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Yahoo
29-06-2025
- Business
- Yahoo
Opinion - Congress should look to Tennessee as an example for Medicaid reform
As Congress wrestles with the need to trim spending, attention has turned to Medicaid, and to a lesser extent, Medicare. These are hardly new issues. Within seven years of the 1965 enactment of Medicaid, for those eligible for federal income support (largely those in poverty), and Medicare, primarily for those eligible for Social Security, Congress in 1972 turned its attention to concerns about containing costs in those programs. Tennessee has been a pioneer in managing its Medicaid costs, and Congress might benefit from the Tennessee experience with TennCare, the state's Medicaid program. About 30 years ago, Tennessee faced unsustainable annual increases in its Medicaid program. A popular Democratic governor, Ned McWherter, called the state's Medicaid program the Pac Man of the state's budget. He sought to find a way to pay for the Medicaid increases through a state income tax (Tennessee does not have one) but failed. The TennCare program was designed to address the issue by containing the rate of increase in costs. Tennessee received a waiver so that it could implement a universal and mandatory managed care program. Tennessee had no managed care in Medicaid, and a move to 100 percent managed care was projected to reduce costs by 20-25 percent on a recurring basis. Support from patient advocates was secured by agreeing that cost savings would be used to increase access to Medicaid to previously uncovered persons. The mandatory Medicaid managed care program was deemed such a success that, in 1997, Congress allowed states to implement Medicaid managed care without a waiver. Managed care introduced economic considerations into the process of medical decision-making. While the cost savings projections were pretty much on target; once those savings were fully realized, the projections recognized that the rate of cost escalation would be restored, albeit from a lower cost basis. That projection also turned out to be pretty accurate. A Republican governor, Don Sundquist, succeeded McWherter and unsuccessfully sought to implement an income tax. Another wonderful Democratic governor, Phil Bredesen, was elected to succeed Sundquist under a promise not to seek an income tax. Bredesen was determined to find a way to manage down the rate of increase of Medicaid spending. I served as his outside counsel. A reform team determined that the target for reform should focus on the concept of 'medical necessity.' That insight was informed by work I had done as part of an Institute of Medicine study group, which looked at hospital staffing in a system that had recently merged three hospitals. There were three distinct models, and no consensus about which was the 'right' one. Traditionally, the concept of 'medical necessity' was the term used to define the scope of benefits under health plans, including Medicaid. The concept assumed that there was a single correct way of practicing medicine, and that it had a justification based on scientific consensus. But the existence of clinical uncertainty called into question that traditional view. As it turned out, many alternatives were available at varying costs, and evidence of superiority of one particular approach was often lacking. Those insights led to the policy conclusion that, if a more expensive alternative were proposed, the state should not pay for that more expensive alternative unless there was good scientific evidence that it was superior and worth the additional cost. If an aspirin were adequate, it should be used instead of a more expensive prescription-based alternative. If an adequate outpatient procedure were available at lower cost, TennCare should not pay for a more expensive inpatient option. These insights resulted in a TennCare definition of 'medical necessity' that could serve as a national model at considerable (but hard to measure) cost savings. That definition has been in place for nearly 20 years and has been approved by a federal court. TennCare has kept costs manageable so that the state has been able to live within existing sources of revenue, and the state even proposed to accept financial risk if it could share in the cost savings from TennCare above a projected baseline. The TennCare definition includes the traditional requirement that a medical item or service be recommended by a treating physician (no doctor shopping) and that it be 'safe and effective.' The reasonably anticipated medical benefits must 'outweigh' the reasonably anticipated medical risks 'based on the enrollee's condition and scientifically supported evidence' to be covered under TennCare. That is, a medically based risk-benefit calculation is a requirement as part of medical decision-making. The innovative aspects have three components. First, a medical item or service must be required 'in order to diagnose or treat an enrollee's medical condition.' That circumscribes the type of item or service covered under the program. Second, the medical item or service must be the 'least costly alternative course of diagnosis