#medpartners

[editorspride]

Unleash Optimal ROI and Enhanced Services with Urgent Care Medical Coding by CodeMatrix MedPartners LLC

http://dlvr.it/SpYfxX

[medpartnerinc-blog]

Continuation Of Pay for Injured Federal Workers

In case you've been injured working as a federal employee, you can expand your pay by documenting a Federal Workers Compensation Claim with the help of MedPartners in Little Rock. We are an medical clinic that provides injured federal workers claims and also help them with our physical therapy services. Contact us at (501)-246-3784

[iremozker]

Gün💜ydın iyi Pazarlar herkese 😊😊 Türkiye’nin ilk şampuanı #blendax ı yeniden nostaljik ambalajında denemeye ne dersiniz 😉😉 hem erkek hem de kadınlar için dolgun saçlar vaat eden #blendaxnostaljiserisi sadece @migros_tr da bulunuyormuş 😊😊 dün #migros da bir de #nostalji standı gördüm ki gerçekten insana o eski günleri hatırlatıyor 😍😍 #bencenostalji #sadecemigrosta #türkiyeninilkşampuanı #ilkşampuanblendax #medpartners #haircare #bblogger #turkishblogger #influencer #audreyyblog (Istanbul, Turkey) https://www.instagram.com/p/Bq4bRDLFPvA/?utm_source=ig_tumblr_share&igshid=1my924ookbhr6

[yunimama]

Hanpeique涵沛高係數抗UV防曬棒 : SPF50+清爽不黏膩，路跑帶上它不怕曬！

 Hanpeique涵沛高係數抗UV防曬棒 :

SPF50+清爽不黏從臉到身體一次防曬

 第一次看到Hanpeique涵沛高係數抗UV防曬棒時

覺得它好酷  跟婗媽使用的止汗劑造型與使用方法一樣 （（笑

  擁有高係數防曬（Sun Protection Factor）SPF50+  Boots Star ★★★

Boots Star ★★★是UVA 對UVB 的比例等級  星星越多代表防曬的均勻度越好喔!

涵沛則是有三顆星等級的防曬屬於GOOD~good

圖片來源:MedPartner

 涵沛防曬棒屬化學性防曬   比較清爽不油膩（物理性質地偏油)

