Overall health plan shake-up could disrupt coverage for reduced-income Californians

Virtually 2 million of California’s poorest and most medically fragile citizens may have to swap well being insurers as a end result of a new strategy by the point out to increase care in its Medicaid method.

A very first-ever statewide contracting opposition to participate in the method, identified as Medi-Cal, demanded industrial managed-treatment programs to rebid for their contracts and contend in opposition to some others hoping to take these contracts away. The contracts will be revamped to call for insurers to give new advantages and meet up with stiffer benchmarks for treatment.

The prolonged-planned reshuffle of insurers is possible to come with limited-term pain. 4 of the managed-care insurers, together with Health Net and Blue Protect of California, stand to shed Medi-Cal contracts in a small about a yr, according to the preliminary outcomes of the bidding, declared in late August. If the outcomes stand, some enrollees in rural Alpine and El Dorado counties, as very well as in populous Los Angeles, San Diego, Sacramento, and Kern counties, will have to alter health and fitness ideas — and possibly medical professionals.

“I’m still stunned and I’m nevertheless reeling from it,” claimed John Sturm, a single of about 325,000 customers of Local community Wellness Team, the most significant Medi-Cal system in San Diego County, which could lose its contract. “Which medical practitioners can I keep? How extensive is it likely to get me to switch strategies? Are there contingency programs when, inevitably, individuals slip by the cracks?”

Sturm, 54, who has 3 mental well being ailments, mainly since of childhood sexual abuse, explained obtaining a psychologist and psychiatrist he could rely on took a ton of time and work. He pointed to the disruption triggered by the rollout of Medi-Cal’s new prescription drug program this 12 months, even with assurances it would go efficiently.

“I have issues, and I know other individuals in the community have concerns about what we’re remaining explained to as opposed to what the reality is likely to be,” Sturm mentioned.

Arguably, the most significant loser in the bidding is Wellbeing Web, the biggest commercial insurance company in Medi-Cal, which stands to drop fifty percent its enrollees — including much more than 1 million in Los Angeles County by itself. St. Louis-primarily based Centene Corp., which California is investigating more than allegations it overcharged the condition for prescription medicines, acquired Health Web in 2016, in portion for its Medicaid enterprise, of which L.A. is the crown jewel.

But the state’s wellbeing prepare selections are not established in stone. The shedding insurers are fiercely contesting the benefits in formal appeals that read through like declarations of war on their competition and on the state. Some of the losers are fundamentally calling their winning rivals liars.

The stakes are high, with contracts in enjoy really worth billions of pounds yearly. Insurers that drop their appeals with the condition Department of Overall health Treatment Products and services, which operates Medi-Cal, are very likely to just take their complaints

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IBD may disrupt gut-brain axis, raising risk of anxiety, depression

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New research in mice suggests that a broken link between the gut and the brain may explain the effect of IBD on mental health. RapidEye/Getty Images
  • Around 30% of patients with inflammatory bowel disease (IBD) experience depression, anxiety, or both.
  • A new study in mice suggests that impaired communication between the gut and the brain may be partly responsible.
  • The study found that a gateway between the bloodstream and cerebrospinal fluid may close to protect the brain from inflammation during flare-ups.
  • This may disrupt the gut-brain axis, a communication channel between the gut and brain with possible links to mental health.

IBD involves chronic inflammation of the gut.

There are two main types: Crohn’s disease, which can affect any part of the gastrointestinal tract, and ulcerative colitis, which only affects the large intestine and rectum.

In 2015, an estimated 3.1 million adults in the United States, or 1.3% of the adult population, had received an IBD diagnosis.

Symptoms of IBD include persistent diarrhea, abdominal pain, weight loss, and fatigue.

According to one study, around 30% of individuals with IBD also experience depression, anxiety, or both.

The pain and discomfort that some people experience with certain chronic illnesses increase their risk of developing mental health illnesses. However, that does not appear to be the whole story in IBD.

“While the overall impact of the disease on overall quality of life no doubt plays an important role in triggering anxiety and depression in IBD, there is also increasing evidence of direct biological connections between IBD-associated inflammation and neuropsychiatric diseases,” said Dr. Gerard Honig, director of research innovation at the Crohn’s & Colitis Foundation in New York, NY.

“Anxiety and depression are, in fact, experienced by a large proportion of patients affected by [IBD],” he told Medical News Today.

“These comorbid conditions are also associated with worsened IBD outcomes,” said Dr. Honig.

According to Crohn’s & Colitis UK, feelings of stress, anxiety, or depression can trigger new symptoms in the gut.

A newly published study now suggests that IBD directly affects the brain by disrupting the gut-brain axis.

The gut-brain axis is a two-way channel of communication between the gut and the central nervous system. Microorganisms living in the gut play a prominent role in the relationship, although, as in this new study, findings to date are mainly in rodent models.

The new study found that inflammation in the gut may close a key gateway in this communication system that controls the exchange of signals between the blood and cerebrospinal fluid (CSF).

Unlike the blood-brain barrier, which prevents large molecules in the bloodstream from entering the brain, the gateway between the CSF and blood usually permits the passage of smaller molecules.

But the study found that it responds to inflammatory signals from the gut by slamming shut, presumably to prevent inflammation from spreading to the brain.

The research showed that in a mouse model of IBD, closure of the gateway disrupted memory and caused anxiety.

The research

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