Category: Policy and politics

Colleges adapt porn industry policies for safe reopening

published date
July 2nd, 2020 by
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Giving it the old college try

Top colleges are taking a page from the adult film industry’s playbook to ensure that they can reopen this fall and stay open, despite the COVID-19 pandemic. I applaud them for it.

As I wrote in early April (Let the porn industry reopen the economy):

Donald Trump, the CDC and much of the rest of the federal government have demonstrated sustained incompetence on getting testing going…

The obvious answer is to enlist the adult film industry in returning the economy to normalcy. The industry has operated a testing system successfully for years to stave off threats of infections from HIV and other sexually transmitted diseases.

I went on to describe the PASS system that had operated successfully for a decade, with frequent testing and follow-up. I encouraged employers to do something similar.

Employers haven’t really taken this on, but one sector of the economy is not only adopting this approach but taking it to the next level. Some high-end private colleges and universities are determined to return to campus this fall. Online classes are ok but they are a very poor substitute for the in-person experience and are frankly not worth the tuition.

Unlike some of our red state governors, certain college presidents are taking a cold, hard look at what it will take to make it happen. They aren’t relying on science and public health experts, not wishful thinking. And they have come to the same conclusions that the porn kings did.

Here’s what Colby College is doing (emphasis mine). They expect to spend $10 million this year.

Colby’s testing program… will require the participation of all members of the campus community—students, faculty, and staff. Students will be tested prior to arrival with test kits provided by Colby, and all community members will be tested three times during the opening weeks of the semester. Thereafter, everyone will be tested twice per week, a rate that scientific models have demonstrated will greatly limit the spread of the virus by detecting infections in individuals prior to them becoming contagious. To put this in perspective, we expect to administer roughly 85,000 tests in the first semester alone, a number that almost equals the total number of tests administered in the entire state of Maine since the start of the pandemic.

…Test results will be returned to the individual and the College within 24 hours, allowing for any required mitigation efforts to be instituted quickly. We have leased additional housing for quarantine and isolation of students, who will be provided with a range of support services, including facilitating their coursework, attention to medical and mental health, and food delivery.

And Brandeis?

Brandeis will provide high-frequency, mandatory COVID-19 testing to all on-campus community members…All students living in campus residence halls will be tested upon their arrival to campus, and students living off-campus will be tested at a designated time before the start of the fall term. There will also be mandatory testing multiple times per month for all students, faculty, and staff who either live on campus or who come to campus several times per week, whether or not they are symptomatic. This will enable us to quickly identify and contain any instances of infection on our campus. Those coming to campus less frequently will also be tested, though not as frequently.

Testing is part of broader plans, but it is the core and let’s us know they are dead serious. Both of these schools are working with the Broad Institute for testing.

Interestingly, some other colleges are wavering on testing or throwing in the towel with a move to online only. Good luck with that.

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By healthcare business consultant David E. Williams, president of Health Business Group.

How does COVID-19 change Medicare Advantage?

published date
June 29th, 2020 by

Medicare eligible Americans have borne the brunt of coronavirus. Some of the immediate impact on Medicare Advantage plans is obvious. They are covering telehealth and paying for acute hospital stays.

But there are longer term implications, too. Their risk adjustment scores are thrown off by the lack of visits. Certain supplemental benefits (think gym membership!) no longer sound so healthy, while others (meal delivery) become super valuable.

In this episode of #CareTalk, CareCentrix CEO John Driscoll and I lay it all out,

Massachusetts school reopening plan gets an A from me

published date
June 26th, 2020 by
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See you in the fall

There’s much to like about the new Massachusetts Initial Fall School Reopening Guidance document. It is:

  • Purposeful –aiming to meet the objective of educating children in person while keeping them and staff members safe
  • Timely –coming at the end of the school year, with updates promised over the summer
  • Evidence based –relying on the latest medical and public health guidance and the experience of schools abroad
  • Appropriately detailed –with enough specifics to  guide decisions that need to be made now without being overly prescriptive
  • Circumscribed –acknowledging and accounting for issues of racism and disparities without purporting to solve every problem
  • Balanced –recognizing that we are living in the real world (such as it is!) and that COVID-19 is part of it. None of the measures (hand washing, masks, staying home when sick, social distancing) on their own will prevent the spread, but taken together they have and will

I’m not an easy grader, so my A for this assignment is real. I have publicly criticized Massachusetts’ reopening plan and its testing plan for being vague, non-evidenced based, and irrational. Privately, I’ve admonished the local school system for its defeatist attitude toward COVID-19.

Predictably, the Boston Globe (School guidelines feel unsafe to some) used today’s lead article to find fault with a wide variety of plan elements. Here are the ones I see mentioned:

  • The plan doesn’t set a cap on the number of students in classrooms
  • COVID-19 testing is not mandated
  • Daily temperature checks are not required
  • It mandates only 3 feet of social distancing even though officials have been telling us 6 feet
  • Superintendents need to develop 3 sets of plans (in person, hybrid, virtual)
  • No clear guidance on whether state should go back to in-person classes when school reopens
  • Doesn’t adequately address  challenges of urban schools that serve children from disadvantaged backgrounds and have limited space
  • Racism is not connected to students’ mental health in the plan
  • It doesn’t say how many students can ride the bus
  • People don’t like the idea of wearing masks all day

The report itself anticipates and addresses these criticisms. The Globe notes  some but not all. Here is the reasoning

