blossoming.

“The way I think it’ll play out is that ACOs will embrace retail as the right solution for them,” Goldbach says. “It’ll allow them a larger primary care footprint, it’ll allow them to deliver care more efficiently.”

When considering the low price point of retail health clinics and the resulting extension of primary care and partnerships with ACOs, Goldbach says it’s logical to think that retail health clinics are going to expand and make an impact on the healthcare system.

“Organizing our care into a way we can be more efficient at providing a better price point and a better patient experience is really rational,” he says.

The integration of retail health clinics and ACOs is already happening, Goldbach says.

“Now, we’re becoming part of care provision for communities as parts of ACOs.  So we get integrated into the ACO, we become part of their scheduling system, we share medical information on patients, we facilitate success in their contracts because now they can provide care for a lower cost point.”

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Wednesday 26 August 2015

Report: VA Falls Short on Mental-Health Care Despite Hiring Push

The Department of Veterans Affairs lacks enough full-time psychiatrists to meet demand for services and those on staff aren’t being used efficiently, despite a multiyear, multibillion-dollar effort, says a report from the department’s internal watchdog.

The VA hasn’t been “fully effective” in hiring psychiatrists or in using those it has, the VA’s Office of Inspector General reported Tuesday, adding that the department has focused on meeting overall hiring goals rather than on hiring personnel to fill gaps at specific facilities.

The VA “did not effectively use psychiatrists in its efforts to improve veterans’ access to psychiatric care,” the inspector general said in the report, adding that poor “clinic management practices resulted in unused capacity of its psychiatrists.”

In fiscal year 2014, the department spent nearly $4 billion on outpatient mental health services, the report says, yet the inspector general identified 94 of 140 facilities that year that needed additional psychiatrists to meet demand and found that 25% of psychiatrists’ time wasn’t used effectively.

The report serves as a follow-on to a 2012 study that identified wait times of more than a month for psychiatrist appointments by veterans and a large number of vacant psychiatrist positions.

In 2012, then-Secretary Eric Shinseki announced an initiative to hire 1,600 mental health professionals, bumping up pay scales to help recruit them. In 2014, Secretary Robert McDonald announced another hiring initiative as part of a broad reform package pushed through in the wake of a departmentwide scandal that led to the resignation of top officials, including Mr. Shinseki.

Since then, the VA hasn’t come up with effective hiring goals or an effective departmentwide system for managing psychiatrists, leaving these determinations to local hospital networks that haven’t been fully effective,the report says.

Earlier this year, Congress passed further legislation to help bolster mental health care, including student-loan forgiveness for psychiatrists, the category of providers the VA has said are among the most difficult to recruit and retain.

“This VA OIG report highlights some very important areas for improvement,” said the Iraq and Afghanistan Veterans of America, an advocacy group, in a statement. The group “continues to recommend the VA conduct regular analyses of staffing needs to continually track current and predict future needs for mental health clinicians, including psychiatrists,” it said.

Sen. Johnny Isakson (R., Ga.), chairman of the Senate Committee on Veterans’ Affairs, said in a statement that the report “does not appear to reflect any sense of urgency to address the shortages or operational inadequacies.” He added that he will be asking the VA secretary “to reconsider addressing the recommendation in a more timely manner.”

The VA concurred with the report’s findings and said it has laid out plans to improve efficiency and management techniques as well as establish more effective hiring goals. The department said it already has begun to make improvements, including requiring mental health providers to maintain productivity targets and establish staffing benchmarks for each facility.

“The Department of Veterans Affairs appreciates the review by the Office of Inspector General, and the opportunity to improve services we provide to our Nation’s Veterans,” said a spokeswoman for the department in a statement. Most of the improvements have a target completion date of September 2016.

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Why employers are really cutting healthcare (it’s not Obamacare’s Cadillac tax)

For employers, the big ogre still lurking in the mists of the Affordable Care Act is the so-called Cadillac health plan tax, a levy on employer-sponsored health insurance plans valued above a certain threshold.

The tax starts in 2018, when the thresholds will be $10,200 for single coverage and $27,500 for family plans, adjusted thereafter for inflation. Any value over those thresholds will be taxed at 40%. For a single employee whose coverage comes to $12,000, for example, the employer would pay tax of $720.

But how many employers would be subject to the tax? The Kaiser Family Foundation is just out with an estimate, and it’s substantial. Assuming that health plan premiums grow by only 5% a year between now and 2018, the foundation’s study says, 26% of employers would have at least one component of the healthcare offerings triggering the tax at its inception. Because the inflation index the government applies would undercut healthcare cost increases, that figure would rise to 42% by 2028.

The Kaiser paper based its estimate only on single coverage, in part because the cost of family plans, which cover two persons or more, are harder to parse.

But it’s obvious that the tax is going to become a major political issue as its implementation grows near. Here are a few points to consider:

There’s a good rationale for a tax of this nature. That’s because employer-sponsored health insurance gets a huge tax subsidy — premiums paid by the employer and employee alike are tax exempt, and employers have the further option to offer tax-advantaged health savings accounts and flexible spending plans and even to help employees with their contributions. The value of these benefits gets counted when the Cadillac plan is calculated. The FSA allows workers to set aside an annual pre-tax sum (up to $2,550 this year) to pay healthcare costs other than premiums.

Tax subsidies for premiums alone cost the government an estimated $250 billion a year, swamping the value of the tax subsidies allocated to individual insurance buyers under the Affordable Care Act (about $45 billion in 2014). The Cadillac tax is partially an attempt to bring these tax breaks into line. Healthcare economists say the tax break for employer-sponsored insurance encourages companies to offer more generous plans than they should, driving up costs and leading to unnecessary usage.

