Instruction: create a high quality summary of the given input

Input:
Emerson mobile IoT solution enables remote process control
 Emerson has launched DeltaV™ Mobile, a new platform that leverages Industrial Internet of Things (IoT) technologies to empower the manufacturing engineer of the future with access to real-time data, trends and insight to make better-informed, critical operations decisions – securely from anywhere in the world.

Part of Emerson’s Plantweb™ digital ecosystem, DeltaV Mobile uses smartphone technology with process control data to make operational intelligence available 24/7 for its customers.

The digital plant of the future uses DeltaV Mobile to remove the confines of the control room and enable the digital worker to monitor operations and see critical operational data more flexibly.

By integrating seamlessly and securely with the DeltaV distributed control system, DeltaV Mobile delivers critical contextual data that is often left behind by other solutions. With added context, DeltaV Mobile users can make better decisions around operational events that could affect bottom-line business results. Incorporating Emerson’s Plantweb Secure First Mile™ technology, DeltaV Mobile provides safe, remote access to important plant data without impacting critical production systems.

“DeltaV Mobile is an important Industrial IoT tool to help companies make decisions faster and smarter,” says Jamie Froedge, President, Process Systems and Solutions, Emerson Automation Solutions. “Mobile intelligence will transform operational workflows and practices and drive collaboration across the enterprise, which helps customers reach Top Quartile performance.”

DeltaV Mobile enables on-site teams to quickly and securely connect with off-site experts, extending organisation-wide expertise and collaboration beyond the plant. Intuitive mobile views and customisable filtering ensure that users see clear and relevant data and alerts about the safety and performance of facilities. It easily provides alarms, trends and data available on DeltaV operator workstations to iOS and Android mobile devices, as well as alarm alerts via push, SMS, or email notification.

DeltaV Mobile is a core platform solution in Emerson’s Always Mobile™ portfolio, which also includes Asset View for the AMS ARES asset management platform and Guardian™ Mobile. Always Mobile technologies deliver operational mobility solutions that improve productivity and collaboration. With secure, instant access to operational information in intuitive views, personnel can make accurate decisions.

Output: Emerson has launched a mobile platform that gives manufacturing engineers access to real-time data, trends and insight from anywhere around the world. DeltaV Mobile draws data from the industrial internet of things (IoT) to allow remote access to plant data and alarms to iOS and Android mobile devices. It also facilitates secure connections between on-site and off-site staff.


Instruction: create a high quality summary of the given input

Input:
Medi-Cal patients sue state, claiming widespread discrimination
 Sign-carrying demonstrators representing doctors, hospitals and unionized healthcare workers rally against cuts in the amount the state pays for Medi-Cal reimbursements at the Capitol in Sacramento.

A group of Medi-Cal beneficiaries filed a lawsuit against the state Wednesday, alleging that low payments to doctors are creating an unequal healthcare system in California.

Thomas A. Saenz, an attorney representing the plaintiffs and president and general counsel for the Mexican American Legal Defense and Educational Fund, said the state is required to provide coverage to low-income Californians through Medi-Cal that’s equivalent to the care other Californians receive through private insurance or Medicare.

But Medi-Cal patients have a harder time finding doctors, wait longer for appointments, end up in the emergency room more often and have their diseases diagnosed later than those in other insurance programs, Saenz said. That’s in part because the state mismanages the health program and delays payments to doctors, making them unwilling to see Medi-Cal patients, he said.

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But “the big issue is that the reimbursement rates ... are woefully, woefully inadequate,” Saenz said in an interview.

The suit, filed in Alameda County Superior Court, claims that because the program is majority Latino, the state is essentially discriminating against Latinos.

“California has created a separate and unequal system of healthcare, one for the insurance program with the largest proportion of Latinos,” Medi-Cal, and one for other insurance plans that are majority white, according to the suit.

Reimbursement rates in Medi-Cal were closer to other insurance reimbursement rates when Medi-Cal was a predominantly white program, according to the suit.

“That changed when the Medi-Cal program became increasingly Latino and then majority Latino. That is discrimination,” said Bill Lann Lee, senior counsel of the Civil Rights Education and Enforcement Center, in a statement.

Medi-Cal patients have long struggled to find doctors to see them, but that problem only got worse after the Affordable Care Act expanded the program in 2014, experts say. Medi-Cal now covers 13.5 million Californians — more than 1 in 3 state residents.

Medi-Cal pays doctors about half of what they’d get through Medicare, the government-run health insurance for people over 65. Of the 50 states, California’s Medicaid payment rates rank 48th.

Esther Castaneda, one of the plaintiffs and a Medi-Cal beneficiary, had to wait a year to get her gallbladder removed because she couldn’t get appointments with her doctors or referrals for surgeons who took Medi-Cal, according to the suit. She stopped eating to minimize the extreme pain and vomiting she’d experience otherwise.

She eventually resorted to getting the surgery in Mexico, where a doctor told her she would’ve died without it, according to the complaint.

The lawsuit asks that the state pay doctors enough to ensure that Medi-Cal beneficiaries can receive medical care of similar quality to others in the state and that there are enough doctors who will take Medi-Cal patients.

State officials said Wednesday that the Department of Health Care Services, which oversees Medi-Cal, monitors patients’ access to care.

“DHCS has not identified any systemic problems with patient access to services in the Medi-Cal program nor has the federal Centers for Medicare and Medicaid Services identified any issues,” department Director Jennifer Kent said in a statement to The Times.

soumya.karlamangla@latimes.com

Twitter: @skarlamangla

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UPDATES:

3:40 p.m.: This article was updated with a statement from a state official.

This article was originally published at 1:10 p.m.

Output: A group of Medi-Cal beneficiaries filed a lawsuit against the state Wednesday, alleging that low payments to doctors are creating an unequal healthcare system in California.


Instruction: create a high quality summary of the given input

Input:
Patient-centered medical homes cut costs, improve quality through collaboration, evidence shows
 New evidence shows a link between patient-centered medical homes and improved quality at a lower cost -- provided there's an adequate investment in primary care, and strong collaboration between the payer and provider.

Released this week by the Patient-Centered Primary Care Collective, the study reviewed 45 peer-reviewed reports and found that, in most cases, PCMHs resulted in cost reduction, quality improvement and utilization, although in some areas results were mixed.

Overall, the analysis of the reports showed that the longer a practice had been transformed, and the higher the risk of the patient pool in terms of comorbid conditions, the greater the effect on cost savings.

Quality results weren't as conclusive. Looking at state-specific data and data from the Centers for Medicare and Medicaid Services, PCPCC found that there was a general trend toward PCMHs improving quality, though some data showed that there was no statistically significant effect.

[Also: Price transparency for inpatient labratory tests has little effect on clinician ordering behavior, JAMA says]

By contrast, studies uniformly showed that PCMHs had a positive effect on patient satisfaction. Team-based interventions, including case management, and having a usual source of care, have positively impacted the patient experience.

Utilization outcomes were mixed. Most studies and state reports showed an increase in outpatient visits, but that wasn't always tied to a decrease in emergency room visits or inpatient stays.

A partnership between Blue Cross Blue Shield of Michigan and local physician organizations has resulted in one of the largest and longest-running patient-centered experiences in the country, and according to PCPCC, there were several factors in that success. With numerous stakeholders on board, program leaders pushed an incremental approach that rewarded physicians' efforts, and multi-payer support was engendered by the five-year Michigan Multi-Payer Advanced Primary Care Practice Demonstration Program.

The report said it's advisable to make primary care attractive to medical students, as most are attracted to the salary and status that comes with being a specialist, drawing them away from family medicine. PCPCC also said primary care should be a key part of insurance benefits.

Twitter: @JELagasse

Output: New evidence shows a link between patient-centered medical homes and improved quality at a lower cost -- provided there's an adequate investment in primary care, and strong collaboration between the payer and provider.


Instruction: create a high quality summary of the given input

Input:
GOP Health Bill Eases Rules For Some Small-Business Plans
 Some small-business owners burdened with high health care costs would get a break from an obscure provision in the Senate health bill. It offers less regulation, more bargaining power and better prices.

But those benefits could come at a cost to others.

The clause — in the proposal advanced by Senate Majority Leader Mitch McConnell (R-Ky.) last month — would exempt insurance sold through “associations” from most Affordable Care Act mandates and state regulations. That means the plans could offer lower-cost coverage that does not include a broad range of medical services or sets premiums based on the health of the businesses’ employees.

In these plans, small businesses can join an association — which may be loosely based on certain types of professional, trade or interest groups — that offers insurance to members.

This KHN story also ran on NPR . It can be republished for free ( details ).

“Our members are clamoring for more control and more affordable options,” said Kevin Kuhlman, director of government relations for the National Federation of Independent Business, which has long opposed the ACA and supports association plans. The idea also has the backing of the National Restaurant Association.

Critics counter that the provision creates two markets, a lightly regulated one with skimpier and less expensive coverage that would attract businesses with younger or healthier workers and a second market left with mainly older, sicker consumers and rapidly rising premiums.

The Senate plan — along with other GOP proposals that would loosen ACA requirements for some policies — could damage both the small-group and individual markets if it leads to cheaper plans siphoning off the healthiest consumers.

State insurance commissioners warned in a letter Wednesday that the Senate proposal would strip regulators’ authority “to preserve important consumer protections, effectively oversee the plans or ensure a level playing field.” While encouraging the idea of more insurance options, the National Association of Insurance Commissioners said the proposal as written “would lead to significant disruptions in the small group marketplace and higher premiums and fewer coverage choices for many small businesses.”

