People who seek medical treatment for obesity or an eating disorder do so with the hope their health plan will pay for part of it. But whether it’s covered often comes down to a measure invented almost 200 years ago by a Belgian mathematician as part of his quest to use statistics to define the “average man.”
That work, done in the 1830s by Adolphe Quetelet, appealed to life insurance companies, which created “ideal” weight tables after the turn of the century. By the 1970s and 1980s, the measurement, now dubbed body mass index, was adopted to screen for and track obesity.
Now it’s everywhere, using an equation — essentially a ratio of mass to height — to categorize patients as overweight, underweight, or at a “healthy weight.” It’s appealingly simple, with a scale that designates adults who score between 18.5 and 24.9 as within a healthy range.
READ MORE: To Improve patient care, doctors are rethinking longstanding biases around obesity
But critics — and they are widespread these days — say it was never meant as a health diagnostic tool. “BMI does not come from science or medicine,” said Dr. Fatima Stanford, an obesity medicine specialist and the equity director of the endocrine division at Massachusetts General Hospital.
She and other experts said BMI can be useful in tracking population-wide weight trends, but it falls short by failing to account for differences among ethnic groups, and it can target some people, including athletes, as overweight or obese because it does not distinguish between muscle mass and fat.
Still, BMI has become a standard tool to determine who is most at risk of the health consequences of excess weight — and who qualifies for often-expensive treatments. Despite the heavy debate surrounding BMI, the consensus is that people who are overweight or obese are at greater risk for a host of health problems, including diabetes, liver problems, osteoarthritis, high blood pressure, sleep apnea, and cardiovascular problems.
The BMI measure is commonly included in the prescribing directions for weight loss drugs. Some of the latest and most effective drugs, such as Wegovy, limit use to patients who have a BMI of 30 or higher — the obesity threshold — or a lower level of 27, if the patient has at least one weight-related medical condition, such as diabetes. Doctors can prescribe the medications to patients who don’t meet those label requirements, but insurers might not cover any of the cost.
While most insurers, including Medicare, cover some forms of bariatric surgery for weight loss, they might require a patient to have a BMI of at least 35, along with other health conditions, such as high blood pressure or diabetes, to qualify.
With medications, it can be even trickier. Medicare, for example, does not cover most prescription weight loss drugs, although it will cover behavioral health treatments and obesity screening. Coverage for weight loss medications varies among private health plans.
“It’s very frustrating because everything we do in obesity medicine is based on these cutoffs,” said Stanford.
Critics say that BMI can err on both ends of the scale, mistakenly labeling some larger people as unhealthy and people who weigh less as healthy, even if they need medical treatment.
For eating disorders, insurers often use BMI to make coverage decisions and can limit treatment to only those who rank as underweight, missing others who need help, said Serena Nangia, communications director for Project Heal, a nonprofit that helps patients get treatment, whether they are uninsured or have been denied care through their health plan.
“Because there’s such a focus on BMI numbers, we are missing people who could have gotten help earlier, even if they are at a medium BMI,” Nangia said. “If they are not underweight, they are not taken seriously, and their behaviors are overlooked.”
Stanford said she, too, often battles insurance companies over who qualifies for overweight treatment based on BMI definitions, especially some of the newer, pricier weight loss medications, which can cost more than $1,500 a month.
“I’ve had patients doing well on medication and their BMI gets below a certain level, and then the insurance company wants to take them off the medication,” Stanford said, adding she challenges those decisions. “Sometimes I win, sometimes I lose.”
While perhaps useful as a screening tool, BMI alone is not a good arbiter of health, said Stanford and many other experts.
“The health of a person with a 29 BMI might be worse than one with a 50 if that person with the 29 has high cholesterol, diabetes, sleep apnea, or a laundry list of things,” said Stanford, “while the person with a 50 just has high blood pressure. Which one is sicker? I would say the person with more metabolic disease.”