化學性防曬的化學分子經肌膚吸收後與紫外線產生交互作用

把紫外線轉換成不傷害肌膚的物質喔！出門前擦一下就ｏｋ嘍！

  初次使用會有防護蓋　通常之後就不使用了

因為它不會像液態防曬會有外漏的困擾～

 然後藉由白色璇轉按鈕　把防曬棒轉出即可喔！

自己是不會轉太多出來　然後使用完就直接蓋上蓋子這樣～

  其實婗媽第一次使用��　摸肌膚會覺得黏但不嚴重的那種

但第二次使用後　就沒這感覺了　感覺還滿自在的～

  Hanpeique 涵沛 高係數抗UV防曬棒

雖然外型　感覺只能擦身體　其實它也很適合擦臉喔！

原本很擔心悶感～實際使用後　臉上不會有特別的痕跡　也不覺油感

整體感覺蠻無感的說！

 涵沛防曬棒是清新的綠茶味道　不是婗媽喜歡的口味

但擦在身上跟臉上　味道被空氣稀釋走了　所以不會一直跟著～這點還行

 無色無感的防曬棒～除了防曬　無遮瑕力～婗媽使用後會再上一層粉底液

但這防曬棒後來都以擦身體為主～

  小小一瓶　婗媽滿常放在包包的　上班～中途出差或買東西

可以隨時做防曬的補充　～誰叫太陽醬子毒呢～

  而且　婗媽覺得不錯的是　使用時不用沾得手黏TT的

隨時補充也不會覺得麻煩

  如果去拜訪朋友

離開前可以再補充一下

  有一天回娘家跟阿木吃飯～日正當中～趕快拿出來讓婗媽娘體驗一下

婗媽娘很阿沙力的　二話不說全身都抹一輪　然後什麼都沒說　我也忘了問她舒不舒湖～哈哈

  涵沛果冰防曬棒　質地透明

所以塗抹後即便流汗也不會呈現白濁的冏境

而且任何肌膚都可以使用　覺得男生朋友應該會很喜歡它

然後　婗媽希望它出別的味道或無味的～呵

    再來～剛剛好　婗媽參加路跑帶著　Hanpeique 涵沛 高係數抗UV防曬棒上路準沒錯

婗媽把它放進褲子的小口袋　一路上補抓它的踪跡

也剛好　友人們全部都只擦了臉部防曬　忘了帶身體防曬出門

是說～這很重要耶～路跑一趟下來　防曬沒做好可不得了哩！

   這是參賽前

 全程手都沒得防護只有擦防曬棒

不然以往婗媽都是會穿著長袖（很怕曬　更怕黑）

這一天　正是風和日麗的大晴天

雖然早晨六點多開跑　但太陽公公可勤勞的很呢～

 臉跑到都紅通通嚕！！

對了～防曬棒還有一個有趣的地方

因為質地透明　沒有界限～有時會不知哪裡擦了！呵呵

 這是完賽後～報告！報告！婗媽手跟脖子安全過關沒曬黑～

不過黑這件事因人而異　同行友人一樣有擦防曬棒　但她吸黑～呵呵！

但至少沒曬傷啦！這比較重要～

然後　流汗時覺得滿無感的　就是沒特別的不舒服或黏膩

一般防曬乳如果流汗　都很怕用手去擦汗　怕黏～

因此　整體下來　除了自己比較挑剔味道之外

方便性　實用性與功能性　都很不錯唷！

  涵沛官網　／　涵沛FACEBOOK

 婗媽去路跑時順便拍了使用過程　剛好友人沒帶

才有機會讓大美女小美女入鏡當MODEL~　婗媽覺得真幸福～

   訂閱》Follow NiMa Pixnet

////ENJOY MY LIFE////

NiMa+Ali Lifestyle in 67'  ⇊

[willpony]

誇張！談武漢肺炎疫情…潘懷宗上中國節目喊「希望老大哥不記台灣小老弟的錯」   武漢肺炎疫情於國際蔓延！新黨議員潘懷宗繼日前表示，病毒起源地並非來自中國而是美國，遭台大醫學院教授葉秀慧打臉後，近來他出席中國深圳衛視《決勝制高點》節目中又「語出驚人」表示，「當大陸的疫情能夠控制好了以後，行有餘力希望老大哥不記小老弟的錯，還是要繼續支援，如果有多的口罩還是可以來幫助台灣小老弟。」   多份證據顯示中國是病毒起源地，但潘懷宗日前出席政論節目時，卻引用中國研究報告指出，美國武漢肺炎確診個案共有「ABCDE」5種類型，但中國僅出現一個C類型，且美國早前還發生多起肺纖維化的死亡案例，尚未查清原因，因此病毒起源地並非來自中國而是美國。對此，引來葉秀慧反駁，分析國內確診患者體內病毒後發現，此在台灣出現病毒主要為4個分支，「起源皆是來自中國」。   因應武漢肺炎疫情，我國政府限制每人口罩購買量。然而，臉書粉專「MedPartner美的好朋友」日前在臉書發表一支影片，內容顯示潘懷宗出席中國深圳衛視《決勝制高點》節目時，他語出驚人說，疫情以前台灣生產口罩大部分都是進口，「而且都是來自祖國大陸」，現在大門關閉後自己生產，我認為這是不夠的；潘表示，「在這邊誠摯期望，當大陸的疫情能夠控制好了以後，行有餘力希望老大哥不記小老弟的錯，還是要繼續支援，如果有多的口罩還是可以來幫助台灣小老弟。」   言論一出，引來網友紛紛留言砲轟：「潘懷宗到底您有什麼資格代表全台灣」、「面具終於帶不住了」、「身為市議員卻不避嫌代言這麼多保健產品 似是而非講一堆道理，誤導別人以為他是醫學背景，其實根本沒有」。     （顯圖取自MedPartner美的好朋友臉書）   查看原始文章 Total count of Like 0 Total count of Comment 0 LINE share button Facebook share button Twitter share button

[darrenphung-blog]

【黃斑部在眼睛裡的哪裡】❓

@medpartner

👉黃斑部（ Macula ）位在眼睛視網膜中央窩上，在外觀上呈現黃色，是因為含有大量黃色的類胡蘿蔔素的關係。

👉人類眼球內，負責視覺傳導的視錐細胞，就大量分布在黃斑部，如果這些細胞受損了就會影響人類視覺。

👉在視網膜黃斑部中，如果針對其中所含的類胡蘿蔔素去做分析，會發現其中含有葉黃素（ Lutein ）、玉米黃素（ Zeaxanthin ）和內消旋玉米黃素（ meso-zeaxanthin ）三種成分。

[proidenceollife]

防曬魔人攝理OL-理膚寶水全護清爽防曬液UVA PRO 潤色

說攝理OL是防曬魔人實在不誇張，對於防曬有莫名的執著，

只要看到有人推薦就會心癢+手癢~

目前服役中的防曬至少有6罐不同的產品!

看了邱品齊醫師和Medpartner 實測防曬品並依照防曬力結果排行之後，

攝理OL心癢癢的買了好幾款來擦(是有幾張臉?!)

今天要介紹的就是BOOT STAR 有三顆星的 理膚寶水全護清爽防曬液潤色款SPF50 PA++++

攝理OL一直以來有一個困擾就是，追求防曬效力但臉又容易出油， 所以很多排行很前面的防曬品對我來說都是太油，

這款理膚寶水的其實也是偏油， 但衝著他的防曬力勝過很多知名品牌，決定不要白擦、白花錢、白白讓皮膚受罪， 還是持續使用著。

目前為止使用的期間都沒有曬黑，表現挺優秀的。 理膚寶水全護清爽防曬液UVA PRO 潤色款沒有什麼遮瑕力，輕微潤色，對膚色偏白的人來說應該算很夠用了。 平常上班的話，因為容易出油的關係，我會用小海綿壓全臉(額頭、鼻頭、兩頰、下巴)，櫃姐說這樣比用手塗還要不油?! 