The pushback against the tax is coming chiefly from the largest employers and labor unions. Big companies tend to offer the widest range of Cadillac-taxable benefits and make it easiest for workers to participate; the Kaiser analysts estimate that 46% of companies with more than 200 employees will pay some Cadillac tax in 2018, rising to 68% in 2028. Unions have spent decades negotiating better health benefits for their members as alternatives to wage increases, only to find their hard-won benefits tipping over the Cadillac thresholds.
— What’s most important about the Cadillac tax is how employers respond. Some may raise deductibles on health plans to lower premiums, or place limits on FSAs or even eliminate them outright. Some may eliminate or scale back benefits that aren’t required by law but service as recruitment tools. “For the most part,” the Kaiser report says, “these changes will result in employees paying for a greater share of their healthcare out-of-pocket.”

Some companies started cutting benefits and raising deductibles years ago, citing the tax, even though it’s still two years off. This amounts to bosses scapegoating Obamacare while doing something they wanted to do for their own reasons. As we observed in 2013, when this practice first materialized, “If your company is cutting back your benefits now, it’s because it wants to cut its payroll costs, period.”The argument seems to be that waiting until 2018 to bring health benefits below the trigger would lead to such sharp reductions that workers would be “shocked” by the sudden changes.

This doesn’t make much sense. Cutting benefits now to ease workers into the concept of a cheeseparing package three or four years down the road resembles the old story of turning up the heat on a cauldron bit by bit so the frog inside doesn’t realize he’s dinner until it’s too late. It’s probably a safe bet that most employees would prefer to keep all their traditional benefits until it’s absolutely necessary to slash them and deal with the “shock” when the time comes.

The concept also resembles the familiar plea that we need to cut Social Security benefits today because if we wait until it may be necessary 20 years from now, the reduction will be too sudden. Cutting bit by bit now so we don’t have to cut more later doesn’t hold water in that context, either.

— There’s reason to believe that the Cadillac tax may never be implemented, at least in its current form. The opposition from unions and big companies is one reason. Another is that its complexities will produce inequities within companies, with some workers choosing packages that exceed the thresholds while others are thriftier with their employers’ money. As it’s set up, the tax must be calculated on each individual worker’s benefit. There may also be geographical inequities, as the tax will fall harder on employers in regions with high healthcare costs.

A functioning and grown-up Congress would have every opportunity to adjust the tax to make it easier to administer, more equitably applied or smaller. Of course, it first would have to find another revenue source to make up the $87 billion the tax is expected to bring in. Any such tweaks will have to wait, as the current Congress majority is unequipped to address any changes in the Affordable Care Act without braying for full repeal.

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Freakonomics and end-of-life health care

Stephen Dubner admits that he and the team behind Freakonomics Radio sometimes explore ideas most sane people would leave untouched. This time, Dubner decided to look at the economics of end-of-life health care.

It’s certainly a touchy subject, but also one that most families will have to face at some time in their lives.

Dubner poses the question: “What if someone was suffering from a terminal illness and they had the option of forgoing standard-end-of-life medical care, and instead they could get a cash medical rebate from their insurance companies?”

He’s calling the idea the Glorious Sunset Proposal, and the Freakonomics folks even made a fake commercial so you can hear how it might be pitched.

Dubner took the Glorious Sunsets Proposal and shopped it around to health care experts to see what they thought.

Health care economist Uwe Reinhardt wasn’t having it. Reinhardt says if he were an insurance company CEO, he wouldn’t offer a Glorious Sunsets option. As a health insurer, “your incentive is actually, in many ways, to increase health spending,” Reinhardt said.

When Dubner took the idea to doctor and bioethicist Zeke Emanuel, he wasn’t interested either.

“It’s so cold blooded, it’s so calculating, it’s so utilitarian that it’s not American,” Emanuel told Dubner.

Thomas Smith is an oncologist at Johns Hopkins. Dubner says Smith actually tried a Glorious Sunsets-like experiment years ago that gave cancer patients the option to forgo treatment and keep the money. But the experiment failed.

“Our patients were actually interested, but their doctor/providers weren’t,” Smith said. “It’s pretty hard to look at those two choices and decide what to do.”

It’s clear these three health care experts weren’t thrilled about the Glorious Sunsets Proposal. But Dubner says all three people — and more — that they spoke with did agree on one thing: “If anything in our health care system really needs to be revolutionized right now, it’s end-of-life treatment.”

But Dubner says, in the end, the economics are perhaps the least important factor. He points to what Zeke Emanuel had to say on the matter. “The health care system, instead of talking to a patient and getting it right, we sort of pound on their chest and try to resuscitate them, even when that may not be what they want,” Emanuel said. “And I think trying to get what patients want ought to be our primary focus.”

Dubner says doctors may soon pay more attention to what patients want. “The Centers for Medicare & Medicaid Services has just proposed a regulation that would actually finally pay doctors to do nothing more than have a conversation with patients about their impending death,” Dubner says.

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Rock Health’s Halle Tecco: The Many Challenges Healthcare Tech Startups Face

Rock Health sees the future, and healthcare technology is an integral part of it. The company, founded by Halle Tecco, funds startups in the field of digital health. Last year was a record year for digital health funding, with more than $4 billion invested in the market — a 127 percent year-on-year growth. The speed of growth in digital health is faster than growth in traditional healthcare and software in general.

As a result, investors have turned their collective attention to the industry. This is evidenced by the fact that 30 percent of Google Ventures’ investments last year were in healthcare.

But, the industry faces serious obstacles as a longstanding industry adjusts to the changes technology will bring.

Innovative Ideas
Rock Health specifically seeks out ideas that will make a big difference in healthcare. Healthcare is a $3.7 trillion industry, and Tecco has found there are many areas that could be dramatically improved through technology.

“I would say that’s first and foremost is that the product or the service that a company is creating can make a really big difference and not just be incremental, ‘okay this is a little bit better than it was before,'” Tecco says.