It would create “an unlevel playing field” that “is likely to lead to cherry-picking, adverse selection and increased costs for sicker individuals,” the American Academy of Actuaries warned in a June 30 letter.

The Senate bill’s language is similar to legislation adopted in March by the House. Previous legislation passed the House in 2003 but never won approval in the Senate.

Association health plans have been around for decades, but some had solvency problems and went bankrupt, leaving consumers on the hook with unpaid medical bills. In several states, regulators investigated whether the plans were advertising that they had comprehensive coverage when, in fact, they provided little or no coverage for such things as chemotherapy or doctor office visits.

The ACA, passed in 2010, still allows the plans but requires them to follow state rules for small-group coverage. That cemented authority in the states to oversee association plans.

The Senate proposal was drafted by longtime proponent Sen. Mike Enzi (R-Wyo.). It would classify association plans as large-group plans, like those offered by major employers to their workers. The large-group plans face far fewer ACA rules and are generally overseen by the federal government.

Large-group plans don’t have to offer the ACA’s 10 “essential health benefits,” and insurers can base their premiums on the health of those covered, although the employer must charge both sick and healthy workers the same amounts. Additionally, most traditional large-employer plans tend to be more generous than the ACA requires. Association plans, by contrast, are not generally as comprehensive as large-employer coverage.

Despite the Senate’s previous rejection of similar legislative language, the idea may have more legs now. After all, some GOP lawmakers appear to be embracing a similar proposal by Sen. Ted Cruz (R-Texas). It aims to allow insurers to sell individual policies that don’t meet all the requirements of the ACA, so long as they sell at least one type of policy that does.

Support for either Cruz’s plan or the association proposal will run up against opposition from state regulators, actuaries and some small-business owners.

Insurers, they say, would be able to provide minimal benefits, charge small businesses based on the relative health of their workers, or both. That could be a boon for some companies, including some restaurants or other franchise operations that employ mainly younger, healthier workers. Self-employed individuals who are healthy might also be able to join associations and qualify for the cheaper policies. But as those consumers are siphoned off, insurers would raise rates on their other plans, which must follow more stringent consumer protection rules, including those left in the ACA.

“Some small businesses might be able to move into these plans and save money, but that will cause rates to go up for others [with older or sicker workers],” said David Chase, vice president of national outreach for the Small Business Majority, which supports the ACA.

If enough healthy small groups opt for the association health plans, siphoning off those consumers, “the small-group market will go into a death spiral if only employers with sicker and older workers participate,” said Mila Kofman, the former Maine insurance commissioner who now heads the DC Health Benefit Exchange Authority.

Insurance commissioners and actuaries have made similar dire predictions about the effects of splitting the market. Those concerns are overblown, say supporters of association health plans.

Said Kuhlman at NFIB: “The existing marketplace [premium costs] may go up a percentage point or two, but other [small businesses] would have a more affordable plan.”

Output: Some small-business owners burdened with high health care costs would get a break from an obscure provision in the Senate health bill. It offers less regulation, more bargaining power and better prices.


Instruction: create a high quality summary of the given input

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Obamacare Is Not Collapsing, Imploding or Exploding
 The biggest lie that President Trump and other Republican leaders have been repeating about the Affordable Care Act for years is that it is collapsing, imploding or exploding. The truth is that the law is actually working reasonably well, and even the part that has shown the most weakness — the health insurance marketplaces — has been stabilizing.

Insurers that sell policies to individuals and families are doing better financially than in the first two years of the A.C.A. They are also doing better than they were before the federal and state governments opened the marketplaces in 2014, according to a Kaiser Family Foundation report published on Monday. The data showing improvement confirms earlier reports by Standard & Poor’s, the Congressional Budget Office and research groups that were based on 2016 numbers. While there are still problems in marketplaces in some states, the A.C.A., or Obamacare, is hardly coming undone.

Yet Republicans in Congress and the Trump administration continue to peddle horror stories about the A.C.A. as they try to gather the votes for repeal of major provisions of the law. To that end, the Senate majority leader, Mitch McConnell, says he will present a new version of his health care bill on Thursday. His earlier proposal would take health insurance away from 22 million people and raise premiums for millions of others, according to the C.B.O. There is no indication that the changes he has in mind will meaningfully improve that dreadful legislation.

Many Americans who do not get health insurance through employers have been frustrated with the marketplaces. The launch of HealthCare.gov by the Obama administration was disastrous. And the insurance policies have high deductibles and premiums that are unaffordable to many people, because the law did not provide enough subsidies to middle-income families. Insurers did a poor job designing their policies and suffered big losses initially, forcing them to raise premiums even more. Republicans also weakened the markets by repealing provisions meant to stabilize them and by filing a lawsuit to reduce federal subsidies. Despite these challenges, more than 10 million people have bought policies on the marketplaces. Most have been protected from big premium increases through subsidies.

Output: The biggest lie that President Trump and other Republican leaders have been repeating about the Affordable Care Act for years is that it is collapsing, imploding or exploding. The truth is that the law is actually working reasonably well, and even the part that has shown the most weakness — the health insurance marketplaces — has been stabilizing.


Instruction: create a high quality summary of the given input

Input:
Don’t Assume That Private Insurance Is Better Than Medicaid
 As we recently wrote, it’s better for patients to have Medicaid than to be uninsured, contrary to critics of the program. But is having Medicaid, as those critics also say, much worse than having private insurance?

This idea has become a talking point for conservatives who back big changes to Medicaid, as the Senate health bill proposes. The poor would benefit simply by being ushered off Medicaid and onto private insurance, they write.

But it’s far from proven that Medicaid is worse than private insurance. A lot depends on what kind of insurance is compared with Medicaid, and how they are compared.

Many studies that measure Medicaid against private insurance suffer from the same flaws that compare Medicaid with being uninsured. They’re terribly confounded, and can show only associations, not causation. People with private insurance are healthier and wealthier than those on Medicaid, and in ways not fully controlled for in statistical analyses. These factors almost certainly predispose someone on Medicaid to have worse outcomes than someone with private insurance.

Output: As we recently wrote, it’s better for patients to have Medicaid than to be uninsured, contrary to critics of the program. But is having Medicaid, as those critics also say, much worse than having private insurance?


Instruction: create a high quality summary of the given input

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Senate Republicans, Preparing New Health Bill, Have No Votes to Spare
 WASHINGTON — The likely defection of two Senate Republicans has left their leaders no margin for error as they move on Thursday to unveil another version of their bill to repeal much of the Affordable Care Act — without an assurance that they have the votes even to begin debate next week.

Senator Rand Paul of Kentucky flatly declared on Wednesday that he would not vote to take up the bill, which he said left too much of President Barack Obama’s health law in place. Senator Susan Collins of Maine has gone almost as far, saying that the bill cuts too much and that only major revisions could win her over.

The loss of a single additional senator would doom, at least for now, the Republicans’ effort to make good on their seven-year promise to uproot the health law. Unity is proving elusive. A lunch meeting of Republican senators on Wednesday ended with no clear consensus.

After scrapping plans for a vote last month, the majority leader, Senator Mitch McConnell of Kentucky, wants to try again next week. But senators have shown few signs of substantial progress toward the needed 50 votes.

Output: The likely defection of two Senate Republicans has left their leaders no margin for error as they move on Thursday to unveil another version of their bill to repeal much of the Affordable Care Act — without an assurance that they have the votes even to begin debate next week.


Instruction: create a high quality summary of the given input

Input:
Blogging platform Verst targeting mobile users with updates
 If you're looking to build your brand with some fresh content, your first stop may be WordPress.com or Medium, or you may choose Wix (the favorite of part-Victoria Secret model, part-coder Karlie Kloss).

CEO AJ Frank would rather you pick Verst(opens in a new tab) to post, manage, and monetize your words (from anywhere including your smartphone) and really understand your audience.

Just over a year old, Verst launched several new features Wednesday that include paid subscriptions, homepage designs, a cheaper pricing tier, content migration from WordPress, and email delivery.

Frank previously worked as a senior product manager at Uber, the general manager at Vine, and in new business development at Google. So, he's quite familiar with getting people online, especially on their smartphones, to click, scroll, and watch.

While competitor sites like WordPress, Medium, Wix, and custom-made websites seem plentiful, Frank said he and his team saw a need for a mobile-focused and data-empowered solution.

"We're a fully featured publishing platform, for professionals, not just hobbyists. We want you to own your audience -- the way that you won’t on Facebook — and use Verst as your central hub," Frank said.

Credit: verst

The latest update lets bloggers put some of their content behind a paywall, offering a way to making money beyond digital advertising also offered on the site. Bloggers take 90 percent of the revenue.

Verst is less of a drag and drop experience like Wix and not just a one-option only version like Medium. Instead, quite like WordPress, users can choose between a handful of design options which can then be easily altered. Unlike WordPress, Verst is well-designed and has a mobile app for publishing.

"Our number one [priority is] making it easier to use and maintain a site," Frank said. "We have a mobile solution, where we want any publisher to be able to work off their phone or their tablet."

Frank didn't disclose how many users they have but pointed to some popular pages. For example, Reid Hoffman, cofounder of LinkedIn, is an advisor to the company and runs his blog(opens in a new tab) with Verst. He shares some blog posts to LinkedIn too. Political pundit and activist Ian Capstick(opens in a new tab), YouTuber Chris Klemens(opens in a new tab), and mental health app Stigma(opens in a new tab) also use Verst.