壓完之後稍微再T字部位上一點點蜜粉就大功告成了! (不喜歡太多層的攝理OL，連蜜粉都不想擦全臉XD)

假日或特別場合需要畫全妝的話， 我也會用這罐當底妝，先用小海棉壓全臉，之後上粉餅，再上蜜粉，基本上他的油感就會消失了!臉的感覺也是舒爽的。 在意防曬力的人可以試看看這款，這是讓我用完之後會想回購的一瓶。

又來到激勵攝理OL的一句立志教會箴言時間~~

瞭解後就會發現，<福>與<禍>都左右於[自己的行為]

出自攝理教會 鄭明析牧師的證道話語~~

箴言卡出自見面與對話

之後再陸續跟大家分享其他防曬品唷 XDD

[s888anete]

美豬牛開放》醫學粉專：禁止瘦肉精在科學上站不住腳

總統府今（28）日宣布將放寬美國豬肉、牛肉進口。臉書專頁「MedPartner 美的好朋友」表示，如果以「國民健康」作為反對理由，真的站不住腳，而且「台灣豬真的是比美豬好吃非常非...… from 生活新聞 - 自由時報 https://ift.tt/2EEJq6S via IFTTT

[willpony]

台灣「傲人」防疫被世界看到！韓媒以蔡英文當週刊封面、日媒讚唐鳳「天才大臣」   我國政府捍衛邊境防疫有成，國際間對台灣至今的成績單更是讚不絕口！1968年創刊的週刊朝鮮，在日前發行的第2597號週刊以總統蔡英文做為封面人物，除在標題寫下「封鎖中國─借鏡台灣」，內文更大篇幅介紹台灣的防疫措施，比較南韓與台灣在出入境管制、口罩出口、對中關係等政策差別。另外，我行政院數位政委唐鳳近來也頻頻躍上日媒版面，甚至稱呼其是來自台灣的「天才大臣」。   韓國武漢肺炎疫情嚴重，早前新天地教會的大規模感染，更使疫情迅速升溫。統計至上午11時，韓國已出現5766人確診、36人死亡案例。僅次於病原重災區中國，確診個案數為世界第二。   相較台灣第一時間落實嚴謹的邊境防疫，韓國政府則因第一時間處理不利，日前還「豪捐」百萬口罩給中國，因此也讓南韓總統文在寅遭外界狠批「親中」、「中國總統」，甚至引爆韓國民眾的「排華」情緒。更有韓國網友紛紛留言羨慕表示，「好希望蔡英文來當韓國總統」、「台灣防疫真的是史上最強」。   台灣防疫上的好表現響徹國際，週刊朝鮮日前發行的第2597號週刊，以蔡英文做為封面人物，大篇幅介紹在武漢肺炎疫情爆發後，政府部門的反應措施，並且比較南韓與台灣在出入境管制、口罩出口、對中關係等政策上的差別。   期刊內容指出，韓國、台灣對中貿易金額分別是2434、2262億美元，若是以人均貿易額計算，台灣卻遠高出韓國，但此次防疫上台灣對中國的政策強度與韓國卻差距甚大；台灣比韓國早一個月就實施口罩出口禁令，雖韓國社區感染爆發後，已大幅提升醫療能力，但韓國政府仍遭受到不少質疑。   期刊進一步比較，台灣2月7日起禁止14天內有中港澳旅遊史的外籍旅客入境，且入境後也需配合居家隔離14天，否則將開罰；反觀韓國政府還尚未對武漢以外的中國其他地區旅客採取入境管制，被批「開著房門抓蚊子只是做做樣子」，韓國當局甚至回應「冬天沒有蚊子」。文章最後寫下，「指揮官的能力，造就台韓今日的不同」。   此外，唐鳳因防疫有功，近來頻頻登上日本媒體版面，引發網友熱議。日媒紛紛報導日台間的防疫政策差別，數度提及台灣有一名IQ180、年僅38歲的IT數位大臣，並冠以來自台灣的天才大臣稱呼，反觀日本數位大臣則已是78歲的官員。   昨臉書粉專「MedPartner美的好朋友」也發文透露，一名畢業於日本慶應大學醫學部的醫師向他感嘆，「人口1至2億的日本，怎麼出不了這種官員」；該醫師甚至直言「日本即便有這樣的天才，如果在性別認同、學歷都非主流的狀況，社會幾乎不可能讓這樣的人出任政務官」。     （顯圖取自ANNNEWS、週刊朝鮮）   查看原始文章 Total count of Like 0 Total count of Comment 0 LINE share button Facebook share button Twitter share button

[darrenphung-blog]

