“short of comprehensive reform by Congress, CMS may find it challenging to build value in Medicare over this decade if TM’s [traditional Medicare] scaffolding erodes [due to the rise of Medicare Advantage (MA)]. Much can be done under CMS’s existing authorities to promote efficiency and equity, but, under Medicare’s present configuration, that requires preservation of TM. Without substantive legislative reform on the horizon, regulatory policy will thus need to keep the long view in mind, lest several years of inertia set in motion an unalterable course to a lesser outcome. [..] MA has been clearly successful in managing utilization more … Read More
All posts by Anupam
Excerpt – No public health decision is purely scientific, so the agency cannot avoid the small-p politics of health policy. No matter what we may yearn for, there is no ethereal scientific plane the CDC can ascend to. “The ‘politicization’ accusation implies that we should just isolate the CDC and let it do its work by itself,” said Gil Eyal, a sociology professor at Columbia University. “But I think that’s wrong. I don’t think we know of an obvious way to organize the relationship between science and politics.” That is, they are always intertwined, especially when it comes to the … Read More
“If we do want to change our relationship to technology, I think we’d have to do it intentionally. My basic thoughts are roughly: We should accept the premise that people will not run their own servers by designing systems that can distribute trust without having to distribute infrastructure. This means architecture that anticipates and accepts the inevitable outcome of relatively centralized client/server relationships, but uses cryptography (rather than infrastructure) to distribute trust. One of the surprising things to me about web3, despite being built on “crypto,” is how little cryptography seems to be involved! We should try to reduce the … Read More
“People are starting to get the message that text/SMS is a weak form of multi-factor authentication (MFA). Fewer people know that there’s a big gap between the post-SMS MFA options as well. [..] it doesn’t really matter how you got that MFA code. It might have been a text, or it could have been something “strong”, like a mobile authenticator app like Google Authenticator or Authy. However you got it, you now have it, which means you can now type it into a text field owned by a bad guy. [..] FIDO stands for Fast Identity Online, and it uses … Read More
“[..] artificial intelligence (AI) is well suited to the detection and reporting of follow-up recommendations because of the large volume of imaging studies requiring screening and the relatively standardized language employed by radiologists in preparing reports. Natural language processing (NLP) methods, including text pattern-matching and traditional machine-learning techniques, have been developed for this task. In this article, we use the term traditional machine learning to refer to all machine-learning methods that are not deep learning, and these terms will be defined in detail in the sections that follow. More recently, novel deep-learning methods for NLP have shown great promise for … Read More
“Before the pandemic, most health centers did not offer telehealth visits for primary care or behavioral health, in large part because of reimbursement policy. In spring 2020, dramatic policy changes removed many of the restrictions on telehealth delivery, and health centers responded by standing up large telehealth programs. This sudden and dramatic change in health care delivery posed numerous challenges. Health centers had to quickly make changes to technology, workflows, and staffing to accommodate telehealth visits. To support health centers in these efforts, the California Health Care Foundation established the Connected Care Accelerator (CCA) program, a quality improvement initiative that … Read More
“One of the problems with screaming “How could you be so stupid?” at people who behave stupidly is that we too often think of the question as rhetorical when it isn’t. Though vaccine hesitancy is often seen as purely political, that’s not necessarily the case. It also correlates to lack of health care, which means that when public-health officials urge the unvaccinated to consult their family doctors (on the assumption that they might be more persuasive than government agencies), they’re assuming facts not in evidence. If you can’t afford health insurance, you probably can’t afford a doctor either, and if … Read More
“In 2017, a total of 31% of Americans died at home, making it the most common site of death for the first time in decades. In the United States, we tend to believe that someone who died “peacefully at home, surrounded by family” (as the obituaries put it) has had a good death. Yet reality frequently diverges from this scenario. Unprepared family caregivers are routinely tasked with managing distressing symptoms (including pain, agitation, and dyspnea), administering medications, and providing intimate personal care (including bathing and toileting assistance) to bedbound patients. In other care settings, these tasks are performed by trained … Read More
“But for all we know now about long COVID, it is still not enough. Researchers still don’t know who’s most at risk, or how long the condition might last; whether certain variants might cause it more frequently, or the extent to which vaccines might sweep it away. We do not have a way to fully prevent it. We do not have a way to cure it. We don’t even have a way to really quantify it: There still isn’t consensus on how common long COVID actually is. Its danger feels both amorphous and unavoidable. People already struggle to deal with … Read More
“These companies [Meta (Facebook), Alphabet (Google), Amazon, Apple, and Microsoft] are so successful—and generate so much consumer data and cash—that it sometimes feels as if they can’t be stopped. Not only have they been on the cutting edge of technology, but now they also have the power of incumbency. Yet according to Jonathan Knee—who is a veteran investment banker specializing in media and tech, a Columbia Business School professor, and the author of The Platform Delusion: Who Wins and Who Loses in the Age of Tech Titans—even digital superpowers face threats, from start-ups as well as seasoned competitors. In this … Read More