Regulatory Obstacles
Since healthcare is heavily regulated on both the local and federal level, Tecco sees a great deal of concern from tech innovators over whether a product will be required to go through regulatory hurdles. Telemedicine shows a great deal of promise, with companies like Neurotrack and Cellscope revolutionizing medical diagnosis. Tecco hopes to see a day when diagnosis leaves the medical environment and resides in every home, but there are some major regulatory obstacles to reduce first.

“One of the biggest burdens is around state credentialing for doctors,” Tecco says. “You can’t actually treat patients across state lines if you’re a doctor. As you can imagine, if you’re building a platform that’s a telemedicine company, you’d have to hire doctors in every state. That’s a big issue and that’s something that the states want control over.”

Change Resistance
The medical community is understandably resistant to the idea that computers may someday replace humans in diagnosing and treating disease. Vinod Khosla’sstatement that 80 percent of doctors could be replaced didn’t help matters. Tecco doesn’t see digital medicine as replacing humans, but instead improving the industry as a whole.

“A lot of what doctors do is going to be replaced,” Tecco says. “And we think that’s a good thing because then doctors can be freed up to really focus on the most complex cases. If a diagnosis can be made more accurately and more cheaply with a computer, then we should allow that to happen.”

Finding Talent
Among the biggest problems Tecco currently sees is a lack of talent, especially in the Bay Area. Finding talented developers and support staff for the many healthcare-related startups emerging in California is an ongoing challenge for entrepreneurs.

“The real barriers are the same as any other industry, which is hiring,” Tecco says. “That’s the biggest complaint we hear.”

Good Bets
Entrepreneurs are always seeking to learn more about the types of projects venture capitalists are interested in funding. Tecco says entrepreneurs should look for ideas that can be completely transformative. Investors see so many great projects every day that it usually takes a project with a big idea behind it to get their attention.

“Don’t pitch me something where the margin and the mission do not align,” Tecco says. “In healthcare, we see a lot of things that can make a lot of money but actually would keep people unhealthy. There’s too many ways to help people be healthier versus reduce access. Don’t bring anything that is bad for healthcare.”

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Low Testosterone Can Affect Your Sexual Health

Testosterone is a hormone that is produced by the human body. It is mainly produced in the testicles in men and belongs to a class of male hormones called androgens. It stimulates sperm production and a man’s sex drive and also helps build muscle and bone mass. Although it is called the ‘male sex hormone’, women also produce testosterone, but at lower levels.

Testosterone plays an important role in sexual health. It stimulates desire, increases libido, heightens arousal, and increases sexual satisfaction.

Testosterone production typically decreases as men age. Men can experience a range of symptoms if it decreases more than it should. Low T is diagnosed when levels fall below a normal range (300-1,000ng/dL, according to the US Food and Drug Administration). A blood test (called serum testosterone level) is used to determine the level of circulating testosterone.

A range of symptoms can occur if testosterone production drastically drops.

Signs of low T (also called hypogonadism) are often subtle and can be mistaken for a natural part of ageing.

Among the symptoms of low T levels are:

LOW SEX DRIVE

Testosterone plays a key role in libido (sex drive) in both men and women. Men may experience some decline in sex drive as they age. However, someone with low T will likely experience a more drastic drop in his desire to have sex. Low T can also decrease the sex drive in women, along with other factors, such as other hormonal and mood changes.

DIFFICULTY ACHIEVING ERECTION

Testosterone stimulates a man’s sex drive – and it also aids in achieving an erection. Testosterone alone doesn’t cause an erection, but it stimulates receptors in the brain to produce nitric oxide – a molecule that helps trigger an erection. When testosterone levels are too low, a man may have difficulty achieving an erection prior to sex or experience spontaneous erections (for example, during sleep). Other health problems can influence erectile function, so it is important to determine whether low T is causing this symptom.

LOW SEMEN VOLUME

Testosterone plays a role in the production of semen, which is the milky fluid that aids in the motility of sperm. It’s pretty simple: The more testosterone a man has, the more semen he produces. Men with low T will notice a decrease in the volume of their sperm during ejaculation.

HAIR LOSS

Testosterone plays a role in several body functions, including hair production. Balding is a natural part of ageing for many men. However, men with low T may experience a loss of body and facial hair.

FATIGUE, LACK OF ENERGY

Men with low T have reported extreme fatigue and a noticeable decrease in energy levels. You might be experiencing symptoms of low T if you are tired all of the time, despite getting plenty of sleep, or if you are finding it harder to get motivated to hit the gym or exercise.

LOSS OF MUSCLE MASS

Because testosterone plays a role in the building and strengthening of muscle, men with low T might notice a decrease in both muscle mass and strength. Those who try to reverse the muscle loss through weight training might find it difficult to build or rebuild muscle.

INCREASE IN BODY FAT

Men with low T may also experience increases in body fat. In particular, they sometimes develop gynecomastia, a condition in which they develop enlarged breasts. Although the reasons behind this are not entirely clear, research suggests that testosterone influences the way your body stores fat.

DECREASE IN BONE MASS

The thinning of bone mass (osteoporosis) is often thought of as a condition that women experience. However, men with low T can also experience bone loss because testosterone aids in the production and strengthening of bone. Men with low T – especially older men who have had low T for years – are more susceptible to bone fractures.

MOOD CHANGES

Women often experience changes in mood during menopause, when their levels of estrogen drop. Men with low T can experience similar symptoms. Testosterone influences many physical processes in the body. It can also influence mood and mental capacity. Research suggests that men with low T are more likely to experience depression, irritability, or a lack of focus.

TREATMENT

Testosterone levels decrease naturally over time, so you may experience some degree of change in these symptoms as you age. Your doctor can conduct a blood test and recommend treatment if needed, and discuss any benefits and risks.