【葉黃素】

@medpartner

👉葉黃素是一種黃色的天然色素，和 beta-胡蘿蔔素一樣，都屬於類胡蘿蔔素。

👉天然的葉黃素可由植物、藻類、細菌與蕈類的 alpha-胡蘿蔔素轉化生成。人類沒有辦法自行合成葉黃素與玉米黃素，因此都必須從食物中獲取才行。

👉葉黃素（ Lutein ）與玉米黃素（ Zeaxanthin ）兩種會出現在人類視網膜黃斑部。

[tw-trend-blog]

印度香料一把抓－治病、染布、燉湯：多才多藝的薑黃

文 / FYH

薑黃。插畫／FYH

聽到薑黃，人們大多會出現堪稱為「薑黃膝跳反應」的反射性回應——熱愛或黑特，非常極端，是一種處在M型社會中，被大愛大恨著的印度常見香料。

薑黃熱愛者：「薑黃超級健康、薑黃素抗發炎、降血壓、降血糖、降脂肪……」他們總能滔滔不絕地說著薑黃的各種益處，如果在市場遇見販售薑黃粉、紅薑黃的攤位，不僅會給你一張寫滿薑黃療效和食譜的A4紙，還一路印到背面整個說不完。誰還能不腦波弱化，買它個三罐送一罐？

薑黃黑特者：「薑黃很苦、味道很重、不知道怎麼用。」拒之千里之外，與我無關速速退散。

事實上，不論是���一邊，都掌握到薑黃的其中一些特性。薑黃是薑科薑黃屬分類底下，多種單子葉植物的根莖，與臺菜料理中常見的薑是近親，不過薑黃的纖維較少、口味沒有薑的辛辣，質地比較接近澱粉、帶有一點奶油的柔滑和香味。這讓它除了被研磨成粉之外，也可以直接切片當作沙拉食用。

當我們看見薑黃時，不可能不注意到它惹眼的顏色。誰沒有吃咖哩噴到上衣，永遠都洗不掉的經驗？那就是薑黃的傑作。印度料理中，幾乎所有黃色的來源都是薑黃——經常作為早餐的「Kanda Poha」（薑黃扁飯），就是使用薑黃、茴香、綠辣椒與豆子等蔬菜煮成的一道風味豐富的料理；無肉不歡的人，也可以參考「Biryani」（薑黃香料飯），使用一層米、一層肉（通常會使用雞肉）和香料平鋪煮熟，肉汁與香料融進白米中，每一口都嚐到宇宙漫遊等級的味覺神展開。

Kanda Poha，薑黃扁飯。照片來源／Megha Mangal from Pexels

在西元前的阿育吠陀醫療法，又稱生命療法（Ayur-veda）的典籍裡，也多次提到薑黃的各種用途。在當時多半以外用為主，例如燃燒薑黃的煙可以治鼻塞、薑黃塗抹在傷口上可以消炎化瘀等。除此之外，在南印的某些地區，還有配戴薑黃作為護身符驅趕惡鬼的傳統，說不定也有行動糧的功能呢（不可以吃掉自己的護身符啦）。印度同時也是世界統計罹患阿茲海默（俗稱老人痴呆症）人口幾乎最低的國家。研究顯示薑黃有防止「β類澱粉蛋白」在腦神經的沉積，這很有可能是印度老者很能記事的原因之一。

除了食用之外，薑黃也廣泛的應用在印度的生活與重要節日之中。

跟著我們，一起來到一場傳統印度婚禮中，一對新人穿著珍珠色澤的傳統服飾，像夜裡綻放的花發柔和的微光。新郎將項鍊小心翼翼地為新娘��上，這是與交換鑽戒一樣重要的儀式，Mangala Sutra（holy threads）則是這項鍊的名稱，它通常由金黃色的線軸穿過重要的首飾做成。不過，這金線可不是真正的黃金，那宛若金線的光澤蘊藏的秘密，就是印度薑黃！

除了項鍊 Mangala Sutra 用薑黃染色之外，許多印度傳統布藝也都使用薑黃當作天然染劑，古埃及甚至也有用薑黃染頭髮的記載（現在你知道怎麼自己染頭髮或布料了吧）。除此之外，把一茶匙的薑黃、少許蜂蜜和無糖優格攪拌均勻（聽起來很好吃呢），就是一款印度傳統中最天然的面膜。在印度的傳統婚禮中，新娘也會將薑黃塗到臉上和身體，可以讓皮膚變美變亮，讓她在這個重要的日子裡，散發金光閃閃的光芒。

到了近代，薑黃素的發現給了這種印度已經使用千年的藥性植物，一炮而紅的契機。不僅是歐美，也許在日本藥妝店都會看見「春薑黃」、「秋薑黃」的種種營養食品。不過，許多相關商品沒有提到的是，其實薑黃的營養素是「溶於油，不易溶於水」的。也就是說，單服薑黃，對身體的保健程度仍相當有限。