  • Number of students isn’t capped because the relevant constraints are adequate space between desks and proper behavior. If a room is larger it can accommodate more students. The report encourages use of new spaces like libraries and cafeterias
  • No one in the country (or world?) is seriously suggesting testing all school age kids. It’s expensive, slow, unpleasant, impractical and unnecessary. Maybe there will be cheap, spit tests at some point. They can be used if the need is real
  • Daily temperature checks produce too many false negatives and false positives, offering a false sense of security and causing students to miss school when they don’t need to. These checks are good for other illnesses, like the flu where fever is a good indication of active infection, but it’s of limited use for COVID-19
  • There’s no magic in 6 feet. Three feet seems to work fine in other countries’ schools, especially in combination with other measures, like wearing masks. Schools with 3 feet of distance abroad have not had outbreaks. Kids aren’t going to be safer out of school
  • Superintendents need to develop plans for different scenarios. Of course they do! If they just developed one plan it would have to be for remote instruction only. Is that what we want?
  • Of course the guidelines can’t be definitive in June about whether students can go back in September. But the goal is to get as many back as possible. To make that happen requires everyone to behave well over the summer (adults, especially!)
  • Although the plan isn’t going to eliminate disparities or solve racism, there are extra funds to help all schools and especially those with extra needs. And the best way to reduce disparities is with kids in school. Disparities widen (as I’m sure they did this spring) when normal routines are thrown off. For extra space, the guidelines suggest working with local community centers, libraries, etc.
  • Kids will need to wear masks on the bus. If the bus is crowded then buses will need to be added or kids will need to get to school in other ways. They can keep windows open, too.
  • It’s true that people don’t like wearing masks all day. The guidelines call for mask breaks and make special mention of how to work with people with breathing or communication problems. If we all behave there’s a good chance we can take our masks off sooner rather than later.

Notably, these guidelines are endorsed by people who know what they’re talking about and have children’s interests at heart. The healthy approach is to work within the guidelines to plan a return to in-person classes this fall. We should continue to challenge the guidelines and expect them to be updated as we learn more and as the situation on the ground evolves.

Meanwhile, we can all contribute to a safer back-to-school scenario by continuing to follow public health guidelines that are knocking the virus down in Massachusetts. The lower the level of community spread, the safer any reopening plan will be.


By healthcare business consultant David E. Williams, president of Health Business Group.

Interoperability for health plans. Interview with WK’s Karen Kobelski

published date
June 5th, 2020 by
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Karen Kobelski of Wolters Kluwer Health

The 21st Century Cures Act (signed by President Obama in 2016) set out to make healthcare more patient-centric and increase patient access to medical records held by health plans. Implementation is occurring this year and health insurers need to improve interoperability in order to meet the requirements.

In this podcast interview, Karen Kobelski, who runs Wolters Kluwer Health’s Clinical Surveillance, Compliance & Data Solutions business unit explains what plans are doing and how her organization is helping.

Here are some of the topics we covered:

  • What are some of the key challenges health plans face in gathering and managing data?
  • There has been talk of interoperability for many years —but seemingly little progress. What does interoperability mean in the context of health plans?
  • The 21st Century Cures Act addressed interoperability. What was the aim? How are the rules being implemented?
  • COVID-19 is affecting everything in healthcare and in society more broadly. How does the interoperability imperative for payers change when viewed through the lens of the pandemic?
  • What role does Wolters Kluwer Health play in interoperability for health plans? Can you give me an example of a client success story?

By healthcare business consultant David E. Williams, president of Health Business Group.

Are we there yet? COVID-19 test and trace in MA still lags

published date
May 19th, 2020 by
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Can someone explain this to me?

What on earth does that slide mean? You know, the Massachusetts Testing & Tracing Strategy page from the highly anticipated Reopening Massachusetts plan. We were hoping it would provide some clarity and confidence, especially since testing and tracing are the only green lights on the reopening dashboard.

Unfortunately, the graphic raises more questions than it answers. Here are a few that come to mind.

  1. Why are we only using 1/3 of our available testing capacity now?
  2. What good is capacity if we can’t get the tests to the people most in need (symptomatic and high-risk)?
  3. How do we know if the actual caseload is declining if testing continues to be underutilized?
  4. By July, testing will be available for “all symptomatic individuals, even mild symptoms.” Does that mean having symptoms now isn’t enough to justify a test? Is it really true that testing won’t be available for asymptomatic individuals even by summer?
  5. According to the projection, we will be filling all of our available capacity at 45,000 tests per day in just 6 short weeks. However, at that level, we will still be well under the estimated capacity that public health and infectious disease experts are calling for (71,000100,000 tests per day). Why is this an acceptable target?
  6. By December, we still remain at the lower end of target capacity, and woefully under it in terms of daily tests administered. What is the plan for getting further ahead of the necessary testing for the ‘second wave’ – and to avoid making the same costly mistake twice?
  7. Comparing the testing projections in the plan and what many of us believe is required, should we conclude that the committee doesn’t believe the need for more testing is real?
  8. There are a variety of tests available currently – some accurate and some no better than a coin flip.
    1. What types of tests are included in these figures at the various timepoints?
    2. In July, is only RT-PCR with nasopharyngeal samples collected by healthcare professionals accounted for? Or are other tests and collection methods included?
    3. Other methods are mentioned in the December description, so does this assume that there is no use of antigen or sequencing based tests until then?
  9. If commercial entities increase the availability of at-home testing, how does this factor into the plan?
  10. So, thinking through all of this, how can we have a green status on testing capacity now? In July?  Ever?

We have heard repeatedly that adequate COVID-19 testing capacity and contact tracing would be necessary for the safe reopening of our economy.  Until these questions are answered it’s hard to be confident.

We hope that everything will work out for the best, but we also know that hope is not a substitute for a strategy. Some answers to these questions would be a helpful place to start.


By Surya Singh MD, president of Singh Healthcare Advisors and healthcare business consultant David E. Williams, president of Health Business Group