Testosterone replacement therapy is a widely used treatment for low T levels in males. Testosterone may be given as an injection, patch, gel or lozenge.

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Tuesday 25 August 2015

North Carolina’s Hatteras Venture Scores $90 Million Life Sciences, Health IT Fund

Hatteras Venture Partners Announces First Closing of HVP V

  • HVP V to build on success of Hatteras Discovery to further enhance early stage pipeline creation
  • Malin Corporation PLC and the University of North Carolina at Chapel Hill join existing limited partners

DURHAM, N.C., Aug. 24, 2015 (GLOBE NEWSWIRE) — Hatteras Venture Partners announced today the first closing of Hatteras Venture Partners V (HVP V) with more than $90 million in subscriptions towards a final fund target of $150 million. In addition, Hatteras has entered a partnership with Malin Corporation PLC to bolster the firm’s strategic partnering capacity to grow portfolio companies from the seed stage to maturity.

“Having so many of our limited partners return to participate in HVP V and Malin and UNC join as new LPs is a testament to our successful track record of seeding and growing life sciences companies,” said Bob Ingram, General Partner of Hatteras Venture Partners. “The breakthrough science and world-class service providers in our region have created a vibrant ecosystem that has proven capable of taking early stage companies’ products from the bench through approval and to patients, making it an area deserving of capital investment.”

Hatteras will invest funds from HVP V with a strategy similar to HVP III and HVP IV, focusing on science and technology from leading academic centers and the active involvement of the entire Hatteras team of seasoned entrepreneurs and operators. In addition to the Hatteras team, HVP V will leverage its limited partner relationships with leading institutions such as the University of North Carolina at Chapel Hill, GSK, Malin, Laboratory Corporation of America Holdings® (LabCorp®), Alexandria Venture Investments, and other financial investors. The firm will continue to build a diversified portfolio of human health companies, ranging from biopharmaceuticals and medical devices to diagnostics and health care IT.

“This transaction enables Malin to immediately leverage the considerable expertise embedded within Hatteras and extend the company’s existing quality network in a unique and highly efficient manner,” said Malin’s Chairman John Given. “This important collaboration will give Malin broad access to early stage discovery technologies and platforms and to some of the world’s best medical universities located in North Carolina/the Southeast U.S. We are highly confident that the intersection of HVP V, the universities and Malin will lead to the unearthing and subsequent shaping of numerous life sciences opportunities in the U.S. and, we hope, Ireland and other countries.”

Similar to HVP IV, Hatteras will allocate up to 20 percent of HVP V to seed-stage projects and companies. With the closing of HVP V, Christy Shaffer, who served as Managing Director of Hatteras Discovery, has become a General Partner with the firm.

“We launched Hatteras Discovery with HVP IV in 2011 to fund seed-stage projects and companies focused on human medicine and life sciences,” said Clay Thorp, General Partner of Hatteras Venture Partners. “It has been a tremendous success with G1 Therapeutics, Clearside Biomedical, and Lysosomal Therapeutics collectively raising more than $90 million following the seed rounds with Hatteras Discovery and accelerating their clinical programs by 12 months, on average. With HVP V, we look forward to building on the heritage of seeding successful companies.”

About Hatteras Venture Partners

Hatteras Venture Partners is a venture capital firm based in Research Triangle Park, NC with a focus on seed and early stage opportunities in biopharmaceuticals, medical devices, diagnostics, and related opportunities in human medicine. The firm has approximately $350 million under management in five venture capital funds. Hatteras is led by a seasoned team of entrepreneurs and operators and has a long and successful track record of seed and early stage investing and company formation. To learn more about Hatteras Venture Partners, please visit www.hatterasvp.com.

About Malin Corporation Plc.

Malin is an Irish incorporated public limited company. Its purpose is to create shareholder value through the selective long-term application of capital and operational expertise to private, pre-IPO, pre-trade sale operating businesses in dynamic and fast growing segments of the life sciences industry. Through its operational involvement, Malin will work with the investee companies to enable them to reach the full potential of their value proposition and to achieve commercial success. For more information visit www.malinplc.com.

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Complaints to Private Health Insurance Ombudsman hit 12-year high

A consumer watchdog has rebuked private health insurers for confusing people with vague or conflicting information on benefits, especially public hospital cover, as complaints hit a 12-year high.

On Tuesday, the Private Health Insurance Ombudsman said it had received 1219 complaints between April and June this year, a 30 per cent rise on the same period last year and the highest number since 2003.

While routine hikes in premiums and end-of-financial-year deadlines usually drive a spike in complaints in the second quarter, the ombudsman said frustration over benefits and membership issues caused the increase.

Number of complaints by issue to the Private Health Insurance Ombudsman.Number of complaints by issue to the Private Health Insurance Ombudsman. Photo: Private Health Insurance Ombudsman

It chastised health insurers such as Medibank and Bupa for a lack of clarity surrounding public hospital-only cover, saying too many customers were being led to believe they could avoid a public hospital waiting list.

It said that in some cases “aggrieved” policyholders were “clearly misadvised”.

“Policyholders tell us they have been advised they can avoid the public hospital waiting list by purchasing public hospital cover, and then complained that they have in fact been required to wait on the list,” the ombudsman said.

“Sometimes this has occurred after the consumer has purchased the policy and served a 12-month waiting period for pre-existing conditions, and only then are advised that their policy doesn’t avoid the public hospital waiting list,” it said.

“They feel particularly aggrieved because they could have been waiting on the public hospital waiting list for those 12 months and instead are faced with at least another 12-month wait.”

About a third of the complaints were about Bupa, and another third about Medibank Private. Each accounts for about a third of the market.

The highest number of complaints between April and June concerned misinformation over the phone or in person.