那，我們該拿薑黃怎麼辦呢？別忘了，溶於油正代表著「薑黃非常適合用來烹飪」。要引發薑黃的功效，可以搭配黑胡椒使用。它的苦味在加熱後，會柔化成一種溫厚的土質香氣。在風味上，可以嘗試用薑黃粉拌檸檬汁、茴香籽，直接做成醃料，塗抹在像是雞肉、豬肉上，進入炙烤；薑黃的柔和口感和椰奶、檸檬葉也是絕配，煮成海鮮湯更可以提出海的鮮味。懶得開發新食譜嗎？拿起你的薑黃粉，倒進咖哩中，也是一種決不出差錯的方法。

下次遇見薑黃，我們想起它可以染布、染頭髮、治瘀血，還能做成多種美好的南洋風味料理，對「薑黃膝眺反應」測驗，可能不再是單純的 YES or NO了，也許給它一個機會試試看吧！

薑黃？——yea, maybe.

資料來源： MEDPARTNER—-薑黃及薑黃粉 17 種可能功效及副作用全攻略！9 種體質禁忌請注意！ https://www.ncbi.nlm.nih.gov/books/NBK92752/ Turmeric – The Ancient Healing Spice – History & Recipes

更多YaoIndia 就是要印度文章： 印度尤超市時尚搜奇：不容錯過的印度餅乾零嘴 紛亂舊德里大街上的寧靜古董茶店：Aap Ki Pasand 你的選擇

  ＿＿＿＿＿＿＿＿＿＿＿＿＿＿ 【Yahoo論壇】係Yahoo奇摩提供給網友、專家的意見交流平台，本文章內容僅反映作者個人意見，不代表Yahoo奇摩立場。有話想說？不吐不快！>>> 快投稿Yahoo論壇

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OB/GYN Needed North of Flagstaff, AZ

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from Find job in the USA https://jobsfind.tumblr.com/post/176902028243

[kristinsimmons]

Making Sense of the Health Care Merger Scene   

By JEFF GOLDSMITH

In the past 12 months, there has been a raft of multi-billion-dollar mergers in health care. What do these deals tell us about the emerging health care landscape, and what will they mean for patients/consumers and the incumbent actors in the health system?

Health Systems

There have been a few large health system mergers in the past year, notably the $11 billion multi-market combinations of Aurora Health Care and Advocate Health Care Network in Milwaukee and suburban Chicago, as well as the proposed (but not yet consummated) $28 billion merger of Catholic Health Initiatives and Dignity Health. However, the bigger news may be the several mega-mergers that failed to happen, notably Atrium (Carolinas) and UNC Health Care and Providence St. Joseph Health and Ascension. In the latter case, which would have created a $45 billion colossus the size of HCA, both parties (and Ascension publicly) seemed to disavow their intention to grow further in hospital operations. Ascension has been quietly pruning back their operations in markets where their hospital is isolated, or the market is too small. Providence St. Joseph has been gradually working its way back from a $500 million drop in its net operating income from 2015 to 2016.

Another notable instance of caution flags flying was the combination of University of Pittsburgh Medical Center (UPMC) and PinnacleHealth, in central PA, which was completed in 2017.   Moody’s downgraded UPMC’s debt on the grounds of UPMC’s deteriorating core market performance and integration risks with PinnacleHealth. As Moody’s action indicates, investor skepticism about hospital mega-mergers is escalating. Federal regulators remain vigilant about anti-competitive effects, having scotched an earlier Advocate combination with NorthShore University HealthSystem in suburban Chicago. The seemingly inevitable post-Obamacare march to hospital consolidation seems to have slowed markedly.

However, the most noteworthy hospital deal of the last five years was a much smaller one: this spring’s acquisition of $1.7 billion non-profit Mission Health of Asheville, NC, by HCA. This was remarkable in several respects. First, it was the first significant non-profit acquisition by HCA in 15 years (since Kansas City’s Health Midwest in 2003) and HCA’s first holdings in North Carolina.  While Mission’s search for partnerships may have been catalyzed by a fear of being isolated in North Carolina by the Atrium/UNC combination, Mission Health certainly controlled its own destiny in its core market, with a 50% share of western North Carolina. Mission was not only well managed, clinically strong and solidly profitable, but its profits rose from 2016 to 2017, both from operations and in total.

Precisely because it was not a distress sale, and because Mission was in an unassailable market position, this deal should have sent shockwaves through the non-profit hospital industry. Yet, there was remarkably little public discussion of its significance. There was no burning platform here. Rather, the ability of HCA to lower Mission’s operating expenses with its austere management culture and break even on Medicare may have been viewed as a key to long-term sustainability by Mission’s board, as well as access to HCA’s more-or–less bottomless capital pool.

HCA’s willingness to be patient and wait for the right deals, and crucially, its ability to break even at Medicare rates, are the real sources of its long-term strength. It may well be that HCA’s ability NOT to follow the herd, and to decide which assets, markets, and relationships make sense long term is more valuable than mass and scale. The Rick Scott Columbia HCA had 360 hospitals at “peak roll-up.” The present, better focused HCA is a much stronger company at half the number of hospitals.

