Category: Uncategorized

Op-Ed: Health in All Policies

Aug 3, 2009• 1

By SUSAN BLUMENTHAL, MD and DENIS CORTESE, MD

At the heart of current health care reform discussions – which focus on expanding access to care and establishing mechanisms to finance broader coverage as well as reduce rapidly escalating costs – must be the promotion of good health and the prevention of disease.

Good health is essential to the economic prosperity and wellbeing of the American people. Individually, we are less productive when we become ill; collectively, our nation is less secure when burdened with the high cost of disease. Today, with 45 percent of Americans suffering from a chronic condition and a national fiscal crisis, both our nation’s health and economic security are in peril.

Deteriorating health is a major driver of this crisis. One in five Americans smoke and 66 percent of adults are obese or overweight, fueling a chronic disease epidemic and skyrocketing health care costs. As childhood obesity rates dramatically rise, American children may, for the first time ever, live shorter lives and be less healthy than their parents.

Just as Americans are ailing, so too is our health care system. The U.S. health care system suffers from considerable fragmentation, inefficiencies and inequities. The United States spends nearly twice as much on health care, per person, as any other nation, and the health sector constitutes one sixth of our economy. Yet this significant investment delivers shockingly poor results. America ranks 49th on life expectancy worldwide, 37th on overall health status and performs the worst among industrialized countries at avoiding premature deaths through timely and effective medical care.

Say we get some sausage–then what?

Aug 1, 2009• 9

By MICHAEL PAINTER J.D., M.D

sausage (sô´sǐj)
n. A highly seasoned minced meat usually stuffed in casings of prepared
animal intestine.

Congress is obviously in the thick of the sausage making. The August recess is pending. Bills may or may not be moving. The legislative process, especially at this point, is not particularly pretty or, to be honest, as thoughtful as we all might hope. It is the process, though, right? There was essentially no way around something like this intestine stuffing, especially in an effort to fix health care–such a large sector of the American economy. And in spite of the messy work and depending on the day, the observer and the poll, it nevertheless seems likely that something will come out of the kitchen, right? It is also probably safe to say, though, that any reform law is not going to be the panacea–the ultimate health and health care fix. Instead, if a law indeed passes, it's clear that we're going to spend the next five, 10, 15 years adjusting, backtracking, redesigning and working toward better care. In other words, the implementation is going to matter, and it's going to matter a lot. On July 30 in Washington, D.C. at the Hart Senate Office Building, the RWJF-funded High-Value Health Care Project led by Mark McClellan of the Engelberg Center at Brookings hosted a panel discussion focused on just that–the implementation. Specifically, Mark, Carolyn Clancy of AHRQ, John Tooker of the American College of Physicians, Steve Findlay of the Consumers Union and Jim Chase of Minnesota Community Measurement talked to a large Capitol Hill audience about what it will take to make health care deliver sustainable high value.

California Moves Backward on Covering Uninsured Children

Jul 31, 2009

By JOCEYLN GUYER

During tough budget times, most states have maintained their commitment to covering uninsured children. At least eighteen states have even further strengthened coverage for uninsured children, despite budget problems, as the recession has increased the need.While many states have prioritized covering uninsured children, California lawmakers voted to deny coverage to nearly 800,000 children. This decision ignores strong public support for providing affordable health coverage to children and families. This decision also undermines California’s ability to access federal funds, just when the state needs them most. The Children’s Health Insurance Program Reauthorization Act of 2009 made the federal government an even stronger partner for states that prioritize covering uninsured children. California’s $144 million children’s coverage cut will cost the state $267 million in federal funds.This is a difficult time for state budgets but an even harder time for family budgets, and many states are responding to meet the need. Alabama, Washington, North Dakota, Colorado, Iowa, Kansas, Nebraska, Arkansas, West Virginia, and Montana have all expanded coverage; Oregon and Ohio are on the verge of doing the same. Other states have instituted reforms designed to make their CHIP and Medicaid programs more family-friendly, all with the goal of increasing access to affordable health coverage for children.California faces unique public policy challenges that have contributed to this step backward for children. The state was hit particularly hard by the economic and housing crises. More importantly, California has legal restrictions that put large shares of the state’s budget out of lawmakers’ reach, as well as supermajority requirements for passage of budget legislation.While the search continues for ways to help California restore affordable health coverage options for children and families and hope remains high that national health insurance reform will be enacted soon, California’s decision should not diminish the accomplishments of the other states. It is critical that states keep working to strengthen and maintain the gains they’ve made in offering affordable health coverage options to uninsured children and that the federal government remain a strong partner in their efforts.

IDEO and Ix Innovation Design

Jul 31, 2009• 3

By ARNA IONESCU

Next week Matthew will be in a workshop with the folks from design firm IDEO and our friends from the Ix Center. In preparation we’re posting this article from IDEO’s Arna Ionescu who was at the recent joint Health 2.0 Meets Ix Conference on a panel moderated by the Center for Information Therapy’s President Josh Seidman. And if that wasn’t all incestuous enough, this post was originally on Josh’s blog over at Ix.

Thank you to those of you who participated in our interactive webinar last Tuesday. During the webinar we used IDEO’s design approach to tackle the challenge of providing effective Information Therapy (Ix) to a fictional character named Vernon, who has minimal resources and was recently diagnosed with high blood pressure.

To inspire solutions for this challenge, members of the IxAction
Alliance submitted images of unexpected learning moments in their daily
lives. These images spanned from public service billboards to Snapple
caps and restaurant placemats. In advance of the webinar, the IDEO team
synthesized the images into brainstorm questions.