“Most complaints about oral advice concern an allegation that a health insurer’s staff member misadvised a consumer and caused them to hold an incorrect level of cover,” the ombudsman said.

This was followed by complaints about membership cancellation, mostly in cases where requests for clearance certificates and refunds were not responded to quickly enough.

Next were hospital policy exclusions and restrictions, premium payment problems and waiting periods for pre-existing conditions.

Consumer network One Big Switch said with premiums rising almost $300 a year, customers were increasingly seeking to downgrade their cover.

“But many consumers are unaware what they’re trading away,” campaign director Joel Gibson said. “Consumers need to take care when downgrading their health insurance that they don’t trade away vital cover.

“Consumers are doing what they have to to stay in private health insurance: they’re shopping around, switching and downgrading. This is a good sign, as it means greater competition between funds, but the funds do need to be very clear about what it is they’re selling.”

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After rejecting state health dollars in 2013, Anoka County reconsiders

Two years after two Anoka County commissioners spearheaded the county’s rejection of more than $1 million in state public health aid, arguing that it paid for feel-good, do-little programs, the county is back to pursuing those dollars.

This time, commissioners say they’ve figured out a better way to spend Statewide Health Improvement Program (SHIP) money.

In 2013-14, Anoka was the only Minnesota county to reject SHIP money earmarked to fight obesity and smoking, after having received it since 2009. The county’s Human Services Committee declined to reapply for it, an effort led by commissioners Rhonda Sivarajah and Julie Braastad.

“It seemed like a lot of window dressing — the fancy brochures, the trinkets and pedometers. I don’t think that is what changes behaviors,” said Sivarajah.

Anoka County now will limit the amount spent on new county health staff and brochures extolling healthy eating, exercise and the dangers of smoking, and instead funnel dollars into existing nonprofits, homeless shelters, foster homes, schools and senior center lunch programs.

These programs already serve meals and can incorporate healthy eating messages and education into their missions, the county said. The new approach calls for one new staff position; the old plan called for as many as five.

“These community programs have credibility and established clientele and established reputations,” said county spokeswoman Martha Weaver.

Anoka County Health Department staffers, who are drafting a new SHIP strategy in concert with the state Department of Health, said about 75 percent of it will be new ideas. The county will seek $1.3 million for 2016-17.

In 2013-14, commissioners had questioned spending to pay for public health staff to observe children on playgrounds and determine what barriers they faced. It also was to have sent county staff into schools to help school nurses revamp wellness programs, which commissioners viewed as unnecessary.

The new strategy is more action-oriented, Sivarajah said.

We took a lot of time to really identify what some of the community wants and needs were,” she said. “How can we target those resources in the best way possible to leverage some of the expertise already out in the community?”

A state public health official had bristled at past criticism, pointing out that Anoka County has the highest rate of smoking in the metro area. Anoka County Commissioner Jim Kordiak also expressed displeasure with his colleagues’ decision to leave SHIP in 2013, especially since they could have tailored how that money was spent.

“We did have the ability to make changes in the old grant,” said Kordiak, pointing out that his colleagues could have removed the offending pedometer distribution and kept the rest of the program. “There was a political undertone to that discussion. I tend to be more liberal on social issues, and some people tend to be more conservative.”

He said many of the former partners, including cities and school districts, were blindsided by the 2013 decision.

Columbia Heights schools had used SHIP money to build and staff Blooming Heights, a garden educators called an edible classroom where more than 800 students studied biology, nutrition and cooking, history and even math. The children run a weekly roadside produce stand.

The sudden loss of SHIP dollars sent the district scrambling to save the program.

“It was really hard,” said Nicole Halabi, student services director for Columbia Heights schools.

Halabi said the garden does have a direct impact on community health. “Our kids are certainly eating healthier. They are consuming the produce,” she said.

“There is a ripple effect. We donate a lot of produce to the Southern Anoka County Assistance food shelf.”

The county now will re-establish partnerships with schools, including Columbia Heights, Fridley and St. Francis schools.

“We decided to concentrate on specific schools that have the highest need,” Braastad said.

The aims of SHIP

Legislators created the SHIP program in 2008 with the aim of improving health and containing health care costs. Local health boards tailor their approach by selecting from a “menu of strategies.” From 2009 to 2015, Minnesota has spent $97 million on SHIP statewide.

According to state health data, nearly 26 percent of adult Minnesotans are obese and 14.4 percent smoke. State health officials say SHIP efforts are responsible in part for a 2 percent decline in smoking since 2010 and a leveling-off of obesity rates.

Sivarajah said she’s satisfied with the new Anoka County plan, which tentatively partners with University of Minnesota Extension, the nonprofit Lee Carlson Center for Mental Health and Well-Being, Stepping Stone Emergency Housing, the Hope 4 Youth homeless shelter and the North Anoka County Emergency Food Shelf.

Sivarajah, who was running for the Sixth District congressional seated vacated by Michele Bachmann in 2013, said politics played no role her 2013 decision.

“Anybody who knows me knows that is not how I do business,” she said. “It’s not about re-election.”

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Mark Costello had spoken about need for better mental health care in Oklahoma

At an April state Capitol gathering, Labor Commissioner Mark Costello told advocates they help others understand that when Oklahomans see people in need “we are looking to the image and likeness of Christ and that we must be humane.

Almost exactly four months ago, in now what seems like a chilling speech, Oklahoma State Labor Commissioner Mark Costello thanked mental health advocates for the help they gave to him and his family.

At an April state Capitol gathering, Costello told advocates they help others understand that when Oklahomans see people in need “we are looking to the image and likeness of Christ and that we must be humane.

“And we must be understanding and understand that society cannot ignore this problem, and if it does so, it does so at its peril.”