Implications

So many large non-profit and investor-owned health systems formed as roll-ups of smaller enterprises are struggling to generate operating earnings just now, including many prominent market leading systems. For this reason, many other potential roll-ups in the vein of Ascension-Providence and Atrium-UNC might not survive the courtship stage. Those roll-ups might actually weaken the combined enterprise by burdening them with hospitals that could not have survived on their own and which probably should close.  Bigger may no longer equal stronger in hospital management.

It has never been clear how actual patients would benefit from vastly greater scale of hospital operations. The burden of proof is on the industry that patients will notice a difference in service quality or lower prices from further consolidation of hospital systems. It is not clear that benefits to patients or their physicians has played any meaningful role in the flurry of post-Obamacare deals.

Physicians – Is Vertical Integration Inevitable?

In December 2017, United HealthGroup’s $100 billion subsidiary Optum purchased the troubled DaVita Medical Group for $4.9 billion. This deal set off a frenzy of speculation that United was positioning itself to become the next Kaiser. Industry pundits opined that Optum and United will transform itself into a closed panel vertically integrated care system that would enable United to sell a comprehensive exclusive care system product. I believe this is not a strong likelihood.

Optum’s first entry into the physician group business was opportunistic, obtaining a captive physician delivery system in Nevada as part of United’s 2008 acquisition of Sierra Health Plan.  The physician group asset did not belong in the health plan part of United and was therefore lodged in Optum as a one-off. Subsequent Optum acquisitions in California, Texas and Florida consisted of successful risk contracting Independent Practice Associations with significant and diverse (e.g. non-United) contracts. Some of those IPAs had a core multi-specialty employed medical group at its core. Optum’s early strategy was not a “physician employment” strategy, but rather not dissimilar to that of MedPartners or Phycor in the 1990’s: buying risk-bearing contracts through the acquisition of physician enterprises that had negotiated them.

Obamacare was expected to catalyze a wave of capitation. Owning risk-bearing physician groups was an asset-light way of playing this presumed shift to capitation. However, the expected post-ACA surge in delegated risk contracting did not materialize. Optum ceased buying care system assets in 2012 because the bidding for physician groups, particularly from health systems, had gotten out of hand. They resumed buying in 2016, adding urgent care centers and ambulatory surgical centers to the portfolio, in addition to the DaVita deal.

While some have claimed that Optum now employs 47,000 physicians, this number seems more likely to be the sum of its IPA networks.  The actual employed physician cadre is probably more like 15 thousand, a number smaller than the combined Permanente Medical Groups inside Kaiser.  There are roughly a million licensed physicians in the United States.

Presently, Optum has care system assets in markets which contain 70% of the US population, but there is limited “integration” among the care system assets, or between Optum and United’s Health Insurance operations. Obviously, United’s health insurance subscribers can use Optum’s group physicians. But Optum patients are not required to or even encouraged to use United’s health insurance products. It would damage the Optum care system asset value to exclude other insurers from paying Optum for a physician or ambulatory care.

Despite its large footprint, I believe that Optum’s strategy in the physician space is disciplined but opportunistic “conglomerate” style diversification. In only two markets, greater Los Angeles and San Antonio, does Optum have a significant local market share in the risk-bearing care system market? Optum has not shown any interest in canceling the substantial number of non-United network contracts and going “closed panel.” Nor is there yet evidence of a backlash from non-United insurers in anticipation of a closed panel strategy that would cause United’s health insurance competitors to shun contracting with Optum care system assets. United/Optum has more to lose than to gain in contracting advantage by closing their panels.

Optum is also unlikely to diversify into the slow growing hospital business. Despite a “buyers’ market” for hospital-based physician enterprises like Envision, Team Health, and MedNax, Optum has thus far studiously avoided acquiring hospital-linked assets. Rather, it is capable of surrounding hospitals with low-cost alternatives and stepping in front of them where possible as risk bearing physician-based care systems, leaving hospitals in those markets, as one analyst put it, as “stranded assets.” We will be watching the “integration” of these diverse Optum assets closely but are skeptical that “integration” will yield significant earnings or growth potential.

Implications

Regardless of who owns their physicians, a significant fraction of Americans will need to use the hospital as they age, and an increasing percentage will be publicly funded. Though successfully organized physicians can rigorously minimize the use of the hospital by substituting lower cost non-hospital alternatives (e.g. in surgery and imaging), the residual demand for hospital care related to complex conditions and for the fragile elderly seems likely to grow, not shrink, in years ahead.

The challenge hospitals face is making money at publicly funded rates and driving out the unnecessary or inappropriate use of its services. Hospitals can learn from Optum’s long time horizons, its market-by-market pragmatism about organizational models and insistence on deals being “accretive” rather than “mission driven.” Strategic discipline is the best response to the threat posed by Optum and other organizers of physician care.

Consumers may or may not be willing to “bond” with a corporate giant like Optum. They are likely to make their decisions about where they get their physician care based on responsiveness to their needs and the strength of the physician relationships that develop.