The webinar attendees voted and selected the brainstorm question,
“How Might We leverage curiosity to prompt Vernon to engage with Ix?”
Following IDEO’s brainstorm rules attendees submitted ideas using the webinar software.

More than 30 ideas were generated in the ten minute brainstorm, and
a second vote allowed the attendees to select which idea to pursue
further. Attendees selected the “High Blood Pressure Club.” We
discussed “$10, 10 minute prototypes” – an approach that allows us to
try out fast and cheap experiments to gain insight before costly design
and implementation efforts.

E-Health – It All Depends on How It’s Used

Jul 30, 2009• 15

By MERRILL GOOZNER

Technology isn’t a quick fix. Just ask General Motors. In the 1980s, the auto giant spent $50 billion to automate and computerize its plants in an effort to compete with Toyota. Today, GM is emerging from bankruptcy while Toyota still leads in producing high quality, fuel-efficient vehicles.

What happened? “The Japanese have a great way of describing the error that General Motors made,” said Thomas Kochan, co-director of the Institute for Work and Employment Research at the Massachusetts Institute of Technology Sloan School of Management. “It’s workers who give wisdom to these machines.”Continue reading…

Health Care Reform Coming Out of Senate Finance?

Jul 29, 2009• 20

By ROBERT LASZEWSKI Baucusgrassley110th

We’ve been getting lots of news these past few days leading to optimism that a bipartisan health care bill will soon emerge from discussions between the “Coalition of the Willing.” That term refers to the three Republicans and three Democrats trying to find common ground in the Senate Finance Committee.First, let me be clear that I have the greatest respect for Senators Baucus and Grassley and their four colleagues. Theirs is the kind of bipartisan approach that all of Washington, DC should be following on any number of issues.And, as I have posted here before, I am concerned that in their efforts to find compromise they are headed for a health care bill that is based on a formula of cost containment “lite,” minor paring of Medicare and Medicaid provider payments, and at least $500 billion in new taxes. I don’t see much changing fiscally if that is the final result in a health care system that is already unsustainable and on the way to spending upwards of $35 trillion to $40 trillion over the next ten years as it goes to 22% of GDP by 2018.From what we have heard, their bill would hardly "bend" any curves.

Op-Ed: Sustainable Healthcare Reform

Jul 29, 2009• 12

By LAWRENCE W. ARRINGTON

President Obama made a risky wager when he decided to let Congress take the lead on crafting health care legislation, rather than presenting his own reform package. Congress is not known for taking bold, decisive leadership on tough issues. Normally, it reacts and gridlocks; it doesn’t lead.

As Congress takes its usual August recess without acting, it appears that Obama’s strategy has failed. But, has it? Is there a deeper strategy? What’s really at stake here?

Obama reportedly reasoned that Congress will do better in the long-run if it protects its institutional prerogative as law maker and doesn’t take on the appearance of being the President’s rubber stamp. This is a plausible calculation. The last time Congress was asked to respond to a President’s health care reform proposal during the Clinton years it did so by throwing the whole package in the trash can.Continue reading…

Op-Ed: The Payoff from Preventative Healthcare: How disease screening saves lives and money

Jul 29, 2009• 9

By MARK GUMZ Mark2

To understand and effectively navigate the current healthcare debate, every U.S. CEO must now be a healthcare leader.

From the health, well being and productivity of employees and their families to the impact on a company’s bottom line, healthcare is a major business concern for everyone. Five consecutive years of double-digit health insurance premium increases have hit the business community hard.

If we don’t identify new efficiencies in the way we administer employee-based healthcare programs, the negative impact of these costs on businesses will only grow. Healthcare spending currently accounts for 18 percent of U.S. economic output. It could reach 34 percent by 2040, according to a June 2, 2009 report by the White House Council of Economic Advisers, if the current rate of cost growth continues.

E-Health – It All Depends on How It’s Used

Jul 29, 2009

By MERRILL GOOZNER

Will the Obama administration’s $20 billion push to flood the nation’s physician offices and hospitals with electronic medical records (EMRs) suffer a similar fate? The July/August cover story in the Washington Monthly by Phillip Longman pointed to one possible stumbling block on the road to widespread diffusion of EMRs – self-interested software firms pushing proprietary systems that can’t talk to each other.

But there may be an even greater danger. The people who actually deliver care will fail to achieve the potential health benefits of having every patient’s EMR at their fingertips.

That was the reality facing Kaiser Permanente’s Colorado medical group in Denver five years ago. The health maintenance organization, touted as an exemplar of quality care, was an early adapter of EMRs. And what those records told local managers when it came to controlling blood pressure — a major goal — was troubling. Despite annual free checkups and prescribing lots of blood pressure pills, only 59 percent of patients had achieved control in follow-up visits. “Putting a blue sticker on a piece of paper that says you have high blood pressure wasn’t working,” said Sean Riley, the medical director of the group.Continue reading…

Sermo, malpractice, and Howard Dean

Jul 29, 2009• 14

By MATTHEW HOLT

Sermo’s Daniel Palestrant got on TV with Howard Dean. It was an amusing (and short) little debate which you can find here.

The best moment was at the start when Dean claimed that Sermo was just a poll. Palestrant pointed out that Dean spent last week explaining how reflective online communities were about what their members thought. Given how Dean rose to national prominence I’m a little surprised that he’s trashing the Internet!Continue reading…