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Medicare expands access to in-home support for seniors

In a harbinger of potentially big changes for Medicare, seniors in many states will be able to get a..

In a harbinger of potentially big changes for Medicare, seniors in many states will be able to get additional services such as help with chores, safety devices and respite for caregivers next year through private "Medicare Advantage" insurance plans.

The shift reflects a growing recognition that simple help at home can have a meaningful impact on patients' well-being — and reduce some costs for taxpayers. A couple of hundred dollars to install grab bars in the shower can prevent a fall leading to a broken hip, a life-changing injury.

The newly covered services are similar to what people might need if they required long-term care, said Howard Gleckman, a senior researcher at the nonpartisan Urban Institute think tank. "It begins to break down the wall between long-term care and Medicare, which with very few exceptions, has never paid for long-term care."

Change is starting slowly. The services will be offered by some Medicare Advantage plans in about 20 states next year, expected to grow over time.

There has to be a health-related reason to qualify, and costs will vary among plans. In some plans, there's no added cost. But limits do apply. For example, a plan may cover one day per week at an adult day care center.

Nearly 23 million Medicare beneficiaries, or more than 1 in 3, are expected to be covered by a Medicare Advantage plan next year. The private plans generally offer lower out-of-pocket costs in exchange for limits on choice of doctors and hospitals and other restrictions such as prior authorization for services. It's a growing business for insurers.

Medicare Advantage open enrollment for 2019 ends Dec. 7. But it's not easy to use Medicare's online plan finder to search for plans with expanded benefits, so beneficiaries and their families will have to rely on promotional materials that insurers mail during open enrollment.

For years, Medicare has permitted private plans to offer supplemental benefits not covered by the traditional program. Think free gym memberships, transportation to medical appointments or home-delivered meals following a hospitalization.

The new benefits take that to a higher level, with Medicare's blessing.

"It is a big concept, in the sense that it is officially encouraging plans to get across the line into the many, many things that affect the health and well-being of beneficiaries," said Marc Russo, president of insurer Anthem's Medicare business. "I, for one, who have been in and around Medicare for decades, believe it pays."

Insurers under Anthem's corporate umbrella are offering different packages in 12 of 21 states they operate in. They can include alternative medicine, like acupuncture, or adult day care center visits or a personal helper at home.

Other major insurers like UnitedHealthcare and Humana are participating.

Still, Medicare's opening is no substitute for full long-term care coverage, which many people need for at least part of their lives and remains prohibitively expensive. Seniors trying to get long-term care through Medicaid — the program for low-income people — must spend down their life savings.

"Medicare policy has not kept up with the times," said Sen. Ron Wyden, D-Ore., one of the authors of bipartisan legislation seen as a catalyst for expanded services through Medicare Advantage.

Wyden said he's working to bring similar options to traditional Medicare, which is still the choice of 2 out of 3 seniors. "Clearly this is going to have to be an effort that is going to have to be built out," he added.

The changes represent a rare consensus at a time when health care issues are among the most politically divisive. Republican and Democratic lawmakers, as well as Seema Verma, the Trump administration's Medicare chief, are pulling in the same direction.

The idea of broader services through Medicare Advantage was embodied in a bipartisan Senate Finance Committee bill to improve care for chronically ill seniors. The legislation got spliced into a massive budget bill passed earlier this year. The Trump administration issued regulations in the spring trying to accelerate the changes.

According to Medicare, 12 insurers will be offering expanded supplemental benefits next year through 160 plans in 20 states. In four other states and Puerto Rico, such benefits may be available to seniors with certain health conditions.

"The guidance came out fairly late in the annual planning process, and that's one reason why some of these benefits may start out small," said Steve Warner, head of Medicare Advantage program development for UnitedHealthcare.

Medicare estimates that some 780,000 beneficiaries will have access to the new benefits next year. In-home helpers and support for caregivers are the most popular.

Consumer advocates recommend that seniors carefully weigh whether Medicare Advantage is best for them. If they don't like it, they can go back to traditional Medicare, but those with a pre-existing condition may not be able to buy a "Medigap" policy to help cover out-of-pocket costs. They can also switch to another Medicare Advantage plan.

Medicare doesn't pay the insurers more for offering added benefits. Under a complex formula, they're primarily financed out of the difference between bids submitted by insurers and Medicare's maximum payment to plans. If the companies bid below Medicare's rate, they can return some of that to beneficiaries in the form of added benefits. Costs for beneficiaries may vary. Some will face no added costs.

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The organization helping to bring new drugs for rare diseases to market

A research team has reason to celebrate after the Food and Drug Administration granted it approval o..

A research team has reason to celebrate after the Food and Drug Administration granted it approval on Friday to begin a clinical trial for a new pediatric brain cancer drug, one that might have ended up overlooked by pharmaceutical companies.

The lead researcher on the team, Dr. Teresa Purzner has already beat impossible odds. The neurosurgeon and mom of three managed to get the approval in record time and with little money thanks to the help of a team of scientific altruists called SPARK.

The development of new medications in the United States is driven by pharmaceutical companies; researchers at universities rarely bring their discoveries to the bedside. For every 10,000 potential new medicines sitting on laboratory shelves around the country, only one will ever reach patients in need, according to the National Institutes of Health. Why? Because the process can take 10 to 15 years, costing upwards of a billion dollars per drug.