Additionally, BMI can overestimate obesity for tall people and underestimate it for short ones, experts say. And it does not account for gender and ethnic differences.
Case in point: “Black women who are between 31 and 33 BMI tend to have better health status even at that above-30 level” than other women and men, Stanford said.
Meanwhile, several studies, including the long-running Nurses’ Health Study, found that Asian people had a greater risk of developing diabetes as they gained weight, compared with whites and certain ethnic groups. As a result, countries such as China and Japan have set lower BMI overweight and obesity thresholds for people of Asian descent.
READ MORE: Majority of Americans unhappy with health care system: AP- NORC poll
Experts generally agree that BMI should not be the only measure to assess patients’ health and weight.
“It does have limitations,” said David Creel, a psychologist and registered dietitian at Cleveland Clinic’s Bariatric and Metabolic Institute. “It doesn’t tell us anything about the difference between muscle and fat weight,” he said, noting that many athletes might score in the overweight category, or even land in the obesity range due to muscle bulk.
Instead of relying on BMI, physicians and patients should consider other factors in the weight equation. One is being aware of where weight is distributed. Studies have shown that health risks increase if a person carries excess weight in the midsection. “If someone has thick legs and most of their weight is in the lower body, it’s not nearly as harmful as if they have it around their midsection, especially their organs,” said Creel.
Stanford agrees, saying midsection weight “is a much better proxy for health than BMI itself,” with the potential for developing conditions like fatty liver disease or diabetes “directly correlated with waist size.”
Patients and their doctors can use a simple tool to assess this risk: the tape measure. Measuring just above the hipbone, women should stay at 35 inches or less; men, 40 inches or less, researchers advise.
New ways to define and diagnose obesity are in the works, including a panel of international experts convened by the prestigious Lancet Commission, said Stanford, a member of the group. Any new criteria ultimately approved might not only help inform physicians and patients, but also affect insurance coverage and public health interventions.
Stanford has also studied a way to recalibrate BMI to reflect gender and ethnic differences. It incorporates various groups’ risk factors for conditions such as diabetes, high blood pressure, and high cholesterol.
Based on her research, she said, the BMI cutoff would trend lower for men as well as Hispanic and white women. It would shift to slightly higher cutoffs for Black women. (Hispanic people can be of any race or combination of races.)
“We do not plan to eliminate the BMI, but we plan to devise other strategies to evaluate the health associated with weight status,” said Stanford.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
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(Nortel Networks Limited, Brampton, Ontario) Once a world leader in telecommunications products, Nortel filed for bankruptcy in 2009 and sold its CDMA business and LTE assets to Ericsson and its enterprise and government business to Avaya.
Nortel's products included switching, wireless and broadband systems for service providers and carriers, telephones and systems for residential and business users, computer telephony integration, multimedia and telephone network management systems.
With an international history that goes back more than a century, Nortel was a pioneer in telecom. After Alexander Graham Bell's father sold his share in his son's telephone patent to National Bell Telephone of Boston in 1880, a former sea captain, Charles Fleetford Sise, was sent to Montreal to create Bell Telephone Company of Canada. Within two years, the company began to make its own telephones. By 1895, the manufacturing branch was spun off into Northern Electric and Manufacturing, later renamed Northern Electric when it merged with the wire and cable subsidiary of Bell in 1914.
Over the next decades, Northern Electric manufactured equipment designed by Western Electric, which owned as much as 46% of the company at one time. It also made a raft of other products including radios, TVs, amplifiers, Hammond organs, sound equipment and police and fire call boxes. After the 1956 consent decree that caused AT&T to eliminate its partnerships, the company gained technical independence from Western Electric and established its own R&D labs in Ottawa.
In 1971, Northern Electric merged its research and development with Bell Canada to form BNR (Bell Northern Research). A year later, it introduced its first line of computerized PBXs, which evolved into digital PBXs and digital switches.