What Verst can't guarantee, Frank said, is building you an audience.

While Medium has a built-in social network aspect, Verst acts simply as your landing page. It's up to you to share the page across Facebook, Twitter, and LinkedIn, for example. Verst does help with search engine optimization to improve your Google ranking and also provides other audience insights so you can be smarter about when to post.

Of course, content hosting isn't free. Verst has been charging $29 per month for the whole experience but is also introducing a $12 per month tier.

Next up for Verst is offering more insights and tips. A mobile notification of the Verst app may suggest when would be a good time to post and maybe one day even post or share automatically.

"We can be not only a place you can publish and view analytics but also a coach for you. The more you publish the easiest it is to build an audience," Frank said.

Output: One-year-old blogging platform Verst is targeting mobile bloggers by launching several new features such as; paid subscriptions, paywall options for authors, homepage designs, email delivery and content migration from other platforms. The app is native to mobile displays and in the future will notify authors when it is a good time to upload. CEO AJ Frank said  "Our number one [priority is] making it easier to use and maintain a site...where we want any publisher to be able to work off their phone or their tablet". Verst costs $29 per month but has recently added a $12 per month option.


Instruction: create a high quality summary of the given input

Input:
Repair instead of repeal? Here's what a smaller fix might look like
 With Senate Republicans struggling to find votes for sweeping legislation to roll back the Affordable Care Act, several GOP lawmakers have raised the prospect of a more limited bill — passed with help from Democrats — to stabilize health insurance markets around the country.

That may be heresy for conservative Republicans who’ve spent seven years demanding the full repeal of Obamacare, as the law is often called.

Obamacare 101 is a periodic primer on the debate over repealing and replacing the Affordable Care Act »

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But most patient advocates, physician groups, hospitals and even many health insurers say more-targeted fixes to insurance marketplaces make more sense than the kind of far-reaching overhaul of government health programs that Republicans have been discussing.

Could such an approach work? Here’s a primer on what such legislation might look like and how it might get done.

Why do a more limited Obamacare ‘fix’?

For one thing, it would be politically easier. More-targeted legislation also wouldn’t threaten insurance protections for tens of millions of Americans.

The political debate over the 2010 healthcare law has focused for years on what has been happening to insurance marketplaces like HealthCare.gov, which were created by the law for Americans who don’t get health insurance through work.

For a variety of reasons, the marketplaces’ first several years have been rocky.

Insurers in many states struggled to figure out how much to charge for their plans and then raised premiums substantially when customers turned out to be sicker than they expected.

And as uncertainty over the future of the markets has intensified since President Trump’s election last year, several leading national insurers have decided to stop selling plans in some states, leaving consumers in some places with few if any health plans to choose from. Trump has called Obamacare a “disaster” and “dead.”

But the marketplaces — where about 10 million Americans currently get coverage — represent a very small fraction of the U.S. healthcare system.

By contrast, more than 70 million Americans rely on Medicaid and the related Children’s Health Insurance Plan, the government safety net plans for the poor.

Altering Medicaid, as proposed under the GOP plan, would be far more disruptive. And, as congressional Republicans are learning, it is much more controversial.

But isn’t Medicaid a big problem, too?

Many conservatives have long argued the federal government can’t afford to provide so much healthcare assistance to the poor.

But Medicaid has become a vital lifeline for tens of millions of Americans. Medicaid provides assistance to more than one in three U.S. children, protects millions of Americans with disabilities and is the largest funder of nursing home care for elderly Americans, in large part because Medicare does not cover nursing homes.

Obamacare’s Medicaid expansion, which made coverage available to working-age adults in many states, is credited with driving down the nation’s uninsured rate to the lowest levels ever recorded.

And a growing body of evidence shows it is improving low-income Americans’ access to needed medical care, reducing financial strains on families and improving health.

That is why Medicaid has been fiercely defended by patient groups, doctors, nurses, educators and even some Republican governors.

What would it take to stabilize insurance markets?

Probably not that much, actually.

There is widespread agreement that the federal government must first continue funding assistance through Obamacare to low-income consumers to help offset their co-pays and deductibles.

This aid — known as cost-sharing reduction, or CSR, payments – was included in the original law.

But the payments have become a political football as Republicans argued the aid can’t be provided without an appropriation by Congress. And Trump administration officials keep threatening to cut off the payments.

Many insurers say that would be devastating, forcing them to raise premiums by double digits.

Congress could simply put an end to that uncertainty by voting to appropriate the CSR money.

Secondly, most insurance industry officials and independent experts say the federal government must create a better system to protect insurers from big losses if they are hit with very costly patients.

Such reinsurance systems are used in other insurance marketplaces such as the Medicare Part D prescription drug program and are seen as critical to stabilizing markets.

Thirdly, current and former marketplace officials say, the federal government should aggressively market and advertise to get younger, healthier people to buy health plans on the marketplaces.

This strategy has helped Covered California, that state’s marketplace, which has not been beset by some of the problems in other markets.

Finally, many experts say, federal officials likely will have to come up with additional incentives to convince health insurers to offer plans in remote, rural areas.

Some Republicans have suggested that consumers in these areas could be allowed to buy health plans that don’t meet standards set out in the current law.

Would these steps cost more money?

Yes.

But both the House and Senate GOP bills to roll back Obamacare included billions of dollars to stabilize markets over the next several years.

So could Congress put that aid in a smaller healthcare bill?

That’s still unclear.

Many congressional Republicans are reluctant to spend any more money on healthcare aid, especially for a law that most have sworn to repeal.

But polls indicate that Americans now hold congressional Republicans and the Trump administration responsible for the fate of the nation’s healthcare system, including the insurance marketplaces.

That suggests that there could be a political price to pay for the GOP if the markets are not stabilized.

At the same time, Senate Democrats have signaled a willingness to work with Republicans on marketplaces fixes if GOP lawmakers agree to drop their repeal campaign.

But major hurdles remain, including demands from many GOP lawmakers that at least some of Obamacare’s provisions be repealed, such as the highly unpopular mandate requiring Americans to have health insurance.

Rather than stabilizing markets, however, eliminating the insurance requirement could lead to even more turmoil, experts say.

noam.levey@latimes.com

@noamlevey

MORE OBAMACARE 101

What’s going to happen to 70 million Americans who rely on Medicaid?

A side-by-side comparison of Obamacare and the GOP’s replacement plans

Would sick Americans still be able to get insurance under the House Republican bill?

Output: With Senate Republicans struggling to find votes for sweeping legislation to roll back the Affordable Care Act, several GOP lawmakers have raised the prospect of a more limited bill — passed with help from Democrats — to stabilize health insurance markets around the country.


Instruction: create a high quality summary of the given input

Input:
How digital health innovators are changing the status quo for end-of-life planning
 About the author: Stephanie Nieman is a Principal at SJF Ventures based in Durham, NC. SJF Ventures is a venture capital fund investing in high growth, positive impact companies across the U.S. and an active health care investor.

Benjamin Franklin famously wrote that “nothing can be said to be certain, except death and taxes.” And yet the inherent optimism of human nature causes us to avoid talking about the inescapable truth of death. Studies have repeatedly shown that while we widely recognize the value in end-of-life consideration and planning, we do not take much, if any, action to ensure personal desires will one day happen.

A 2013 national survey found 90 percent of Americans believe it is important to have end-of-life care discussions with their families, yet fewer than 30 percent had actually done it. Another 2014 study reported only 26 percent of Americans surveyed had completed an advanced directive, like a living will -or other legal documentation of one’s end-of-life wishes. Another study confirmed again that while 63 percent felt it was very important to communicate their funeral wishes to family members prior to death, just 21 percent had done so.

And since we are not taking action in either family conversations or legal documentation, individual wishes are not being realized. Seventy percent of Americans state they would prefer to die at home, although only 25 percent actually do.

In addition to the gap of unmet patient wishes, unnecessary end-of-life care also comes at a high financial cost. The United States spent $646 billion on Medicare in 2015, and it is estimated 28 percent of that was spent on patients’ last six months of life. Patients also pay high healthcare costs at the end of life; a Mount Sinai School of Medicine study found average out-of-pocket expenses for Medicare recipients during the five years before their death were around $39,000 for individuals and $51,000 for couples where one spouse died. Twenty-five percent had bills exceeding their total household assets, and 43 percent exceeded their non-housing assets.

But when terminally ill patients choose to remain at home, focus on palliative and/or hospice care, and avoid unnecessary treatments, patients and families have demonstrated higher satisfaction and patients have shown to live longer. Some health care providers and payers are seeking to better meet patient wishes and reduce unnecessary end-of-life care costs with advance care planning (ACP) programs where clinicians and/or social workers actively engage patients to consider all options and document their preferences. Examples include Gundersen’s Respecting Choices program in Wisconsin and Sutter Health’s Advanced Illness Management (AIM) program in northern California for patients with late-stage chronic illnesses. Gundersen’s program has demonstrated 7.2 fewer days in the hospital and $23,000 in cost savings per patient versus the national average in the last two years of life with a 25 percent increase in length of life for its patients.

There are also national advocacy efforts around end-of-life planning to help educate Americans on the need for personal decision-making, family communications, and legal documentation. Examples of great nonprofit resources include The Conversation Project, DeathWise, and ACP Decisions.