As a result, the number of new medications approved by the FDA has remained stagnant at about 31 per year over the past 10 years. The majority of these medications are similar to already existing ones, and many target diseases for which there are large markets — like hypertension and high cholesterol — and therefore, a return on investment.

Enter SPARK, a non-profit program created in partnership between Stanford University and volunteers from the biotechnology, pharmaceutical, and investment industries, which helps academic researchers bring their discoveries to patients. Since its founding, SPARK has given special consideration to projects typically neglected by pharmaceutical companies, including rare diseases and diseases affecting children.

Purzner put her neurosurgery practice on pause to study medulloblastoma, a type of childhood brain cancer. Compared to diseases like hypertension and high cholesterol, which affect millions of Americans, medulloblastoma is rare, affecting only 250 to 500 children every year.

“Theres something especially poignant about seeing children —beautiful, wonderful, innocent things — and seeing the impact of the therapies we are giving them. The medications, the radiation therapies impact their cognition, their quality of life and their ability to function as independent adults in the future,” Purzner said in an interview with ABC News.

Purzner had a clear goal: to find a targeted therapy that could shut down the basic biochemical pathway responsible for the development of this cancer, and she did. She tested the potential drug in mice with good results, and she just received FDA approval to test it in clinical trials, which she will do through the Pediatric Brain Tumor Consortium. She did it all in five years and for a price tag of $500,000.

“To get from my initial findings in the lab to the point where the Pediatric Brain Tumor Consortium picked it up for clinical trials would have never happened without the help of SPARK… they gave me a clear pathway and made me believe it was possible,” said Purzner.

Every year, SPARK provides 10 teams with funding and expert mentorship to promote efficient and cost-effective drug development. (more…)

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Widowed father works with congresswoman on legislation to prevent maternal deaths

Sitting in the hospital room, mother and newborn baby were sound asleep.

“I was overjoyed. I reme..

Sitting in the hospital room, mother and newborn baby were sound asleep.

"I was overjoyed. I remember thinking my family is complete," Charles Johnson told ABC News.

But then he looked down and saw his wife Kiras catheter turn pink and then red with blood.

April 12, 2016 was supposed to be a joyous day for the Johnson family, but it turned into a "nightmare."

Ten hours later, Kira Johnson died as a result of internal bleeding following a cesarean section.

Now, two years later, Johnson is raising two children on his own and advocating to rectify the country's maternal health policies and regulations to prevent anyone else from sharing the same tragedy. Johnson took to Capitol Hill to share his wife's story before members of Congress, working alongside a congresswoman who experienced her own personal difficulties during pregnancy.

Charles and Kira Johnson welcomed their first son Charles V. in 2014. He was delivered via C-section. Two years later, the Johnson family relocated from Atlanta to Los Angeles and learned they were expecting their second baby boy.

"Kira and I had always wanted two boys," Johnson said. "I was excited."

The Johnsons decided to have Langston delivered at Cedars Sinai medical center, a non-profit hospital that is currently ranked as the eighth best hospital in the country by U.S. News and World Report.

Charles Johnson said his wife was in exceptional health and that she took all the necessary prenatal measures to ensure their second child would be born healthy. Since their first son was born via C-section, the doctor suggested the same for their second. (more…)

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States look to breathalyze convicted drunk drivers to reduce fatalities

This story is from Kaiser Health News

On Jan. 1, California joined the majority of states that ha..

This story is from Kaiser Health News

On Jan. 1, California joined the majority of states that have laws requiring drivers with drunken-driving convictions to install breathalyzers in vehicles they own or operate.

Researchers, public health advocates and political leaders believe these laws are helping reduce alcohol-related road deaths.

The gadgets, known as ignition interlock devices, are mounted on the steering wheel of a vehicle and prevent it from starting if the drivers blood-alcohol reading is above a predetermined level.

In California, the breathalyzers are mandatory only for repeat offenders. Five other states — Georgia, Indiana, Massachusetts, Montana and Ohio — have similar laws. Thirty-two states and D.C. require the devices even for first-time offenders.

The advent of such laws across the United States in the past 15 years has been accompanied by some good news: Deaths involving drunken driving are only about half of what they were in the early 1980s, though they have ticked back up in recent years. The long-term decline is largely attributable to greater public awareness, stricter seat belt enforcement and the establishment in 2000 of a nationwide legal blood-alcohol threshold of 0.08 percent — far below the 0.15 percent standard commonly used before then.

State Sen. Jerry Hill (D-San Mateo), the author of the California law, said breathalyzers in cars will make roads safer than under the current law, which generally relies on license restrictions and suspensions.

“Weve seen people on a suspended license continue to drive and continue to cause destruction,” said Hill, who lost his best friend to drunken driving in the 1980s.

There is some evidence that the breathalyzers have an impact. Nationally, from 2006 to 2016, ignition-locking breathalyzers prevented 2.3 million attempts to drive by people with a blood-alcohol level at or above 0.08 percent — the legal threshold for driving under the influence — according to a 2017 report by the advocacy group Mothers Against Drunk Driving.

Emma McGinty, an associate professor at the Johns Hopkins Bloomberg School of Public Health, found that laws requiring interlocks for all DUI offenders were associated with a 7 percent drop in the rate of fatal crashes caused by drunken drivers. Another study found that laws covering all offenders were associated with 15 percent fewer alcohol-related fatalities compared with states that have less stringent laws. (more…)

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