Only 116 days later, Costello was dead after his son, Christian Costello, 26, allegedly stabbed him at a Braum’s restaurant in Oklahoma City.

For more than five years, the Costello family tried to find quality, consistent mental health treatment for Christian Costello, who has been diagnosed with schizophrenia and has suffered from paranoid thoughts about his parents, a family spokesman and a source knowledgeable about Christian’s medical history said.

Many struggle

Schizophrenia is a chronic, serious and disabling brain disorder, according to the National Institute of Mental Health. People with the disorder might hear voices other people don’t hear, or they might believe other people are reading their minds, controlling their thoughts or plotting to harm them, according to the institute.

In most cases, they are not violent to others.

“Most individuals living with mental illness are not violent, but when substance abuse is also present or treatment is not available, risks can increase,” Mary Giliberti, executive director of the National Alliance on Mental Illness and Traci Cook, executive director of NAMI Oklahoma, said in a joint statement. “Mental illness can involve many challenges, both for individuals struggling with its effects and for families as a whole. There is no one solution.”

Oklahoma ranks No. 2 in the nation for the highest rates of adults with serious mental illnesses, according to the federal Substance Abuse and Mental Health Services Administration.

Meanwhile, the state ranks No. 46 in the U.S. for the amount of money the state spends on mental health, according to Kaiser Health Foundation.

In general, too many Oklahomans struggle to find access to care in the early stages of their mental illness, said Jeff Dismukes, spokesman at the Oklahoma Department of Mental Health and Substance Abuse Services.

Additionally, after an Oklahoman suffers from a mental health crisis, finding follow-up care at the community level also can be limited.

“This is a situation that impacts all of us, regardless of whether or not we have private health insurance,” Dismukes said.

“We need to address the need for a comprehensive mental health and substance abuse treatment system. These are issues that have long been of great concern among behavioral health advocates and treatment providers. It is a discussion that should be had, but it should be done at a more appropriate time and in a way that does not cause additional pain for the Costello family.”

‘A difficult thing’

Since October, Christian Costello had been in and out of involuntarily commitments at local psychiatric facilities — the crisis center and St. Anthony’s Behavioral Medicine Center, a source knowledgeable of his medical history said.

He had received medication through NorthCare, an Oklahoma City-based community mental health agency. Since 2010, he’s also had multiple run-ins with the police.

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iPatientCare Set to Participate and Celebrate 10th Anniversary of National Health IT Week

iPatientCare, Inc., a pioneer in mHealth and cloud-based ambulatory EHR, integrated Practice Management and Patient Engagement solutions, declared to participate in the 10th Annual National Health IT Week as a proud partner, October 5-9, 2015.

The 10th anniversary of the Annual National Health IT Week will be celebrated during October 5-9, 2015. National Health IT Week is a synergistic forum and virtual awareness week that gathers public and private key healthcare constituents dedicated to working together to elevate the necessity of advancing health through the best use of information technology for the U.S. healthcare system.

National Health IT Week supports health IT to achieve technological medical advancement, specifically electronic health records (EHRs) to improve the quality of healthcare delivery, increase patient safety, decrease medical errors, and strengthen the interaction between patients and healthcare providers.

“We work hard to achieve technological advancement for medical informatics that helps medical systems work better. We participate in National Health IT Week to highlight our organization’s commitment to ensure health information technology is integrated, interactive, interoperable, and intelligent to provide the best patient outcomes,” said Udayan Mandavia, CEO, iPatientCare.

About iPatientCare

iPatientCare, Inc. is a privately held medical informatics company based at Woodbridge, New Jersey. The company is known for its pioneering contribution to mHealth and Cloud based unified product suite that include Electronic Health/Medical Record and integrated Practice Management/Billing System, Patient Portal/PHR, Health Information Exchange (HIE), and mobile point-of-care solutions that serve the ambulatory, acute/sub-acute, emergency and home health market segments.

iPatientCare EHR 2014 (2.0) has received 2014 Edition Ambulatory Complete EHR certification by ICSA Labs, an Office of the National Coordinator-Authorized Certification Body (ONC-ACB), in accordance with the applicable eligible professional certification criteria adopted by the Secretary of Health and Human Services (HHS).

Full certification details can be found at ONC Certified Health IT Product List.

The ONC 2014 Edition criteria support both Stage 1 and 2 Meaningful Use measures required to qualify eligible providers and hospitals for funding under the American Recovery and Reinvestment Act (ARRA).

The company has won numerous awards for its EHR technology and is recognized as an innovator in the field, being a pioneer to offer an EHR technology on a handheld device, an innovative First Responder technology to the US Army for its Theatre Medical Information System, the first to offer a Cloud based EHR product. iPatientCare is recognized as one of the best EHR and Integrated PM System for small and medium sized physicians’ offices; has been awarded most number of industry Awards; and has been recognized as a preferred/MU partner by numerous Regional Extension Centers (REC), hospitals/health systems, and academies.

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Monday 24 August 2015

Lack of school nurses ‘a risk to health of young’

The nursing union has warned of an “escalating health crisis” among children due to a lack of school nurses.

The Royal College of Nursing (RCN) said school nurses have a unique opportunity to help improve some of the key issues facing children’s health – particularly the huge problem of obesity with one in three children in the UK overweight, and one in five classed as obese.

Citing a recent Government report suggesting there are five more children under 14 who died every day in the UK than Sweden, the union said while health problems facing children continue to accelerate, school nurses are at risk of further depletion following £200 million cuts to public health budgets in England.

Despite steadily growing numbers of school pupils, figures have shown a decrease in school nurses since 2010.

The RCN said they should plainly have been increasing during this time.

There are now more than 8.4 million pupils attending 24,300 schools in England, with almost 94,000 more children in primary schools than there were a year ago – a 2.1 per cent increase.