Digital health solutions to scale these types of advance care planning services and end-of-life preparation programs are newer to market than their counterpart population health and chronic disease management startups. They also face greater obstacles to adoption as they must overcome the highlighted human psychological barriers embedded in end-of-life planning.

That said, I’m bullish on market opportunities for models that can build patient trust quickly, utilize experienced professionals with expertise in conducting these difficult conversations, engage families in patient decision-making, help patients document and communicate their wishes with healthcare providers (both primary and acute care), and ultimately demonstrate higher patient and family satisfaction alongside lower costs of care.

Below highlights 11 digital end-of-life companies, each coming at the challenge in a distinct way. One group of players is aligning more with healthcare payers and providers (who have the greatest financial incentive to engage patients) and focusing on severely ill patient populations, and another group of companies has set out to directly engage individuals and families, casting a broader net and trying to elevate the general population awareness level of end-of-life planning.

B2B Advanced Care Planning Outsourced Solutions

These models generally sell their technology-enhanced services to at-risk providers, health plans, and payers and engage patients, often those identified as severely ill, on their behalf.

Winners must:

· Engage patients on a very difficult, disliked topic (one's mortality), and at a time when they may be trying to fight a severe illness. Furthermore, patients may wrongly akin the idea of ACP with “admitting defeat” in their own minds.

· Also engage families because without family buy-in, advanced directives may not be effective anyway. These are also very difficult conversations to have, and it can be tricky to coordinate communication with both patient and family.

· Secure multiple signed patient documentation that is distributed to primary care physicians, labeled for emergency professionals in the home, presented in emergency health settings, and recorded in EMRs.

· Build patient trust in order to ever begin the conversation. Doctors are typically the most trusted partners for these conversations yet doctors do not have the time, strong incentives, or the training to engage in them. Other players, especially payers, are not generally as trusted by patients.

· Execute in a personal touch environment that can be affordably scaled. End of life conversations are probably best held in in-person settings, yet these may not be scalable so any virtual care or remote communications must be carefully planned.

· Be patient-centric, not cost-centric. Patients think of end-of-life planning comprehensively (i.e. include health care, death, funeral, estate planning decisions altogether) while health plans only consider the care decisions and costs. Successful models will likely serve all patient and family planning needs.

Players:

Copilots in Care was an end-of-life care company that unfortunately proved unable to successfully scale. It attempted a model whereby payers paid for severely ill patient outreach that was initially engaged remotely, and then the company delivered end of life discussions through in-person social worker visits to patient homes. Copilots in Care shut down in 2016.

Emmi Solutions (a Wolters Kluwer company) is a patient engagement platform offering online, interactive multimedia programs, and interactive voice response (IVR) calls to help patients across the continuum of care, from prevention to treatment to follow-up, and includes advance care planning as one of its services. Emmi was acquired by Wolters Kluwer for $170 million in 2016.

Iris Plans is a telemedicine model sold to payers and providers to first identify patients who would likely benefit most from advance care planning, set up video-based conversations with patients, and provide disease-specific education tools to help patients navigate multiple care decisions specific to their condition. Iris Plans raised $1 million led by Better Ventures in 2016.

Vital Decisions is one of the first providers of dedicated healthcare planning and end-of-life decision-making services. It utilizes a largely telephonic communication model for experienced social workers to call and discuss care options with terminally ill patients on behalf of health plans and payers. Vital Decisions was acquired by MTS Health Investors in 2012.

Vynca focuses on healthcare providers and offers a technology solution to share end of life care plans across multiple healthcare providers. It uses the Physician Orders for Life-Sustaining Treatment (POLST) paradigm that ensures a patients’ wishes are actually carried out. POLST is being rolled out in 43 states, but in almost 90 percent of cases the paper POLST forms are not available at the scene of an emergency, so Vynca provides a technology solution to digitize the forms and integrate them into healthcare providers’ workflow. Vynca raised $4.9 million from angel investors in 2015.

WiserCare is a patient clinical decision support information technology paid for by hospitals and health systems to enable smarter, faster, and more effective medical decisions. It has raised $5.8 million from several groups to date.

D2C End-of-Life Planning and Record-keeping

These models acquire individual users directly, usually online, and provide comprehensive end-of-life, funeral, and estate planning education, documentation, storage and/or sharing tools either for free to users or for a small fee. The companies sometimes monetize through various types of distribution partners who sponsor the digital tools as a benefit to their employees, members, or other beneficiaries.

Winners must:

· Reach and engage a general population of users on the disliked topic of end-of-life planning no matter what their current life stage or health outlook (which is even more challenging.)

· Acquire these users at a very low cost.

· Educate on options and deliver documentation tools in a very efficient, low-cost, and likely all digital manner as there is not necessarily a payer/provider customer to pay for 1:1 patient engagement and personalized discussions for this general population.

· Provide ways to store documents for many years until needed and to share the documents with family members.

· Secure multiple signed patient documentation of advanced directives that is distributed to primary care physicians and recorded in EMRs.

· Efficiently cover all personal planning decisions at one time without overwhelming users who may have never even considered these decisions before.

Players:

Cake is an online platform that enables users to express their last wishes and thoughts and helps them to discover, store, and share their end-of-life preferences. Targeting the general population, Cake guides users on making decisions for all aspects of one’s end-of-life plans (health, assets, legal, funeral, etc.). It has worked with employers and health plans to reach their employees and patient populations. Cake raised an undisclosed amount of capital from Bantam Group and Nautilus Ventures in 2016.

Everplans is an online platform for funeral and end-of-life planning. The company provides a platform enabling users to create profiles outlining their end-of-life wishes, living wills, healthcare proxies, financial information, legal documents, bank information and key personal information, which they can share with those people charged with carrying out their wishes. Everplans has raised $12.6 million to date, most recently its Series A was led by Mousse Partners in 2016.

Grace started off as an online concierge service for finding funerals and end-of-life care but has since pivoted, and Grace is now a marketplace for finding hospice care alongside providing patient and family education on the benefits of hospice care. Grace raised $800K in 2016.

MyDirectives (by ADVault) is a completely digital emergency, critical, and advance care planning service that is secure, easy to understand, and free for consumers to use. Apple iPhone users can also download the MyDirectives app for free in the Apple App Store. MyDirectives also works with health plans to distribute the tool to their patient populations.

Willing is a platform designed to create legal wills online. It offers an online tool for users to create a will or living will in minutes and helps users find and compare costs for funeral homes and cemeteries in order to save families time and money. Willing raised an undisclosed amount in 2015.

All models encouraging individuals to engage in end-of-life planning face ongoing barriers to adoption, but recent attention on the topic, growing comfort with virtual care models enabling personal discussions to be delivered at scale, and rising out-of-pocket and overall health care costs all have the potential to make now the time for end-of-life companies to succeed.

Output: The inherent optimism of human nature causes us to avoid talking about the inescapable truth of death. Studies have repeatedly shown that while we widely recognize the value in end-of-life consideration and planning, we do not take much, if any, action to ensure personal desires will one day happen.


Instruction: create a high quality summary of the given input

Input:
Researchers survey strategies to improve end of life quality
 Globally, 20 million people per year require palliative care at the end of their lives.

A new study by Cornell researchers has identified strategies that could help improve their quality of life, especially as their lives come to an end.

The team surveyed 133 staff and volunteers who provide end-of-life care to patients in home and institutional settings for four organizations in two counties in upstate New York. The study points to improvements in end-of-life care through institutional policies, palliative care practices and facility design.

The findings are highlighted in "Strategies to Improve Quality of Life at the End of Life: Interdisciplinary Team Perspectives," published in June in the American Journal of Hospice and Palliative Medicine. The authors are assistant professor Rana Zadeh, professor Paul Eshelman and postdoctoral associate Hessam Sadatsafavi from the Department of Design and Environmental Analysis in the Collage of Human Ecology, as well as Judith Setla, medical director of Hospice Central New York.

"This ethnographic study … is intended to add to the sparse but growing literature promoting quality of life from a practical perspective and to act as a precursor to further research on designing and managing environments to improve both quality of life and end of life."

Survey responses from physicians, physician assistants, nurse practitioners, registered nurses, social workers, chaplains, administrators and volunteers identified numerous areas to enhance and safeguard quality of life for end-of-life care patients and their families.

These included organization philosophy and mission; organizational policies; caregivers' behaviors and practices; symptom management; facility design, operation and management; and patient, family member and caregiver experiences.

The recommendations included family access to 24/7 visitation, patient mobility in the facility and access to the outdoors, staff access to stress relief programs and break times, and avoiding over sedation of patients while promoting spiritual care and counseling.

The study found establishing trusting relationships with caregivers through positive social interactions was important. Optimization of facility space and layout allowing for greater interaction between family members, caregivers and patients were also seen as priorities.

"The diverse list of identified strategies indicates that improving care to address the unique, complex, multilayered dimensions of quality of life at the end of life requires a multidisciplinary approach and consistency among care providers, including administration, clinical management, front-line caregivers and support staff," the authors wrote. "One important implication of the data is that strategies should be applied in concert and tailored to the desires of the individual. When all of these strategies are used in harmony, quality of life in end-of-life care can truly be enhanced."

For example, strategies that provide residents access to the outdoors need the support of the facility's physical environment, staff commitment and regulations.

"The facility would need to have an accessible pathway as well as a pleasantly designed outdoor space protected from rain and wind," Zadeh said. "Staff would need to 'buy in' to the idea of taking patients outside, and an organizational policy would be required that allows patients to spend time outdoors. If one of the three pillars is missing, the aim of healing and soothing patients through such a strategy won't be accomplished."