In 1976, Northern Electric was renamed Northern Telecom. Its DMS line of digital central office telephone switches, introduced a year later, provided explosive growth for the company, especially after the 1984 AT&T breakup. Northern Telecom became the first non-Japanese provider to Nippon Telegraph & Telephone, and the company took advantage of opportunities in Europe and China.
In 1995, it adopted a new logo and name: NORTEL. In 1998, it added Networks to its name when it merged with Bay Networks, a major manufacturer of hubs and routers. From its roots back to Alexander Graham Bell, Nortel Networks became one of the world's largest suppliers of digital network solutions.
William Pullman is a freelance writer from New Jersey. He has written for a variety of online and offline media publications, including "The Daily Journal," "Ocular Surgery News," "Endocrine Today," radio, blogs and other various Internet platforms. Pullman holds a Master of Arts degree in Writing from Rowan University.
In a bid to deliberate on the implementation of Sugar-Sweetened Beverage, SSB, taxation and its potential as a means for increasing healthcare financing, Nigeria Health Watch, in partnership with PharmAccess Foundation, and the World Bank, recently hosted global health stakeholders at its Health Financing Policy Dialogue, themed, ‘New Health Financing Approaches in Nigeria: Implementation of Sugar-Sweetened Beverages, SSB, Tax in Nigeria. Sunday Ehigiator reports
In January 2022, the Federal Government (FG) hinted at the imposition of N10 per litre tax on Sugar-Sweetened Beverages (SSB) as part of the critical policy thrusts of the Finance Act 2021.
The SSB tax was passed in the Finance Act on 31 December 2021 and was thereby implemented on June 1, 2022.
The Minister of Finance, Budget and National Planning, Mrs Zainab Ahmed explained that the tax became inevitable to discourage excessive consumption of sugar in beverages, which had continued to imperil the lives of Nigerians.
Specifically, she said, “This new sugar tax is introduced to raise excise duties and revenues for health-related issues and other critical expenditures. It is in line with the 2022 budget priorities.”
The SSB tax implementation is seen as a win-win situation by the government which hopes the tax will trigger shifts in consumption and purchasing behaviour, incentivise product reformulation, and increase government revenues to fund public services and goods.
It was equally celebrated by stakeholders, particularly by the health sector operators who hoped that the revenues generated would help to provide infrastructure in the country’s health sector, and among other things cater to the victims who had been afflicted by sugar-related health challenges, such as weight gain, overweight, obesity, type-2 diabetes, dental caries, metabolic syndrome, cancer, etc.
However, the implementation of the SSB tax remains at the baby stage and is yet to transcend the aspirations of both the government and every other concerned stakeholder
Exploring Pro-health Taxes
As other concerned stakeholders continue to await the visibility of the projected positive outcome of the SSB, the global healthcare stakeholders at the event sought to explore various strategies to utilize pro-health taxes as an additional source of health financing for Nigeria, while leveraging on the SSB taxes.
In her remarks, the Country Director, PharmAccess Foundation, Njide Ndili, commended the Minister of Finance on the prompt implementation of the SSB tax following intense advocacy which was supported by critical stakeholders in the country’s healthcare sector.
She stressed the importance of increasing health financing and ring-fencing the proceeds from the pro-health taxes as another avenue to funding the health sector in Nigeria.
“The COVID-19 pandemic significantly reduced the external funding from other countries as development aid, because they focused on retaining their funds to manage the effects of the pandemic on their health systems.
“This is, therefore, a turning point for low and middle-income countries in Africa, including Nigeria, to focus on innovation and local resource mobilisation to fund the healthcare sector.”
“With the recent passing of the National Health Insurance Authority (NHIA) law making health insurance mandatory, it is imperative that we mobilise enough resources to fund health service delivery, especially for those who cannot afford to pay for themselves.”
In her goodwill message, the Consulate General of the Kingdom of the Netherlands, Lagos, Sonia Odije-Fajusigbe, suggested that “Nigeria’s Health Insurance Scheme should be decentralised to meet the growing need of the nation and to see that there is more funding for the health sector of Nigeria.”