At the annual RCN School Nurses Conference today, experts from across the UK will emphasise the critical importance of school nurses in improving the health of the nation’s children.

It warned that Health Education England has also predicted a 24 per cent vacancy rate in this area of nursing.

Local authorities in London, Staffordshire, Middlesbrough and Derbyshire are already considering cuts to school nurse funding to plug gaps in other areas of public health, it said.

They will say that by working closely with children as well as their parents and teachers, nurses can also have an important role in helping pupils with their mental and emotional health.

One in 10 pupils suffer from a mental disorder and the Children’s Society Good Childhood Report 2015 placed the UK almost bottom in an international survey of children’s happiness, the RCN said.

Many of the six per cent of children who have a disability could also benefit from a school nurse, while it said 15.4 per cent of pupils in schools in England have identified special educational needs, equating to 1.3 million pupils.

Fiona Smith, professional lead for children and young people’s nursing at the RCN, said: “School nurses play a critical role in the health of our children yet their work is so often overlooked – and undervalued.

“Today’s conference illustrates the wide range of issues school nurses tackle on a daily basis, from conditions such as epilepsy to behavioural disorders like ADHD.

“They are talented, multi-skilled nursing staff who deserve immense recognition. Unlike any other health professional, school nurses work with children and education staff on a daily basis.

“However, investment is fundamental if we are to begin solving this crisis in children’s health and build a healthy and prosperous future population.”

Last month, the RCN warned that childhood obesity, smoking and alcohol misuse could soar as a result of the Government’s planned £200m “stealth” cuts to public health budgets.

The union said more people will become ill from preventable or manageable conditions because of the move “quietly” announced by Chancellor George Osborne.

The cuts will see money slashed from council budgets leading to fears this will jeopardise vital services such as obesity prevention, stop smoking schemes and alcohol misuse programmes.

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Mental health commission could get new addictions mandate

Mental health advocates are praising the Conservatives’ plan to shift the mandate of the mental health commission to research linkages between drugs and mental illness, as long as it remains arm’s-length from government and the politics of its anti-drug strategy.

The shift would mark a new and what many call long overdue chapter for the Mental Health Commission of Canada (MHCC), which since its creation in 2007 has steered clear of addictions research and focused on priorities such as reducing stigma, mental health in the workplace and helping the homeless with mental illness.

But advocates say integrating is critical because addictions and mental illness are “co-occurring disorders.” Those who suffer from mental illness often have addiction problems — from alcohol and prescription drugs to gambling — and alcoholics and drug abusers can develop mental illness.

One in five Canadians are diagnosed with mental illness every year and addiction is the second most commonly diagnosed one, said Peter Coleridge, CEO of the Canadian Mental Health Association.

“There is a significant number of people who have mental health conditions and substance use problems or visa versa. The two go hand-in-hand and the problem is we have treated them independently,” he said.

Michael Kirby, the founding head of the commission, lauded the move. He said it sets the stage to eventually merge the Canadian Centre for Substance Abuse with the commission. It would streamline operations, save money and better co-ordinate issues around addictions and mental health.

But the pledge for the MHCC’s new mandate was made by Conservative leader Stephen Harper on the hustings as part of his anti-drug strategy while driving home his strong opposition to the legalization of marijuana – a hot election issue among the parties. The Conservatives oppose legalizing pot; the NDP want to decriminalize it and the Liberals want to legalize it.

Harper promised more money for the RCMP to target clandestine drug labs and marijuana grow-ops, to set up a national toll-free hotline for information on drug use among youth, and to refocus the MHCC’s mandate.

That has some worried a re-elected Conservative government may try to advance its tough-on-drugs campaign through the work of the commission.

Chris Summerville, co-chair of the Canadian Alliance on Mental Illness and Mental Health, said the commission should remain at arm’s-length from government and its work based on the best research.

“Whether to legalize or not is a political question and we have no position on that. We want people to be informed with the latest knowledge about substance use and mental illness so they can make wise and healthy choices,” he said.

Benedikt Fischer, a senior scientist at Toronto’s Centre for Addiction and Mental Health (CAMH), questions whether making it part of the Conservatives’ anti-drug agenda could influence the scope and perspective of research.

“We need to better understand why and how they co-occur and the implications … so it doesn’t make sense to investigate one without the other and for that reason alone the announcement makes sense in principle and should be supported based on evidence,” said Fischer.

“What is of concern to me is that the government is wrapping this in an anti-drug strategy … Their ideological position is anti-drug and that could lead to problems in the perspective and outcomes of investigations.”

But Kirby said such concerns are overblown and he is confident the commission will remain above the political fray.

He said he’s not surprised Harper would announce the new focus in a speech about drug policy, but the integration of addictions and mental health is such a logical move that it will likely be the direction followed by whatever party is elected.

The commission grew out of the landmark 2006 Senate committee report, Out of the Shadows At Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada. Kirby, then a Liberal senator, headed the committee and was named by the Conservatives to chair the commission.

Kirby said the commission is ready for a new mandate, having accomplished its priorities and drafted Canada’s first national mental health strategy. That mandate and original 10-year funding expires in 2017.

The Conservatives extended the MHCC’s $15-million a year funding in the last federal budget — adding suicide prevention to its priority list — and put former Conservative politician and long-time mental health advocate Michael Wilson at the helm as chair.

The MHCC is now awaiting its new mandate letter from the next Health minister and Kirby argues Harper’s announcement is “precisely what I would have proposed.”

Kirby said the MHCC should also tap into a national grassroots network created by the charitable organization, Partners for Mental Health, which he created. He said mental health needs a charitable and community base like those with breast cancer or HIV-AIDS, built to bring their issues to public attention.