The research results are neither definitive nor universal to all care settings, the authors said. But seeking knowledge from multidisciplinary teams of end-of-life care providers demonstrates an investigative approach that helps fill gaps in current research. Similar investigations can help generate guidelines to help reduce unnecessary suffering and optimize resource use.

Eshelman points to a "painfully compelling" finding from one of the study's focus groups: Progressive loss of control, not only for the patient but also for their loved ones, marks the path toward the end of life.

"If one of the goals in the design of an end-of-life care setting was to accommodate the urge to maintain control, the concept of flexibility could have relevance and be appropriate for application in the design process," Eshelman said. "A question that would be useful in informing the design process then would be, what is the nature of flexibility in an end-of-life care setting such that meaningful and manageable control actually will be realized by patients, family members and staff?"

Eshelman says that similar questions seeded by the present study have the potential to frame a substantive program of research for years to come.

More information: Strategies to Improve Quality of Life at the End of Life: Interdisciplinary Team Perspectives. American Journal of Hospice and Palliative Medicine. DOI: doi.org/10.1177/1049909117711997

Output: Globally, 20 million people per year require palliative care at the end of their lives. A new study by Cornell researchers has identified strategies that could help improve their quality of life, especially as their lives come to an end.


Instruction: create a high quality summary of the given input

Input:
America's Addiction to Abusive Drug Pricing
 Consider what got Martin Shkreli in trouble with the law. Shrkeli is the infamous "pharma bro" who bought patents to lifesaving drugs then hiked their prices to obscene levels. In one egregious example, he raised the price of a 62-year-old drug crucial to AIDS patients by over 5,000 percent.

But this money-or-your-life extortion racket isn't the root of the case against him. It's whether he lied to investors.

Defrauding investors is illegal. Charging outrageous prices to desperate patients is not (a point that Shkreli himself repeatedly makes). This is the only advanced country that puts its people's lives at the mercy of corporate barracudas.

For those who think they can stop these gougers through shaming or otherwise showing them the error of their ways, I wish them luck. Better to pitch a harder ball and get government on the side of the public.

Louisiana is plagued by obesity, opioid addiction and other health crises. It has 35,000 residents with hepatitis C who are on Medicaid or uninsured. Hepatitis C destroys the liver, but the drugs to treat it cost $85,000 for a 12-week regimen. Thus, the state decided to cover only 324 patients already suffering severe liver damage. It was that or have little money left for schools and roads.

But Louisiana's health secretary has landed on a novel approach that other states are watching. Rebekah Gee has dusted off an old federal law that lets Washington regulators sidestep drug patents in the interests of the public good. A panel has advised Gee to ask Secretary of Health and Human Services Tom Price to let Louisiana use the patents at more earthly prices. Just the possibility of taking such measures could get drug makers to the negotiating table.

Gilead Sciences makes the hepatitis C drugs — Sovaldi and Harvoni — but $85,000 is an only-in-America price. Sovaldi sells for about $1,000 a pill in the U.S. while a generic version costs only $4 a pill in India. Canada pays $55,000 for a course of treatment. France recently got Gilead down to a price of about $33,000.

Gilead adopts the Big Pharma line that drug companies must charge huge sums to pay for the research and development of their pathbreaking products. And Sovaldi is undeniably a fabulous drug. But actually, it's not Gilead's invention. The developer was Pharmasset, a company that Gilead bought some years ago. Pharmasset, interestingly, had planned to charge only $36,000 for a course of treatment.

Good capitalists can agree that those who develop cutting-edge drugs deserve to be richly rewarded for their efforts. But then Americans must ask why they alone must bear the costs of bestowing the rewards.

The difference is that our government refuses to intervene meaningfully on the people's behalf. Even our taxpayers don't seem to matter. General revenues cover 74 percent of the Medicare drug benefit, yet Congress has forbid the government to negotiate the program's drug prices.

Clearly, the industry needs a new business model in which costs of development are fairly shared. The same goes for breaks on price.

The real problem in American health care is not that we can't afford what we need. Other countries with far less resources provide as good or better health care than we do. The problem is that, by international standards, we pay inflated prices for just about everything.

Overpaying has become almost an addiction. We don't think we can kick it, and the default has been to not even try. Until we move the emphasis from "How do we pay?" to "What are we paying?" we will never stop the abusive pricing of essential drugs.

Follow Froma Harrop on Twitter @FromaHarrop. She can be reached at [email protected]. To find out more about Froma Harrop and read features by other Creators writers and cartoonists, visit the Creators webpage at www.creators.com.

Output: Consider what got Martin Shkreli in trouble with the law. Shrkeli is the infamous "pharma bro" who bought patents to lifesaving drugs then hiked their prices to obscene levels. In one egregious example, he raised the price of a 62-year-old drug crucial to AIDS patients by over 5,000 percent.


Instruction: create a high quality summary of the given input

Input:
How to stay out of a nursing home and age independently
 Want to stay out of a nursing home in your twilight years? Put down that hot dog.

A new study outlines which aspects of a healthy lifestyle predict independent living late in life. While physical activity and living with someone else can factor into reaching old age, specific behaviors — such as sticking to a Mediterranean-like diet and not smoking — may dictate a person’s ability to live without a caregiver into their late 80s, according to research published Friday in the Journal of the American Geriatrics Society. Experts told NewsHour such guidelines for keeping the elderly mobile are invaluable as the geriatric population continues to grow.

“Preserved independence is highly valued by very old individuals,” Kristin Franzon, a geriatrician and the study’s lead author, told NewsHour via email. In the beginning, her team wanted to know if there was anything people could do to maintain independence as they age, or if dependence is an unavoidable part of getting old.

Her 16-year study at Uppsala University followed a cohort of Swedish men as they became octogenarians. Franzon started her investigation in 2011, but relied on data from the the Uppsala Longitudinal Study of Adult Men (ULSAM) — an ongoing project begun in 1970, when its participants were 50 years old.

Approximately 1,100 participants from ULSAM fit the bill for Franzon’s study, though some chose not to participate or didn’t meet the benchmark for independent living at the start. Over the next 16 years, a portion of the men also passed away or dropped out due to severe illness. To qualify as independent, the men had to meet rigorous standards. The men had to be able to bathe, toilet and dress themselves, and walk alone outdoors until the age of 87. They also had to pass a mental state examination, could not be institutionalized or have dementia.

In the end, 369 men completed the final study — 276 counted as independent agers, while 93 lived co-dependent lifestyles.

This cohort underwent a series of tests during medical checkups. The men were queried on their physical activity, education level, smoking habits and whether or not they lived alone. When they could make it to the clinic, nurses gave them a full physical, looking at health indicators like height, weight, waist circumference, blood pressure, blood glucose, insulin and cholesterol.

Participants also kept food diaries. Those records were scored based on how well their diets conformed to a modified Mediterranean diet — meaning it was adapted for a typical Swede. Typically, a Mediterranean diet emphasizes fish, cereals, polyunsaturated fatty acids, fruits and vegetables. For the Swedes in the study, their diets did not contain a lot of olive oil or nuts, while potatoes counted as a grain.

Output: Want to stay out of a nursing home in your twilight years? Put down that hot dog. A new study outlines which aspects of a healthy lifestyle predict independent living late in life.


Instruction: create a high quality summary of the given input

Input:
How the BCRA would impact enrollee costs, according to your age
 This analysis is part of USC-Brookings Schaeffer Initiative on Health Policy , which is a partnership between the Center for Health Policy at Brookings and the University of Southern California Schaeffer Center for Health Policy & Economics. The Initiative aims to inform the national health care debate with rigorous, evidence-based analysis leading to practical recommendations using the collaborative strengths of USC and Brookings.

This analysis looked at an older version of the Senate’s Better Care Reconciliation Act (BCRA). A more recent analysis of the current version of the BCRA is available here

Much attention has focused on how the recently introduced Senate Republican health care bill – the Better Care Reconciliation Act of 2017 (BCRA) – would impact health insurance premiums, both before and after accounting for lower subsidies, and patient cost-sharing in the individual market. In this analysis, we examine how the law would change people’s total spending on covered health care services, to provide a full picture of health care costs for the average consumer under the BCRA as opposed to current law.

We find that the BCRA would increase total costs for lower-income enrollees in all age groups. For higher-income enrollees, older enrollees would generally experience increases in costs, while younger enrollees would experience reductions in costs, though these reductions would be smaller than the increases experienced by older enrollees.

To construct estimates of the total health care costs (premiums plus out-of-pocket cost-sharing) that an individual market enrollee at different ages and incomes could expect to pay in 2026, on average, under the BCRA and under current law, we rely upon Congressional Budget Office (CBO) estimates of the BCRA. We focus on the year 2026 because CBO provides estimates in that year for individual market insurance premiums at different ages, under both the BCRA and current law. CBO highlights 2026 because it is the last year in the 10-year budget window within which they provide estimates and because it illustrates that law’s effects when fully in effect.

The following policy changes have the largest effects on enrollees’ total costs:

The BCRA reduces the size of premium tax credits available under the ACA, by tying their value to the cost of a less generous health insurance plan (a plan with an actuarial value of 58 percent, as opposed to the 70 percent actuarial value plans that the ACA tax credits are tied to). The BCRA also adjusts the size of tax credits based on the enrollee’s age and income.