or treatment.' That expressly incorporates economic factors into medical decision-making. An alternative course of diagnosis or treatment 'may include observation, lifestyle or behavioral changes, or, where appropriate, no treatment at all.' If an item or service can be safely provided in an outpatient setting at lower cost, then that is what TennCare will pay for. More expensive inpatient treatment is not 'medically necessary.' Third, the less costly alternative need only be 'adequate for the medical condition of the enrollee.' The yardstick is not the best possible standard or some comparison with private plans. The standard of 'adequacy' means that sub-standard medicine is not acceptable, but that some differences between benefits for TennCare enrollees and those on private plans are acceptable. These innovations were controversial 20 years ago, when proposed and enacted, but they have become part of the fabric of TennCare and have been in place successfully for two decades. They help shape the medical decision-making culture that costs are to be considered and that the issue is the adequacy of care not what might be available in some private plans. That type of modest stratification, by the way, is expressly endorsed in the Affordable Care Act. Section 1302(b)(5) expressly allows for supplementation by health plans beyond the essential health benefits mandated by the Affordable Care Act. In the discussions that led to these reforms, the estimated range of savings was from 1 percent to 5 percent of total Medicaid spending. In an environment in which a program entails large expenditures, even a 1 percent per year savings could be considerable. James F. Blumstein is University Distinguished Professor at Vanderbilt Law School and the director of Vanderbilt's Health Policy Center. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Zawya
27-06-2025
- Health
- Zawya
Rethinking Obesity: Novo Nordisk's Latest Initiative Urges Singaporeans to Treat, Not Blame
'Beyond the Scale' focuses on obesity as a chronic disease — urging empathy, early intervention, and evidence-based care. SINGAPORE - Media OutReach Newswire - 27 June 2025 - Imagine a chronic disease affecting more than 600,000 people 1-3 in Singapore — yet often misunderstood, overlooked, or surrounded by stigma. This is the reality of obesity today. For many, outdated perceptions and delays in care have created barriers to support and treatment. Today, a new initiative is calling for a shift — to change how we think, talk about, and respond to obesity, through a lens of science, empathy, and early intervention. Breaking the Myths: A Public Health Reframe "Just eat less." "Try harder." "It's a lifestyle choice." These are more than just phrases — they reflect a deeper misunderstanding of obesity. Today, a bold new initiative, seeks to challenge those misconceptions and open the door to a more compassionate, evidence-based conversation. "Beyond the Scale" launches across Singapore with a clear and urgent call to focus on obesity as not a failure of willpower, but as a complex, chronic disease. The initiative invites the public to go beyond — beyond stigma, beyond myths, beyond labels — and recognise obesity for what science confirms it to be: a multifactorial health condition that deserves understanding, early intervention, and clinical care. Led by global healthcare company Novo Nordisk in collaboration with local healthcare professionals and patient advocates, "Beyond the Scale" is a disease awareness initiative aimed at driving a shift in how individuals, communities, and healthcare providers approach obesity management. "We believe it's time to shift from blame to understanding," said General Manager, Mr Vincent Siow of Novo Nordisk Singapore. "Obesity affects 1 out of 9 people in Singapore 4, yet it's still too often seen as a matter of willpower. The reality is that obesity is a complex, chronic disease driven by biology, environment, and unequal access to care. 1,5 It's time we treat it with the seriousness it deserves — and we are proud to lead that conversation and drive meaningful change through the "Beyond the Scale" initiative. Why This Matters Now The 2021–2022 National Population Health Survey reveals the highest obesity rate (15%) among adults aged 40 to 49, while 43.3% of residents aged 18 to 74 had abdominal obesity, which increases with age and peaks between 50 to 74 years. 6 This is compounded by the fact that perceptions persist about obesity being a personal failing, discouraging individuals from seeking help, delaying diagnosis, and compounding the health burden on families and the healthcare system. Obesity significantly increases the risk of cardiovascular disease (CVD), type 2 diabetes, and chronic kidney disease (CKD) 7, all of which already place a growing strain on Singapore's healthcare infrastructure. The economic impact is substantial: in 2019, metabolic-risk related diseases, including obesity, diabetes, hypertension, CKD, and cardiovascular conditions, cost Singapore S$2.20 billion. 8 Of this, S$642 million were healthcare expenditures 8, and excess weight alone accounted for an estimated S$261 million in annual medical and absenteeism costs. 