Coleridge said the CMHA lobbied to renew MHCC’s funding, calling for a “co-ordinated” approach to addictions and mental health, including the research of the Canadian Institutes of Health Research. The CMHA is calling for new indicators to measure what treatments are working, and an innovation fund.

Officials at the MHCC wouldn’t comment, saying it was inappropriate for a government-funded not-for-profit agency to comment on policy issues raised during the election campaign.

The Centre for Substance Abuse also wouldn’t comment on whether a merger with the commission is in the cards, but clearly the groundwork has been laid for more collaboration between the two organizations.

It teamed up with MHCC and the Canadian Executive Council on Addictions for a report — Collaboration for Addiction and Mental Health Care: Best Advice — to bring the two sectors together to improve treatment and reduce health costs.

In an email, CEO Rita Notarandrea said the centre has a responsibility to work with the MHCC to help those with both mental health and addiction problems but “remain focused on our specific mandates as well.”

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Macon-Bibb public health officials trying to prevent pedestrian fatalities

As a child, Chris Tsavatewa learned the hard way that in a collision between a person and a car, the person is almost always going to lose.

He was riding his scooter when he T-boned a moving truck, was thrown onto the front of the vehicle and landed face down on the concrete, breaking his collarbone.

“It was a silly childhood mistake,” Tsavatewa said. “I was engaging in risky behavior, and unfortunately risky behavior happens all the time when it comes to pedestrians and vehicles.”

Tsavatewa wants to change that. He is chairman of the Health Services Administration Program at Middle Georgia State College and serves on the Macon-Bibb County Board of Health, where he is working to shed light on pedestrian danger in Macon by thinking about it as a public health issue.

The local health department is pursuing a state grant to support education initiatives aimed at reducing pedestrian fatalities.

“We want to change and shift the actions of the community by promoting positive behaviors across the pedestrian, driver and environment stakeholders,” Tsavatewa said.

“It is a public health issue because it kills human beings,” said Nancy White, administrator for the Macon-Bibb County Health Department and a former Macon City Council member.

<b>‘A WINNABLE BATTLE’</b>

Pedestrian deaths are a relatively minor public health problem compared to the major causes of death. According to the Georgia Department of Health, 546 people died of heart disease in Macon-Bibb in 2013, while 10 were struck and killed by a car.

When asked why Macon-Bibb’s health department is choosing to focus on an issue that touches a relatively small number of people, White said, “We keep on reading it in the headline news, and it is getting attention.”

Tsavatewa said the fight against pedestrian hazards is “a winnable battle.”

Moreover, Tsavatewa said, reducing pedestrian danger has other benefits.

“When people feel safe, they’re more likely to engage in healthy behaviors,” such as walking outside, he said.

Tsavatewa’s assertion that individual behavioral changes can help fix the problem did not go over well with longtime Macon transportation activist Lee Martin, who contends pedestrians are too often blamed in accidents.

Martin was among community members who attended a meeting on pedestrian fatalities convened by the Center for Collaborative Journalism this year. “Discussion is a good thing, but what we need is action by our local officials,” Martin said.

“The city and sheriff want to investigate an intersection, which is reactive and not proactive,” Martin said. “Any transportation planner can look and pick out what needs to change in order to make an intersection more safe.”

Tsavatewa acknowledged the perception in the Macon community is that nothing is being done to fix the issue and that pedestrian safety is being ignored.

“We want to develop a comprehensive task force to create solid solutions,” Tsavatewa said. “Moving in this way and partnering with urban planning and others can create pedestrian harmony with bicycles and cars, which leads to overall better communities and community engagement.”

White said the health department is lucky to have Tsavatewa to give a new perspective on the issue.

“We don’t necessarily have all of the solutions quite yet,” White said, “but by illuminating and putting out the information, we can empower agencies that do have the tools” to impact change.

More and more communities are planning for sidewalks, good lighting and bike paths because there is now an increased awareness and emphasis on health, exercise and being outdoors, she said.

Tsavatewa and White said they think the best weapons right now are educational campaigns that can spread awareness throughout the community.

“Progress is very attainable,” White said. “We just have to be tenacious about it.”

<b>EDUCATION IS THE KEY?</b>

Cpl. Austin Riley, the lead traffic fatality investigator for the Bibb County Sheriff’s Office, said most walkers think that when they are standing on the curb, a driver should yield to them. In fact, pedestrians only have the right of way in a crosswalk.

This is something that Violet Poe, owner of Right Start Defensive Driving School, has experienced firsthand. At the community meeting on pedestrian fatalities, Poe said she’s been running an informal experiment outside her office on First Street in downtown Macon.

“I notice a lot of pedestrians outside my window who cross the street not in a crosswalk,” Poe said. “I go outside and ask them questions such as ‘What is the reason for crossing here?’ and ‘Are you aware that the crosswalks are close, and they are here for your safety?’ ”

Poe said most of the responses she gets are the same, and that people claim they did not see the crosswalks or they are unfamiliar with the use of crosswalks because the neighborhoods they live in don’t have them.

“We need to educate and find ways to assist these people to get them to start thinking safely,” said Poe, who in June was named one of two community representatives on Macon-Bibb’s newly created Pedestrian Safety Fatality Review Board.

One example of an educational pedestrian safety campaign is North Carolina’s “Watch For Me NC” program. Launched in 2012, the state program is aimed at helping local communities address pedestrian and bicycle crashes.

According to the campaign’s website, it focuses on two goals: dissemination of safety messages through outreach, and education and high-visibility enforcement of pedestrian, bicycle and motorist laws.

North Carolina law enforcement officers attended training courses on the best practices to uphold road laws, and about $221,000 was spent to market the campaign across the state in the first year.

Successful efforts elsewhere could be modeled in Macon, Tsavatewa said.

“We need to instill into the next generations the appropriate behaviors and patterns to establish community norms that make the road environment a safe place,” he said.

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