The BCRA eliminates the ACA’s cost-sharing reduction subsidies that reduce the amount of out-of-pocket spending required for enrollees with incomes below 250 percent of the federal poverty line (FPL).

The BCRA affects the risk pool in the individual market, and therefore insurance plan premiums before subsidies, primarily by repealing the ACA’s individual mandate, barring enrollment in individual market plans for 6 months for those who did not maintain continuous coverage, introducing a Patient and State Stability Fund, and reducing premium and cost-sharing subsidies.

The remainder of this blog highlights this comparison for five different scenarios: a 21-year old individual, a 40-year old individual, a 64-year old individual, and a 64-year old couple.

21 year old

40 year old

64 year old

64 year old couple

conclusion

The most striking finding is that the BCRA would lead to a large increase in average annual health care costs for those with lower incomes, whatever their age and family type.

The most striking finding is that the BCRA would lead to a large increase in average annual health care costs for those with lower incomes, whatever their age and family type. The adverse impacts would be particularly pronounced for older enrollees with lower incomes. For example, a 64-year-old couple earning a combined income of $28,000 would go from average annual costs equal to 13 percent of their income under the ACA up to 70 percent of their income under the BCRA. The magnitude of this change stems in large part from the elimination of the ACA’s cost-sharing subsidies, which effectively reduce low-income enrollees’ out-of-pocket costs, and that unsubsidized average out-of-pocket costs are particularly high for a 64 year old couple.

The other major difference in average total costs occurs for older enrollees between 350 percent and 400 percent of the FPL, in which range the ACA offers sizeable premium tax credits but the BCRA does not provide any assistance.

For individual market enrollees younger than their mid-40s with high enough incomes, average annual total health care costs would be lower under the BCRA. However, the reduction in costs for such enrollees is generally much smaller than the increase in costs due to the BCRA for low income and older enrollees.

Methodological Appendix

This appendix explains how the “average annual cost of health care for individual market enrollees” in 2026 – the metric used throughout this analysis – is calculated for enrollees of different ages and incomes. The average annual cost of health care for an individual market enrollee is the average net premium paid plus their average out-of-pocket cost-sharing.

We start with the premiums estimated by CBO in 2026 for a “benchmark” plan for a 21, 40, and 64 year old under both the BCRA and current law. Premium tax credits are tied to the cost of these benchmark plans. Under current law, a benchmark plan has an actuarial value of 70 percent (meaning that it pays for 70 percent of covered health care services, on average). Under the BCRA, a benchmark plan has an actuarial value of 58 percent.

To calculate the net premium paid by an enrollee for a benchmark plan, we take the lower of the gross premium in 2026 estimated by CBO or the relevant percentage of their income specified by the premium tax credit schedules under the BCRA and ACA. In order to estimate the premium tax credit schedules in 2026, we adjust the affordability thresholds specified in the legislative language of both bills for 2014 by the extent to which employer insurance plan premium growth – as estimated by the Office of the Chief Actuary (OACT) at the Centers for Medicare and Medicaid Studies (CMS) – is projected to exceed personal income growth over that time period – as estimated by CBO. To estimate the federal poverty line in 2025 (which is used for 2026 subsidy calculations), we trend forward the levels in 2017 by CBO’s projections of Consumer Price Inflation for all Urban Consumers (CPI-U).

To calculate average out-of-pocket cost-sharing for an enrollee in 2026, we assume that 80 percent of insurance plan premiums are dedicated to claims costs. Under the BCRA, we simply multiply 80 percent of the gross benchmark plan premium by (4.2/5.8) to account for the plan’s 58 percent actuarial value. This approach implicitly assumes that the 5 to 1 premium variation between a 21 year old and 64 year old permitted under the BCRA accurately reflects the differences in claims costs by age.

Since premiums are constrained to vary by less than claims costs under current law, this approach would understate claims spending under the ACA—and thus out-of-pocket spending—for older adults and overstate that spending for younger adults. We thus proceed in two steps:

First, we infer what CBO expects average per enrollee claims spending to be in 2026 under current law. To do so, we use the current law age curve to compute premiums at each age. We then compute a weighted average claims cost using a projection of the individual market age distribution in 2026 and multiply the resulting average premium by 80 percent. To project individual market enrollment by age in 2026, we base our estimates on tabulations of the 2015 American Community Survey (ACS) by single year of age. We count individuals as having individual market coverage if they report having directly purchased coverage and do not report coverage through an employer, Medicare, Medicaid, TRICARE, or the VA. We exclude individuals age 65 or older because these individuals are unlikely to have individual market major medical coverage. To project this enrollment distribution forward to 2026 under current law, we assume that enrollment in each age cohort grows in accordance with the Census Bureau’s most recent projection of overall population growth in that age cohort.

Second, we distribute this spending across age groups under the assumption that the relative spending by different age groups matches the 5 to 1 age curve permitted under the BCRA. To do so, we must infer how CBO expects the age curve to change given the allowance of 5 to 1 premium variation. We assume that CBO used the same approach used by two research groups who previously analyzed the effects of this provision. Those groups assumed that the age factors for individuals ages 21 and older would be set equal to twice the age factors under current law minus 1; age factors for individuals under age 21 would be left unchanged. This approach exactly reproduces the ratios between the premiums for the three ages reported by CBO (apart from small differences that can be explained by rounding errors). For these calculations, we use the same individual market age distribution used in the first step.

With these age-specific claims costs in hand, we calculate average out-of-pocket costs associated with a benchmark plan under current law (before incorporating the effects of the ACA’s cost-sharing reduction subsidies) by multiplying those amounts by 3/7, reflecting the ratio of out-of-pocket costs to plan spending under the benchmark plan. For enrollees with incomes at or below 250 percent of the FPL, who receive federal subsidies to assist with cost-sharing, we use a lower ratio to reflect the fact that a portion of out-of-pocket spending is covered by cost-sharing reductions.

Output: Much attention has focused on how the recently introduced Senate Republican health care bill – the Better Care Reconciliation Act of 2017 (BCRA) – would impact health insurance premiums, both before and after accounting for lower subsidies, and patient cost-sharing in the individual market.


Instruction: create a high quality summary of the given input

Input:
Snapchat addresses lack of discoverability with Paperclip feature
 For its new “101 Days of Because Summer” campaign, Malibu is, to use an old phrase, “killing two birds with one stone.” The Pernod Ricard-owned rum brand is not only promoting its Snapchat channel on Snapchat but also on Facebook and Instagram. The ad — featured in Instagram Stories and as a sponsored post on Tasty’s Facebook page — features a Snapchat code and encourages viewers to “Snap to Unlock” to view more content.

This type of cross-promotion is one way brands are working to circumvent the issues they have with being found, or their branded content being found, on Snapchat, which, unlike on other platforms like Instagram, Facebook or Twitter, a user needs an exact username to search for a brand.

“The discoverability of a brand within Snapchat is very low right now, and that’s something that marketers are struggling with,” said Stephen Boidock, director of marketing and business development at ad agency Drumroll. Followers, he said, simply cannot reach branded content on their own. “Snapchat has always prided itself on being exclusive,” he said. “It’s the very reason why users love it and brands struggle with it. It’s no surprise that the company just dipped below their initial IPO stock price of $17 for the first time since going public.”

Because of this, cross-promoting on other social channels has almost become a necessary means to bring in followers to a brand’s Snapchat profile. “Brands are doing this consistently,” said Justin Rezvani, founder and CEO of TheAmplify. In fact, Rezvani works with a client on cross-promotion. “It works to diversify your audience and get more eyeballs,” he said.

Platforms have not been as open to the idea. They have been known to pressure brands into not broadcasting other social channels, according to sources. Last year, Twitter discouraged brands from using Snapchat links, Instagram stopped allowing brands to place a Snapchat link in bios and Facebook’s Messenger no longer supported Snapchat links. It seemed as though publishers were beginning to begin feeling the pressure. Mic and The Huffington Post both removed their Snapcodes from their profile pictures. Rezvani points out the issue—“They don’t want attention moving to another place,” he said. “CNN doesn’t want people to move to NBC tomorrow. Same concept.”

Yet, brands continue to cross-promote their Snapchat channels on social networks. After all, Facebook, Instagram, Twitter, YouTube and Snapchat do not have any policies set against brands taking this approach. Boidock believes the platforms care more about the advertising revenue they are bringing in than policing this kind of activity. “The reality is that they are far more concerned with advertising dollars,” he said. “When those start to migrate to other channels, you’ll start to see some unhappy campers.”

This is not the only way brands are working the Snapchat system.

Yes, cross-promoting on social can work, said Jeff Roach, president and chief strategy officer at independent creative agency Schiefer Chopshop. But he said that rather than simply slapping a Snapcode on an Instagram or Facebook feed, a brand should offer an exclusive gift to the consumer that would make them want to jump ship — well, at least for a little while. “The first look of a new product, exclusive video drop or an offer such as a digital discount code only available in Snapchat drives audiences into the platform,” he said.

Schiefer Chopshop has worked with a number of brands on tactics to help them skirt discoverability issues on the platform. Last week, for instance, the agency launched a game in Snapchat for Boost Mobile called “Galactic Thunder Pony.” To get people to the game, the agency created Snapcodes on out-of-home ads in subway stations to drive users directly into the digital experience.

Another tactic the agency considers, said Roach, is developing partial stories that begin on one channel and continue in another. For instance, a brand might start an experience on Instagram that promotes its Snapchat channel to redirect followers to Snapchat to finish the experience. Sometimes, a brand will attach promotional rewards to encourage engagement from one platform to the next, he said.