Optum seems unlikely to noticeably lower the cost of physician care to patients, as there are yet no demonstrable economies of scale in physician services.

Pharma Distribution: The “Amazon is Coming” Freak-out

In December 2017, CVS, the nation’s largest drugstore chain, and Aetna, the nation’s fifth largest health insurer, announced a $69 billion merger. Aetna had been blocked from its planned acquisition of rival Humana over anti-trust concerns. But CVS, the acquirer, had a much larger and more urgent concern – the mooted entry of Amazon into the pharmaceutical supply chain, either through wholesale distribution, direct-to-consumer strategy or both.

As its retail sales have slowed, CVS has become increasingly dependent on their CVS-Caremark

pharmaceutical benefits management (PBM) business both for revenue and earnings growth. The entire complex and costly US pharmaceutical supply chain is buckling under the financial pressure created by rising drug spending. The PBM business model has come under increasing regulatory scrutiny over concerns over lack of transparency and that PBM rebates negotiated with pharmaceutical firms do not seem to be reaching consumers. In the Aetna transaction, CVS looked to diversify out of its two main businesses to re-establish growth and establish closer and more comprehensive relationships with corporate customers.

Of course, retail in all its forms is being disrupted by Amazon. That Amazon might disrupt the pharmaceutical market by selling directly to consumers became a good deal less speculative with Amazon’s recent $1 billion acquisition of PillPack. BOTH of CVS’s current businesses may be in Jeff Bezos’ crosshairs.

Having said this, the CVS Aetna combination is an “out of the frying pan-into the fire” merger. CVS will discover that the health plan business is actually an extremely fragile web of short-term contracts between the insurer and employers, as well as between the insurer and its care networks. Many of these latter contracts may not be renewed under their present terms, which have been highly favorable to and profitable for insurers. This is because many care systems have been bitterly disappointed by the lack of return to them from the deep front-end discounts made in those contracts in anticipation of rapid growth in “narrow network” lives which have not materialized.

Health insurance is nearing the end of an exceptional profit cycle begun during the roll-out of Obamacare. The creation of health exchanges and the new narrow network contracts designed for them catalyzed a 2010-2014 hospital pricing panic similar to that which ensued on the rollout of PPOs in the mid-1990s. This pricing panic has damaged hospital system earnings and prevented them from recouping escalating losses from Obamacare Medicare rate concessions and the 2012 federal budget “sequester,” which cut Medicare rates by 2% annually going forward.

As with the Optum-DaVita combination, much has been made of the “vertical integration” aspect of Aetna having access to CVS’ network of instore clinics. CVS’s clinical assets – its 1,100 Minute Clinics – are more “nurse in a broom closet” than “doc in the box.” Fully loaded with CVS’s hefty corporate overhead, the Minute Clinics probably lose $20 a visit, with the fond hope of making some of it up on shampoo sales. Despite outgoing Aetna CEO Mark Bertolini’s vision of the CVS clinics as a health care equivalent of Apple’s Genius Bar, CVS/Aetna won’t be a credible player in disease management or anything else complicated by relying on a spindly network of nurse-driven instore clinics. As they did before the deal, consumers will find in CVS’s clinics a great place to get flu shots and back to school physicals, though.

It is also not clear how either business will grow as a result of the combination. CVS Aetna’s consolidation won’t lower the cost of health care for Aetna’s members or corporate clients, nor bring Aetna new health benefits customers.  Though Aetna has a number of large national accounts, it remains a marginal player in most large geographical markets, the venue where bargaining clout really matters. Having a bunch of drugstores and a PBM will not increase Aetna’s leverage with its care networks, hospital or physician. It will also not materially lower Aetna’s drug spend.

On the CVS side, merging with Aetna won’t drive more customers into CVS’s stores, or bring them any additional PBM business, because CVS/Caremark already managed Aetna’s pharmacy claims. And it might lose CVS the recently announced pharmacy benefits management deal with Aetna’s competitor, Anthem, that looked for a new PBM after dumping Express Scripts. There are no good reasons why Anthem would want to contract with a PBM owned by a competitor to their core business.

Implications

Hospitals ought not to be threatened by the CVS-Aetna combination, nor the copycat CIGNA-Express Scripts deal that followed it. Neither is likely to affect the prices paid for the specialty IV drugs that have pressured hospitals in the past several years.

Amazon’s core strengths – merchandising clout, logistics and cloud computing – are minimally relevant to health care provision. Amazon has no significant presence in any service business at the present time, other than cloud computing. But as suggested earlier, the pharmaceutical supply chain is ripe for disruption. Anything that lowers the cost of drugs to patients or care givers will help both cope with tightening cash flows and be welcomed by all.

While Amazon’s future incursion into health care remains “notional” at this point, the spate of deals that have been spawned by the mere potential of its entry into the pharmaceutical business resembles nothing so much as one of those chain reaction freeway collisions, where the first driver was distracted by the sight of a large moose walking out of the woods and up to the roadway. It is worth noting that other tech company invasions of the so-called “health care vertical”- Apple, IBM, Microsoft, Google – have not gone very well.