Similarly, the Director General of the National Health Insurance Authority (NHIA), Prof. Mohammed Sambo, noted that the cost of treating mild to moderate diabetes has become an additional financial burden for individuals affected, as it ranges from N300,000 to N500,000 per annum, and could run into millions in very severe cases.
He said over 82 million Nigerians live on less than $1 per day. “If we must achieve Universal Healthcare Coverage (UHC), we must then prioritise health financing, especially through additional taxes or mandatory insurance.
“This is what many developed nations have done. The SSB tax and National Health Insurance Scheme provide Nigeria with a revolutionary chance to attain better healthcare services that will decrease Nigerians’ suffering in accessing healthcare.”
Earlier, while welcoming the stakeholders, the Managing Director, Nigeria Health Watch, Vivianne Ihekweazu, expressed gratitude to the federal government for implementing the SSB tax.
She however expressed concerns about the compliance with the SSB tax by the concerned companies, and therefore premised the importance of exploring the pro-health tax option on the perceived shortcomings of the SSB.
Also speaking, the Chairman of the Senate Committee on Health, Senator Ibrahim Oloriegbe, spoke on the difficulty of collecting these taxes.
He noted that one of the major challenges with the SSB taxation is the problem of the collection as the payers are always complaining that they are being taxed in multiple ways.
“Apart from that, we are all aware of the struggle over our federalism as to who is to collect or not collect value-added taxes (VAT). This is also a major obstacle that is stifling our efforts.”
He, therefore, stressed the effective utilisation of funds into channels that will create lasting solutions in the country’s health sector.
In his remarks, the DG of the Budget Office of the Federation, Mr Ben Akabueze, stressed the importance of SSB taxation implementation. He noted that 54 countries in the world and five in Africa have introduced SSB taxes.
He, therefore, expressed hopes for the effectiveness of the SSB tax as a tool to Improve the quality of life of Nigerians, especially in the area of health.
The Sugar-Sweetened Beverage tax and National Health Insurance Scheme provide Nigeria with a revolutionary chance to attain better healthcare services that will decrease Nigerians’ suffering in accessing healthcare
DENVER, Oct. 10, 2022 /PRNewswire/ -- Health-tech leader Eon has partnered with UCHealth to complete an implementation of the Eon Patient Management (EPM) platform that not only helps the Aurora, Colo.-based health system track potentially dangerous abnormalities in more patients, but improves the flow of electronic information among providers and patients.
"There are hundreds of EPM implementations throughout the United States and every one of them has the potential to save many lives. With this one, we showed that actionable information can reach providers and patients faster and with less busywork for hospital staff," said Nathan Boehlke, Eon's Director of Customer Success.
"Our goal with innovation and information technology at UCHealth is to fundamentally transform the way we deliver care," said Steve Hess, UCHealth's chief information officer. "In many cases, that is accomplished by bringing actionable intelligence to the providers, clinical teams and patients in their natural workflows. The Eon and UCHealth teams did just that by integrating the EPM solution with the UCHealth electronic health record and patient portal."
UCHealth's version of EPM is the first to use a communication standard called FHIR ("fire") that stems from a 2016 federal law aimed at eliminating information blocking among different electronic systems in healthcare. Thanks to the new standard, UCHealth can now automate many kinds of patient and provider communications, such as reminders to check on a potentially hazardous abnormality that was caught in a radiological image.
"This gives time back to the clinical team to focus on the high-level work they trained for rather than manually entering data," Boehlke said.
In addition to the EPM implementation, several UCHealth hospitals are using Eon's Care Management service to track incidentally found lung nodules due to the challenges of hiring an on-site care navigator. Research shows that the earlier a lung nodule is detected, the better the potential outcome is for the patient.