Snapchat itself has recently released new ways for users to discover brands in the app.

At the end of June, Snapchat introduced Snap Map, a way for users to zoom in on a map to discover the Snapchat Stories in a particular location. Zoom in on New York City, for instance, and a user can find specific events highlighted. Marketers see a lot of potential with this for location-based marketing. “If a brand is going to have a big event, like they were hosting a concert at the Rose Bowl and they want people to engage with it and they want to promote it, [Snapchat] would be a nice way to have people engage with it,” said Matt Britton, CEO and founder of agency Crowdtap. The platform may already be working with a few brands to promote their events. For instance, Daybreaker, a brand that puts on yoga and dancing events in U.S. cities, had its silent disco at Westfield World Trade Center on July 12 spotlighted as a “featured” event, and the stories from the dancers played on rotation all day on the platform.

This week, Snapchat has also introduced a feature called Paperclip, which allows brands to link out to external pages, something brands have long wanted to do. “Out of everything, the Paperclip feature is the biggest win for brands,” said Joey Neal, chief experience officer at The Burns Group. “Being able to link out to other web properties really helps.” Brands are already jumping on it. IKEA, along with ad agency MEC, launched one of the first campaigns on Tuesday that uses the new feature. Google has also already used the feature to promote its Pixel phone as part of a video ad that includes a buy button. Users can swipe up, tap on a buy button and choose from four vendors — Verizon, Google Store, Project Fi or Best Buy — to purchase the Pixel outside of Snapchat.

Not only does Paperclip offer a deeper brand experience, said Noah Mallin, senior partner and head of social at MEC North America, it allows marketers to track click-through rates, proving a return on investment. “A program like this shows real impact,” he said. Still, the feature doesn’t necessarily solve the platform’s discoverability problem, Boidock said. “Paperclip is a great step to get people to find a branded experience internally,” he said, “but you have to get people there first to even experience that.”

Output: Brands looking to advertise on Snapchat are being forced to cross-promote on other platforms due to Snapchat's lack of discoverability. The issue is one reason why the company's shares slipped below their initial price of $17 for the first time recently, but Snapchat could bounce back with new feature Paperclip. It allows brands to link to external pages, offering a deeper brand experience and enabling click-through rates to be tracked.


Instruction: create a high quality summary of the given input

Input:
Buried in Trump’s executive order on drug pricing is a windfall clause for pharma
 The pharmaceutical industry could see windfall profits from a little-noticed tweak to the insurance market tucked into the Trump administration’s draft executive order on drug prices, experts say.

The short, technical paragraph calls for the Internal Revenue Service to allow patients with high-deductible health plans to receive care for chronic diseases, including drugs, before meeting their deductibles.

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This allowance, known as a “safe harbor,” could be welcome news for patients with chronic conditions like diabetes or asthma stuck with skimpy plans. For example, a diabetes patient could fill her prescription for insulin with just a copay, even if she hadn’t spent enough on medical bills for her insurance coverage to kick in. But in the long term, experts say, extending a safe harbor to chronic care would encourage more employers to adopt these skimpy plans, while shielding the pharmaceutical industry from pressure to lower drug costs.

Output: The pharmaceutical industry could see windfall profits from a little-noticed tweak to the insurance market tucked into the Trump administration’s draft executive order on drug prices, experts say.


Instruction: create a high quality summary of the given input

Input:
Pinterest building out ad targeting and formats with two key hires
 Pinterest is after Google’s talent. The San Francisco-based company has scooped up two Google execs as it looks to build out its advertising team.

Jon Alferness, formerly vp of product management of Google’s shopping and travel products, has been named head of ad products at Pinterest. Alferness worked at Google for nearly 13 years and spent roughly half of that time working with Google search ads, mobile display promos and the AdMob ad network.

With Pinterest, Alferness will lead product organization and help develop and roll out global advertising products such as targeting and ad formats, per Pinterest.

Output: Pinterest has hired two former Google executives to join its advertising team. Former VP of product management of Google’s shopping and travel products, Jon Alferness, joins as head of ad products, and Meredith Guerriero as head of partnerships. Alferness will help develop targeting and ad format products for Pinterest. Guerriero, who will join the New York office, worked for Facebook as director of health, grocery and politics ad verticals since 2015.


Instruction: create a high quality summary of the given input

Input:
Google AdSense not allowing pop-ups due to poor user experiences
 At Google, we value users, advertisers and publishers equally. We have policies in place that define where Google ads should appear and how they must be implemented. These policies help ensure a positive user experience, as well as maintain a healthy ads ecosystem that benefits both publishers and advertisers.

To get your attention, some ads pop up in front of your current browser window, obscuring the content you want to see. Pop-under ads can be annoying as well, as they will "pop under" your window, so that you don't see them until you minimize your browser. We do not believe these ads provide a good user experience, and therefore are not suitable for Google ads.

That is why we recently clarified our policies around pop-ups and pop-unders to help remove any ambiguity. To simplify our policies, we are no longer permitting the placement of Google ads on pages that are loaded as a pop-up or pop-under. Additionally, we do not permit Google ads on any site that contains or triggers pop-unders, regardless of whether Google ads are shown in the pop-unders.

We continually review and evaluate our policies to address emerging trends, and in this case we determined that a policy change was necessary.

As with all policies, publishers are ultimately responsible for ensuring that traffic to their site is compliant with Google policies. To assist publishers, we’ve provided guidance on best practices for buying traffic.

Output: Publishers using Google AdSense will no longer be able to use pop-up or pop-under ads. Google stated that these types of ads do not provide a good user experience and said it did not want overly-intrusive ad formats. Google has recently clarified its policies on pop-ups and believes changes will "maintain a healthy ads ecosystem that benefits both publishers and advertisers".


Instruction: create a high quality summary of the given input

Input:
Google AdSense not allowing pop-ups due to poor user experiences
 by Philip Rosenstein , July 12, 2017

Publishers using Google AdSense can no longer serve pop-up or pop-under ad formats.

Google is “no longer permitting the placement of Google ads on pages that are loaded as a pop-up or pop-under," read Google’s Inside AdSense blog post on Tuesday "Additionally, we do not permit Google ads on any site that contains or triggers pop-unders, regardless of whether Google ads are shown in the pop-unders.”

Google explains that “these ads [do not] provide a good user experience, and therefore are not suitable for Google ads.”

Further, “these policies help... maintain a healthy ads ecosystem that benefits both publishers and advertisers.”

The internet giant has been considering for a while a refinement of its ad policies. It had set a Jan. 10, deadline for beginning to downgrade mobile web pages that used intrusive interstitial ads.

Output: Publishers using Google AdSense will no longer be able to use pop-up or pop-under ads. Google stated that these types of ads do not provide a good user experience and said it did not want overly-intrusive ad formats. Google has recently clarified its policies on pop-ups and believes changes will "maintain a healthy ads ecosystem that benefits both publishers and advertisers".


Instruction: create a high quality summary of the given input

Input:
Gas processing plants need more data points to predict failure
 Philip McCusker, Air Products and Chemicals, Inc, UK, explains how advanced data analytics has helped gas processing plants improve reliability and maximise operating efficiency.

In the gas processing sector, reliability is king, but process interruptions are hard to predict. The problem is that early warning of equipment failures is difficult to achieve with conventional process alarm management techniques, as the alarm settings are fixed and need to be suitable for all operating conditions. As such, alarms are set broadly so when they are eventually triggered, the equipment is already on the way to failure.

Figure 1. The winding temperatures of a fan’s motors jump up to an out-of-bounds condition.

Whether it is cryogenic processing or natural gas reforming, all gas processing plants can have equipment issues that cause costly downtime and expensive maintenance. Although alarms are set to notify operating teams of any problems as single measurement data points, they are often too wide in their measurement setting to provide meaningful early warning of a condition to avoid an impending equipment failure or process interruption. As such, problems can go completely undetected until it is too late, causing unplanned interruptions, which are costly to both plant operators and their customers, and require maintenance intervention to remedy the equipment deterioration.

What is changing?

In order to provide earlier warning of an abnormal condition, one needs to use more functionality than is offered by single variable alarm points. By using multi-variable data points fed into a condition algorithm, the abnormal or alarming points can be ‘conditioned’ to reflect the natural variability that is associated with the plant’s specific operating condition. Operating conditions can change on most plants due to factors such as operating mode, loading, and ambient extremes, which all serve to mask the start of an abnormal operating condition. Think of it like this: the minute detail of a snooker table, the smoothness of the cue ball, the speed and angle of the shot, the roughness of the felt, the room temperature, and the air flow are variables that all affect the outcome of the game. It is only by measuring these interdependent relationships that one can theoretically predict gameplay with accuracy. The same can be said of preventing interruptions to gas processing – and it is on this principle that Air Products’ Plant Performance Advisor service is based.

Figure 2. Excessively dirty air filters cause a lack of air cooling flow.

How does it work?

Huge datasets are collected from sensors on all manner of different equipment in use across fleets of plants including compressors, pumps, motors, expansion turbines, blowers, cooling towers and heat exchangers. The sensors measure vibrations, bearing temperatures, winding temperatures, pressures, pressure ratios, temperatures, approach temperatures, flows, performance efficiencies, and every other conceivable monitoring point in the key operating equipment.