9 Without decisive public health action, these obesity-related comorbidities are poised to escalate into a major societal and economic burden. "This is not just a personal issue — it's a public health priority," said Dr Ben Ng, Arden Diabetes & Endocrine Clinic. "We know obesity changes how the body regulates appetite, energy storage, and metabolism. It's a disease, not a choice. Science supports this — and our response should reflect it." The Science Behind the Message Obesity is not simply about calories in and out. Research confirms it involves neuroendocrine (hormonal), genetic, and psychosocial factors, making it both preventable and treatable 10. Studies show that in Singapore, weight stigma is often driven by the belief that obesity is a personal failing, lack of willpower, or lifestyle choice leading to delayed treatment, reduced care-seeking, and poorer health outcomes, particularly in managing chronic conditions such as cardiovascular and kidney disease. 11 Beyond Labels, Toward Lasting Change "Beyond the Scale" is more than a slogan — it is a call to treat obesity as the complex, chronic disease that it is. To move away from blame, appearance-based judgments, and oversimplified narratives, toward empathy, science, and sustained health. It is an urgent appeal to rethink, retrain, and rehumanise the way we support individuals living with obesity. "The earlier we intervene, the better the outcomes," said Dr. Ng."Obesity is not a character flaw. It's a disease. And it's time we responded with the same respect, science, and care we give every other chronic condition." "Beyond the Scale" aims to: Raise awareness of obesity as a chronic, multifactorial disease. Reduce stigma and myths that hinder early care. Encourage timely, evidence-based conversations with healthcare professionals. Promote empathy and science within the medical community. Support patients with tools to take charge of their health. Singaporeans can participate by: Visiting [ ] for factual resources, use a BMI measurement tool, and locate a nearest weight management healthcare professional. Starting honest conversations with GPs, nurses, and pharmacists. Sharing content to help dismantle myths and support loved ones on their health journeys. 1. Cuciureanu M, Caratașu CC, Gabrielian L, Frăsinariu OE, Checheriță LE, Trandafir LM, Stanciu GD, Szilagyi A, Pogonea I, Bordeianu G, Soroceanu RP, Andrițoiu CV, Anghel MM, Munteanu D, Cernescu IT, Tamba BI. 360-Degree Perspectives on Obesity. Medicina (Kaunas). 2023 Jun 9;59(6):1119. doi: 10.3390/medicina59061119. PMID: 37374323; PMCID: PMC10304508. 2. World Obesity. Retrieved from 3. World Obesity. Retrieved from 4. Lee, Y. V., & Tan, N. C. (2014). Obesity in Singapore: An update. The Singapore Family Physician, 40(2), 11–16. 5. World Health Organization. (2024). Obesity and overweight. As accessed on 22nd May 2025. 6. Ministry of Health, Singapore. (2022). National Population Health Survey 2022 Report. 7. Cohen JB, Cohen DL. Cardiovascular and renal effects of weight reduction in obesity and the metabolic syndrome. Curr Hypertens Rep. 2015 May;17(5):34. doi: 10.1007/s11906-015-0544-2. PMID: 25833456; PMCID: PMC4427189. 8. Tan, V., Lim, J., Akksilp, K. et al. The societal cost of modifiable risk factors in Singapore. BMC Public Health 23, 1285 (2023). (2.2 Billion) 9. Junxing C, Huynh VA, Lamoureux E, Tham KW, Finkelstein EA. Economic burden of excess weight among older adults in Singapore: a cross-sectional study. BMJ Open. 2022 Sep 16;12(9):e064357. doi: 10.1136/bmjopen-2022-064357. PMID: 36113947; PMCID: PMC9486358. 10. Bray GA, Kim KK, Wilding JPH; World Obesity Federation. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev. 2017 Jul;18(7):715-723. doi: 10.1111/obr.12551. Epub 2017 May 10. PMID: 28489290. 11. Goff AJ, Lee Y, Tham KW. Weight bias and stigma in healthcare professionals: a narrative review with a Singapore lens. Singapore Med J. 2023 Mar;64(3):155-162. doi: 10.4103/ PMID: 36876621; PMCID: PMC10071861. Hashtag: #NovoNordisk The issuer is solely responsible for the content of this announcement. About Novo Nordisk Novo Nordisk is a leading global healthcare company founded in 1923 and headquartered in Denmark. Our purpose is to drive change to defeat serious chronic diseases built upon our heritage in diabetes. We do so by pioneering scientific breakthroughs, expanding access to our medicines, and working to prevent and ultimately cure disease. Novo Nordisk employs around 77,400 people in 80 countries and markets its products in around 170 countries. In Singapore, Novo Nordisk has been present since 1997 and has approximately 100 employees. "Beyond the Scale" campaign builds on Novo Nordisk's long-standing commitment to tackling chronic diseases. With over 100 years of experience advancing care for diabetes and more than 25 years of focused obesity research, Novo Nordisk is pioneering the medical management of obesity and the science of the GLP-1 hormone — a naturally occurring signal that regulates appetite and plays a key role in achieving sustained weight loss. As part of its mission to drive long-term health outcomes, Novo Nordisk is also investing in scalable prevention efforts. Through the Cities for Better Health initiative — a global public-private partnership spanning over 50 cities — Novo Nordisk is working to reduce chronic disease risk in vulnerable urban communities. Its latest programme, the Childhood Obesity Prevention Initiative (COPI), delivers targeted interventions to promote healthier diets and physical activity among children aged 6–13 in underserved areas. In Singapore and beyond, these initiatives reinforce Novo Nordisk's holistic approach: treating obesity with medicine and empathy today, while building healthier environments for the next generation. For more information, visit Novo Nordisk