"When you initiate an incidental program it's not uncommon to be flooded with 100 new reports daily, and a lot of effort has to go into reading and interpreting the findings. With Care Management, the hospital team can focus on clinical work while we take the clerical tasks," Boehlke said.
Eon is a health data science company that utilizes computational linguistics and care management to track incidental and actionable findings across a variety of medical disciplines throughout the course of a patient's health journey. Eon exists to ensure the right data reaches the right people at the right time to make patients healthier and health care affordable.
UCHealth is an innovative, nonprofit health system that delivers the highest quality medical care with an excellent patient experience. UCHealth includes over 28,000 employees, 12 acute-care full-service hospitals and hundreds of physicians across Colorado, southern Wyoming and western Nebraska. With University of Colorado Hospital on the CU Anschutz Medical Campus as its academic anchor and the only adult academic medical center in the region, UCHealth is dedicated to providing unmatched patient care in the Rocky Mountain West. Offering more than 150 clinic locations, UCHealth pushes the boundaries of medicine, providing advanced treatments and clinical trials and improving health through innovation.
View original content to obtain multimedia:https://www.prnewswire.com/news-releases/eon-and-uchealth-execute-health-tech-implementation-to-push-boundaries-301644094.html
Victor Ogunje in Ado Ekiti
Stakeholders have regretted that poor implementation of the National Health Insurance Policy was responsible for the inability to make headway in achieving universal health coverage.
The stakeholders spoke in Ado Ekiti on Saturday at a one-day validation meeting of the policy brief on full implementation of NHI law, organised by Centre for Social Justice in partnership with Palladium and United States of America for International Development (USAID).
Speaking at the workshop, the Chairman, Nigeria Labour Congress, Ekiti chapter, Com. Kolapo Olatunde and a staff of the National Health Insurance Authority, Dr Jide Oloyede, said National Health Insurance Law that could have made the policy mandatory for all Nigerians could not be holistically implemented due to unemployment and poverty.
The NLC Chairman said many of the workers in the states, who had keyed into the policy could not access quality healthcare in their various facilities as a result of epileptic remittances of their deductions into the accounts of service providers.
He said the programme could only be made compulsory for all workers, if the N30,000 minimum wage and the consequential adjustment are implemented across board.
An expert and staff of NHIA, Dr. Jide Oloyede, said that the cankerworms of poverty and joblessness are issues to be considered before holistic implementation of the law, but hinted that government has special programmes that capture poor Nigerians.
Oloyede said: “What we have noticed is that the health insurance programme is well patronised by the federal government agencies. Health insurance is now mandatory because the NHI law stipulates that and it is going to be effected.
“The authority is trying to create avenues to ensure that many poor and vulnerable people are captured, after that the law will be enforced and sanctions await those defying the order.”
The General Manager, Ekiti State Health Insurance, Dr. Aderiye, said that 70 per cent of Ekiti people did not have the National Identification Number, saying this was impeding their accessibility of the expected healthcare system under insurance scheme.
“Knowing that many people are incapacitated financially, government is introducing equity plan covering elderly, physically challenged, children, pregnant women and poor Nigerians.”
However, stakeholders at the event agreed that transparency and accountability are required in the management of the policy, calling for the deployment of skillful human resources for effective management, while also seeking political patronage to make it all- inclusive.
“The government should provide incentives for formal and informal participants to lure more people into it and it must make the economy stronger. When people are poor, they won’t be able to enroll in health insurance,” they said.
Leon Gordon is a leader in data analytics, a current Microsoft MVP based in the U.K. and a partner at Pomerol Partners.
Data analytics is an emerging trend and has been around for a while. It’s an important tool in business intelligence, decision making and reporting. Organizations use data analytics to find insights to make better decisions and gain a competitive advantage. In this article, I’ll provide an overview of the implementation journey of data analytics in business and finance; I’ll also provide you with a compelling case study of how one organization leveraged its data using big data technologies to Improve its performance metrics across various departments like sales, customer service, marketing, etc.