Through careful data analytics, these enormous datasets are then transformed into composite variables that take into account the backdrop of the current operating conditions, creating a ‘fingerprint’ of the equipment’s operation. Rather than equipment being monitored by broad fixed alarm points, it has an ongoing ‘health check’ through condition multi-variable algorithms that can identify equipment deterioration before conventional process monitoring sensors can.

Figure 3. The filters are replaced causing motor winding and bearing temperatures to improve.

As such, the software will hone in on any deviation from the expected operating conditions.

The early warnings of a failure condition that can be identified through such a system are complex and varied, ranging from slightly raised lubrication oil temperatures for a nitrogen recycle compressor, through to mildly increased vibration of a high pressure boiler feed water pump. Often these issues are subtle and would not be picked up by simple human observation, and occur well before the equipment reaches its alarm point. What they have in common, however, is their ability – if left undetected – to negatively impact plant processing efficiency, costs, downtime, and, crucially, customer experience.

One example of this is the slight increase in valve temperatures of a multi-service reciprocating H2 compressor that occurred on a particular plant just before a planned outage at a sister plant feeding the same pipeline. The Plant Performance Advisor software was able to detect this deviation and predict valve failure. This, in turn, allowed reliability engineers to control and manage the situation, pro-actively shutting down the compressor and replacing the valves ahead of the sister plant’s planned outage. This avoided machine damage that could have cost in excess of US$100 000, as well as significant supply chain costs.

The ability to detect issues and predict and ‘manage out’ problems before they occur is invaluable. At another plant, for example, an axial position alert was received directly after a newly-installed pump was started up for the first time. Investigations revealed that the operating status of the pump was stable and that, in fact, this was an issue with the set-up of the axial position probe rather than the pump itself. Left undetected and unaddressed, this would have left a pump unprotected, which again, if it failed, would result in thousands of dollars worth of equipment damage and process interruptions. As it was, the engineers were able to correct the set-up of the probe, ensuring full protection was in place.

Figure 4. The vibration of a high pressure boiler feed water pump increases rapidly.

Examples like this underline the critical importance of understanding how the wealth of operating data available to a modern process plant can be used to improve the intelligence of equipment condition and facilitate an intervention at a more appropriate time. Real-time monitoring, combined with a pro-active detection of abnormalities, is key to ensuring processing efficiency is at its optimum.

In all of this, security of data remains paramount. Air Products' data processing is stored in a secure digital cloud with high dimensional data matrices, low signal-to-noise ratio and a high degree of correlation, all serving to give an accurate representation of overall asset performance.

The performance fingerprint is monitored by reliability engineers who receive alerts as well as proactively looking for abnormal operating conditions. This allows them to rule out likely causes and escalate alerts so that any issues can be resolved at a time that suits the customer, and before potential failures occur. Any action taken is then analysed for its effectiveness in comparison with previous operating conditions.

This process, which can be summarised in four key stages – monitor, detect, alert, diagnose – allows plant management to predict issues far sooner than they would normally be able to and, therefore, plan maintenance at a convenient time to coincide with pre-planned outages.

A pro-active approach

As well as helping to reduce process interruptions, the software measures the efficiency of each sub-system of the plant and estimates the conditions that would denote maximum efficiency. This is then used to provide monthly reports that contain recommended actions for cost and efficiency savings, ultimately optimising plant performance. This, in turn, gives the plant operator the confidence to extend the intervals between regular maintenance servicing, meaning less gross downtime and reduced overall costs.

The ability to compare a broad dataset is critical in assessing the performance of entire plants. At Air Products, for example, more than 400 industrial gas facilities worldwide are monitored and maintained. This generates hundreds of thousands of data points for analysis in proprietary algorithms and against a set of key performance indicators, allowing plant performances to be benchmarked and each specific site to run at the most cost effective level.

Figure 5. Due to a swift response, the repair is limited to the bearings, the balance disc and throttling sleeve.

Example: a fan motor

The software's dashboard indicates that the winding temperatures of a fan’s motors have jumped up to an out-of-bounds condition. Reliability engineers receive an alert and notify the site maintenance team to perform an online inspection (Figure 1).

The inspection reveals excessively dirty air filters that are causing a lack of air cooling flow (Figure 2). The filters are replaced, improving the motor winding and bearing temperatures, and avoiding overheating of the motor components, long-term abnormal behaviour and any collateral damage (Figure 3).

Example: high pressure boiler feed water pump

The vibration of a high pressure boiler feed water pump starts to increase rapidly, triggering an alert with the reliability engineers who promptly escalate the issue to the machinery engineer (Figure 4). The plant shuts the pump down and swaps operations to a secondary pump. A spare pump is installed while the original pump is sent to the workshop for an expedited rebuild.

Due to the swift response from the machinery engineer, plant operations and maintenance, the repair is limited to just replacing the bearings, the balance disc and throttling sleeve, thus avoiding impeller, bearing housing and casing damage, which could have cost over US$200 000 in extra maintenance expenses (Figure 5).

Figure 6. The lubrication oil temperature of a nitrogen recycle compressor, before and after the replacement of a faulty temperature control valve.

Example: nitrogen recycle compressor

The lubrication oil temperature of a nitrogen recycle compressor was on an upwards trend for several months. This caused the software to generate an alert – high lubrication oil temperature dramatically increases the rate of oil degradation, while negatively impacting vibrations and gear integrity.

The reliability engineers surveyed the lubrication oil temperature, identified a faulty temperature control valve and added the replacement of the valve to the plant’s planned maintenance shutdown. Left undetected, failure of this valve could have resulted in extended plant downtime, and thousands of dollars worth of damage (Figure 6).

Conclusion

When it comes to gas processing, the ‘gift of foresight’ is front and centre. As the sector grows and develops, big data and, more importantly, intelligent data analysis and processing will be key to preventing unplanned interruptions and reducing costly equipment damage.

This article was first published in Hydrocarbon Engineering. To receive your free copy, click here.

Output: Effective predictive maintenance in gas processing plants requires data from numerous sensors that take into account variable operating conditions, according to Philip McCusker, global operations director at Air Products and Chemicals. With conventional process alarm management techniques, the alarm settings are fixed and need to be suitable for all operating conditions, so they are often too wide in their measurement setting to provide meaningful early warning. Multi-variable data points fed into a condition algorithm generate more accurate early warnings.


Instruction: create a high quality summary of the given input

Input:
KFC celebrates 30 years in China with Huawei smartphone launch

Fast food chain KFC has joined hands with Huawei to launch an aptly named new smartphone, the KFC Huawei 7 Plus. The smartphone marks KFC’s 30 years in China. Huawei, incidentally, was founded in the same year, 1987, in Shenzen. Not everyone can buy the device as of now as it is listed at CNY 1099 or roughly Rs 10,000 price tag from the Tmall website. It will go on sale starting July 13.

The limited edition KFC Huawei 7 Plus comes pre-installed with KFC’s mobile app and 100,000 “K dollars” virtual credits in the app. The smartphone also offers K-music — KFC’s new jukebox function from inside the app, as reported by CNBC. It has been revealed that a total of 5,000 units of the KFC Huawei 7 Plus will go on sale.

The limited edition KFC Huawei 7 Plus comes pre-installed with KFC’s mobile app and 100,000 “K dollars” virtual credits in the app. The smartphone also offers K-music — KFC’s new jukebox function from inside the app, as reported by CNBC. It has been revealed that a total of 5,000 units of the KFC Huawei 7 Plus will go on sale.

The smartphone comes in Red colour with the branding of two companies — one of Huawei and the other of Colonel Sanders — at the back.

Some of the key specifications of the smartphone are 5-inch HD screen, Qualcomm Snapdragon 425 processor, 3GB RAM, 32GB inbuilt storage with an option to support microSD card up to 128GB, 13MP rear camera, 5MP front-facing camera and 3020mAh battery.

The smartphone measures 143.5x71x8.05mm and weighs 145 grams. On the connectivity front, the smartphone features Bluetooth 4.1, USB 2.0, Wi-Fi 802.11 bgn, GPS and Glonass. The KFC Huawei 7 Plus runs EMUI 5.1 based on Android 7.0 Nougat. There is a fingerprint sensor at the back as well.

The device will naturally sport a higher screen to body ratio, something similar to the Galaxy S8 or the LG G6. The smartphone could have a 5.7-inch QHD display with dual curved edges and pack a 4,000mAh battery. The dual rear camera setup will be present, as it’s in the P10. Nothing is confirmed about the handset yet.

It is worth adding that Huawei has still not yet revealed its P10 and the P10 Plus flagship smartphones in India. The smartphone was introduced at MWC 2017 this year in Barcelona, Spain. While the P10 sports a 5.1-inch Full-HD resolution display with 2.5D glass coating, the P10 Plus comes with a 5.5-inch QHD resolution display. Both smartphones come with Corning Gorilla Glass 5 protection. Both Huawei P10 and P10 Plus smartphones come with Leica-branded dual-rear cameras.

The Huawei P10 is backed by a 3,200mah battery, while the P10 Plus comes with a 3,750mAh battery. Both smartphones are powered by the company’s Kirin 960 SoC, paired with 4GB of RAM.

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Output: US fast food chain KFC has partnered with China's Huawei to launch a smartphone, the KFC Huawei 7 Plus, marking KFC's 30 years in China. It is being sold for CNY1,099 ($162) on the Tmall website. This limited edition smartphone comes installed with KFC's mobile app, 100,000 "K dollars" of virtual credits and K-music – KFC's new jukebox function.