National Post
08-05-2025
- Health
- National Post
World Ovarian Cancer Coalition Launches Global Expert Advisory Group on Ovarian Cancer
Article content Article content TORONTO — On World Ovarian Cancer Day (#WOCD2025), the World Ovarian Cancer Coalition (the Coalition) announces the formation of the Global Expert Advisory Group on Ovarian Cancer, a new initiative to elevate ovarian cancer as a global health priority. Article content On World Ovarian Cancer Day (#WOCD2025), the World Ovarian Cancer Coalition announces the formation of the Global Expert Advisory Group on Ovarian Cancer, a new initiative to elevate ovarian cancer as a global health priority. Article content Ovarian cancer is the most lethal of female cancers. With no reliable screening test, low awareness and significant diagnostic barriers, millions of lives are at stake – particularly in low- and middle-income countries where the burden is disproportionately high. Without urgent action, the world could lose eight million women to ovarian cancer by 2050. Article content The newly formed Global Expert Advisory Group on Ovarian Cancer brings together patient advocates, leading clinicians and policy makers from 13 nations across six continents. The group's mission is to develop a comprehensive framework for a global ovarian cancer strategy that will have an impact at country level to ensure that everyone living with, or at risk of, ovarian cancer has the best chance of survival and the best quality of life possible, no matter where they live. The group has identified three critical areas of focus: Article content Building Community and Policymaker Awareness Optimising Routes to Diagnosis Access to Services and Treatment for Hereditary Ovarian Cancer Article content The Group is chaired by World Ovarian Cancer Coalition Board Member (and past Chair) Annwen Jones OBE and Assoc. Professor Tracey Adams, a Gynaecological Oncologist at Groote Schuur Hospital University of Cape Town, South Africa. 'This is a global challenge that demands a global response,' said the Co-Chairs. 'Alongside the key areas of focus, we plan to set a target for a reduction in global ovarian cancer mortality in a similar vein to the global breast cancer initiative.' Article content The announcement builds on findings from the Coalition's recent studies: the Socioeconomic Burden of Ovarian Cancer in 11 Countries and the groundbreaking Every Woman Study™: Low- and Middle-Income Edition. These studies revealed: Article content The Group's members are: Article content Dr. Carlos Andrade, Assistant at Gynecologic Oncology Department, Barretos Cancer Hospítal (Brazil) Dr. Garth Funston, Lecturer, Wolfson Institute of Population Health (UK) Nimkee Gupta, Patient advocate (India and Luxembourg) Jennifer Hollington, Retired assistant deputy minister in the Government of Canada, Patient advocate (Canada) Dilyara Kaidarova, MD, PhD, Prof., First Vice-Rector, Asfendiyarov Kazakh National Medical University (Kazakhstan) Bar Levy, CEO, HaBait Shel Bar- Israel's Women's Cancer Association, Patient Advocate (Israel) Prof. Ranjit Manchanda, Professor of Gynaecological Oncology, Wolfson Institute of Population Health (UK) Prof. Ursula Matulonis, Chief, Division of Gynecologic Oncology, Dana-Farber Cancer Institute (US) Dr. Asima Mukhopadhyay, Founder and Director, KolGOTrg, Gynaecological Oncologist/Surgeon, James Cook University Hospital and Newcastle University (India and UK) Dr. Aisha Mustapha, Consultant Obstetrician Gynaecologist, Ahmadu Bello University (Nigeria) Dr. Florencia Noll, Head of Unit, Sanatario Allende Cerro (Argentina) Prof. Amit Oza, Head, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre (Canada) Sarah Powell, CEO, Inherited Cancers Australia (Australia) Prof. Basel Refky, Oncology Center, Mansoura University (Egypt) Dr. Ritu Salani, Professor, Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA (US) Sbba Siddique, Patient advocate (UK) Prof. Sudha Sundar, Gynaecological oncology, University of Birmingham (UK) Carolyn Taylor, Founder & Executive Director, Global Focus on Cancer (US) Dr. Julie Torode, Director Strategic Partnerships, Patient and Community Engagement, Institute of Cancer Policy, Kings College of London, and Board Member, World Ovarian Cancer Coalition (Switzerland and UK) Article content Article content Article content Article content Article content Contacts Article content Media contacts: Annabel Deegan media@ Article content Article content Article content