The Future of Mega-Medicine

In his 2012 book Anti-Fragile: Things that Gain from Disorder, finance guru Nassim Taleb makes a convincing argument that scale and the search for security in the corporate and financial world actually increased those institutions’ fragility and exposure to franchise risk. The reciprocal drive of health systems and health insurers, in particular, to become larger and more “unavoidable” may, ironically, have made them more, rather than less, vulnerable to economic shocks. This includes the effects of the inevitable economic downturn that awaits the American economy in the next year or two.  Larger health care organizations are inevitably more bureaucratic and take far longer to make decisions.

On the narrower issue of “integration,” the economic literature on the effectiveness or economic benefits of vertical integration in health care is remarkably devoid of evidence of consumer or societal benefits, or even benefits to the organizations themselves  https://www.nasi.org/research/2015/integrated-delivery-networks-search-benefits-market-effects.

Health care remains the most intimate personal service in the US economy. Health care organizations that wish to consolidate are increasingly constrained by the legal and political consequences of their actions. They are also increasingly tempting targets for the hostile populist sentiments accumulating on both the left and right sides of the political spectrum.

The lack of evidence of measurable consumer benefits and the rising risks haven’t yet stopped the wave of consolidation in health care. Despite the pro-merger puffery of prominent strategy consulting firms and bankers, it remains to be seen if $50 billion-plus mega-corporations can connect with real people on a consistent basis and deliver measurable benefits that meaningfully affect their health.

Jeff Goldsmith is the national adviser to Navigant Consulting and President of Health Futures, Inc. He is a veteran health care industry analyst and forecaster.

            Making Sense of the Health Care Merger Scene    published first on https://wittooth.tumblr.com/

[thuongluongme]

頭痛について質問ある?

出かけなきゃいけないのに、起きてからずっと頭痛がものすごい酷くて、今追加で腹痛までしてきた これで運転しなきゃとか本当しぬ。 出かけたくないー！

やっぱり頭痛はカフェイン欠乏が原因ぽいなぁ。カフェイン中毒にあてはまるんかなぁこれ（＝＝；明日のバイト休めないからマジで熱と頭痛は治ってほしい…

( *´꒳`*)ありがとうございます

(´・ω・｀)でも使い慣れない画面とにらめっこしながら長時間設定等してたら頭痛と目眩が… 一昼夜ほどスマホを覗く気が起きず今に至りますここ連日の頭痛 確実に光だ、、、、 日光で頭痛起こしてる

まだ頭痛い どうしようもないけどまじで何もできないおはようございます 訳あって午後出社(頭痛) 今日も1日頑張りましょう

点滴の張りどめ、動悸と頭痛すごいな、、、ちょっとは慣れたらマシになるかと思いきや、まったくやわ… ずっとバクバクしてる…田植えの 『あとうえ』したら頭痛と吐き気。田んぼの波で船酔いしたんだなと思う。 田植え 頭痛

前お世話になった大きい病院の耳鼻科来たらよくわかんないけど細菌感染っぽいから抗生剤1週間分出して、熱が下がらなかったり腫れが酷くなったりしたら薬飲み切る前に来てって言われた…頭痛は耳の腫れの影響で、熱はわからんと… SGはたぶん薬局では取り扱ってないと思います。 私は病院で処方してもらってるので･･･ けっこう強い薬なので、あまりおすすめは出来ないのよ���

市販の薬で効いてるなら、それの方が体にもいいと思う。 頭痛は辛いよね(´；ω；`)ｳｩｩ 無理しないでね！

でも頭痛いいいいいい頭痛いやばーい

状態異常リスト 強い 電車(自分の周りに2人以上)：動悸、吐き気、眩暈→失神 PC：動悸、吐き気、眩暈、頭痛 スマホ：動悸、吐き気 電車(自分の周りに0,1人)：動悸、吐き気 テレビ：動悸、吐き気 通常時：動悸 弱い頭痛☆

頭痛、眼精疲労のお持ちの方は ヘッドマッサージですっきりしませんか？？

ゆるり六本木店 ゆるり 六本木 もみほぐし フットマッサージ ヘッドマッサージ 浮腫み 頭痛 癒し お疲れ 疲労回復 リラクゼーション今日はどうしても絶対

横浜駅 頭痛

頭痛怎麼辦？原因有哪些？何時必須就醫？醫師圖文完整解說！ | MedPartner

[veronicakirby]

Broward company sells health care staffing firm for $195M

Coral Springs-based P2P Staffing Corp. has sold MedPartners, a Tampa company that provides back-office staff to keep hospitals running. AMN Healthcare Services Inc. (NYSE: AMN) in San Diego bought MedPartners for $195 million in cash and could pay up to another $20 million based on future financial performance, a filing with the U.S. Securities and Exchange Commission said. MedPartners, which has been one of the largest privately held and fastest growing businesses in Tampa, is at least the third…

Broward company sells health care staffing firm for $195M published first on Miami Local News