Finding The Needle In The Haystack
One of the most important aspects of data analytics implementation is identifying valuable insights from data. With so much information to sift through, it’s essential to have a partner that can help you find the needle in a haystack.
As we’ve outlined, implementing data analytics is no easy task. Data analysts must be highly skilled and trained in order to succeed at their job effectively. While this might seem like an obvious requirement for someone working in such an important field, there are many other challenges that may arise during implementation.
Finding qualified candidates with the skills required for this type of work can be difficult because there aren’t enough qualified people available yet (this will likely change as more businesses adopt data analytics). This means that companies need to plan ahead when hiring new employees because they may not be able to find anyone who has experience with these types of projects yet—which means longer wait times before results start coming back!
Data Is Gold
Data is the raw material of data analytics and can come from many different sources. Data can be collected from websites, social media, mobile apps, sensors or even other databases. Data can take many forms—structured or unstructured—and it can be analyzed to understand trends and patterns. For example, the weather app on your phone knows that you’re running late for work because it predicts that it will rain later today; your online bank has calculated how much money you spend each month on groceries based on previous transactions, and a retailer’s web server records every time someone visits their website (even if they don’t make a purchase).
Creating Value From Data
Data is a source of competitive advantage. The ability to turn data into insight and action gives you the upper hand in your industry and makes you more attractive as a business partner for suppliers, customers and partners.
Data can be used to make better decisions. The right insights allow you to make smarter business decisions that drive growth or Improve efficiency by helping you understand customer behavior, employee engagement and productivity, provider relationships and risk management.
Data can be used to Improve customer experience (CX). Understanding who your customers are before they become customers allows you to provide relevant services at all stages of their journey with your brand—from pre-purchase through life cycle management post-purchase—so that they remain loyal customers over time rather than churning out onto the competition’s doorstep when they need something else from your industry supply chain in another part of town (or country) while continuing shopping online elsewhere!
Data Tells A Story
It’s the most valuable asset of your company. It’s the key to the future, it’s fuel for digital transformation, it’s the new oil and more.
Data is what makes businesses run, and as such, it has become one of the most valuable commodities on earth. We all know that data is a powerful asset: companies will pay anything for access to information about their customers or product usage patterns; governments are investing billions into building up their data infrastructure; people are making careers out of simply analyzing numbers (and getting paid well for it). But there’s so much more we can do with this stuff!
The Implementation Journey In Business And Finance
The data analytics implementation journey begins with the right data. A process that helps you take your company’s data, extract information from it and analyze it is called a “data science” project. Once this is done, the next step is to make a decision based on that analysis. After all, if we can’t interpret the results correctly and put them into practice effectively, what’s the point?
Data analytics doesn’t just help companies make more informed decisions; it also helps them safeguard their investments by providing better risk management strategies for both internal and external stakeholders. It gives businesses an edge over competitors by providing them with advanced technologies such as artificial intelligence (AI), machine learning or user experience design (UXD).
Businesses are looking for partners and consultants who can support them at strategic, implementation and execution stages. Data analytics is a key component of any business strategy. Businesses need to find ways to make sense of the data they have and use it in a way that improves the business.
The implementation journey is the most complex and challenging stage, where businesses require a lot of support for managing their data and making it valuable. Only through strategic planning, implementation and execution can companies extract insights from data to gain a competitive advantage. The business leaders who are willing to invest in analytics solutions today will be able to take advantage of new technologies in the future when they become more affordable or accessible.
Where should these leaders start?
1. Get A Partner: Data analytics is an ongoing process that requires expertise. At the very least, it will require someone with experience finding the right solution for your needs.
2. Consult With Experts: Data analysts know their stuff! They’ll be able to help you understand how it all works and limit any surprises later down the line.
3. Be Patient: Data analytics takes time! It might seem like there isn’t much happening at first, but don’t worry—this is normal.
In the end, data analytics is a simply way of looking at your business from a new perspective. It can help you make better decisions.
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