Author Archives: Susan Dentzer

Promoting A “Green” Culture of Health: Instead of Wasting Food, Getting it to Those Who Need It

Jun 25, 2014, 3:54 PM, Posted by Susan Dentzer

Mercer Street Friends Food Bank Warehouse Trenton

“A mind is a terrible thing to waste,” goes an old slogan of the United Negro College Fund. Another terrible thing to waste is healthy food.

That’s especially true in a nation where 1 in 7 U.S. households are “food insecure”—that is, they lack consistent, dependable access, typically for financial reasons, to “enough food for active, healthy living,” as a U.S. Department of Agriculture report puts it. About 1 in 10 U.S. households have food-insecure children—an equally appalling reality in a country that wastes an estimated 30 to 40 percent of its food supply, or a whopping 133 billion pounds of food in 2010 alone.

In California’s Orange County, however, a solution is at hand—and there’s no reason it couldn’t take hold and spread nationwide. Since 2012, the Waste Not Orange County Coalition, a public-private partnership, has worked to boost donations to local food pantries of surplus healthy food from local restaurants, grocery stores and other facilities. The organization was formed out of the realization that enough food was tossed out every day to feed the nearly 380,000 local residents—almost half of them children—who are deemed food insecure.

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Closing the Gap on Child Obesity

May 22, 2014, 9:56 AM, Posted by Susan Dentzer

RWJF-Detroit-A-0820_RET

Imagine a splashy, big bucks television commercial selling kids on the tantalizing deliciousness of eating ... carrots.          

Or a new course sandwiched into already packed middle-school and high school curricula: “Food Shopping and Cooking for a Healthy Life.”

Sound implausible? Maybe—but then again, such innovations could be a part of what is needed to make more progress in the war on child obesity.

These were some of the suggestions that emerged from a recent conference in Newark, where the Clinton Health Matters Initiative, the Robert Wood Johnson Foundation, and Grantmakers in Health sponsored a day-long summit entitled Closing the Gap: Childhood Obesity (and in which I was a participant). You can watch a video of the meeting here.

As RWJF CEO, Risa Lavizzo-Mourey reminded the audience, the Foundation has set a goal of reversing the U.S. child obesity epidemic by 2015—and as that date approaches, she confessed, “I’m getting a little nervous.” (View Risa's remarks.)

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Choosing Wisely: Intensifying the Spotlight On Health Care of Dubious Value

Apr 30, 2014, 8:52 AM, Posted by Susan Dentzer

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“If you study the kinds of decisions that people make, and the outcomes of those decisions, you’ll find that humanity doesn’t have a particularly impressive track record,” write the brothers Chip and Dan Heath in their masterful book Decisive. Invoking research from psychology and behavioral economics, the Heath brothers demonstrate how people often make decisions by looking at what’s in the “spotlight”—the information immediately before them, sparse as it may be.

But what’s in that spotlight “will rarely be everything we need to make a good decision,” the Heaths counsel. To choose wisely, we need to broaden our focus, or “shift the light.”

That’s especially true in health care, where the consequences of any decision, poorly made or not, may be life or death.

Enter Choosing Wisely, a program that shifts the spotlight onto many of the tests and treatments that both providers and patients should question, if not abandon completely.

(Editor's note: On May 2, 2014, RWJF held a First Friday GoogleHangout to explore how Choosing Wiselysprang from critical examination of the overuse of medical care in the United States—and how it’s changing how care is delivered in communities. Watch an archived version of the Hangout, above.)

This two-year old campaign, launched in 2012 by the American Board of Internal Medicine Foundation, has identified more than 250 tests and procedures that warrant scrutiny because they are ineffective, unnecessary, unsupported by evidence, or possibly harmful. Even so, physicians and other clinicians perform them regularly, and patients sometimes request them.

Fifty-four of the nation’s premier medical specialty societies have joined the Choosing Wisely effort, and most of these have contributed to their own lists of questionable care. This week, three non-physician groups will also sign on to the campaign. Among the categories of dubious care identified on various societies’ “top five” lists are these:

  • Excessive imaging: CT or MRI scans for low back pain shouldn’t be ordered within the first six weeks of treating a patient, unless there are severe neurological symptoms, while patients with minor head injuries shouldn’t routinely get a head CT unless they have a skull fracture or are bleeding. Excessive scans expose patients to radiation that increases their lifetime risk of cancer.
  • Unnecessary medications: Antibiotics are not effective against viruses and should not be prescribed for viral illnesses such as sinus infections or bronchitis, particularly in children. But doctors say they frequently feel pressured to write these prescriptions by anxious parents.
  • Superfluous screening or diagnostic tests: Patients with no symptoms of heart disease and are at low risk of developing it are still frequently subjected to electrocardiograms when they get routine physical exams, despite evidence that this routine screening doesn’t improve patient outcomes. By the same token, hospitalized patients may have their blood drawn countless times for costly diagnostic testing that often yield little useful information, and can contribute to anemia.

The Robert Wood Johnson Foundation is supporting Choosing Wisely with a $2.5 million grant to extend the influence of these lists beyond medical specialty societies and into communities. State medical societies in Texas, Oregon, Minnesota, Tennessee, Washington, and Massachusetts have undertaken steps to promote the lists, including developing continuing medical education courses for doctors. So have ten regional health collaboratives, such as Maine Quality Counts and the Washington Health Alliance outside Seattle (both are among RWJF’s Aligning Forces For Quality communities as well).

Consumer Reports and AARP are among organizations that have taken the lead in publicizing the lists for consumers. All told, these efforts have reached an estimated 170,000 or more physicians and 16 million-plus consumers. There’s even a Wikipedia page for the campaign, with the lists of tests and procedures curated by a “Wikipedian” in residence.

Caveats: Although more than 200 articles have been written about aspects of the campaign in medical journals, there is as yet little hard evidence that is has reduced superfluous care. A recent perspective in the New England Journal of Medicine noted that the specialty societies’ lists “vary widely in terms of their potential impact on care and spending”—and suggests that some societies omitted lucrative elective procedures, such as knee replacement surgery, that also aren’t appropriate for many patients.

The bottom line: As a nation, we need to shine a spotlight on an even broader range of questionable health care in the future. But for now, the Choosing Wisely campaign is illuminating plenty of “care” that we can clearly pass up with impunity as we pursue our real objective:  better health.

 

Understanding The Value In Medicare's Physician Payment Data Dump

Apr 14, 2014, 9:24 AM, Posted by Susan Dentzer

New Jersey Patient Care

A 35-year battle is over and the taxpayers have won: We have the right to know how much physicians receive in Medicare dollars in exchange for providing our care. But now that the Centers for Medicare and Medicare government has released data on $77 billion in Medicare Part B payments to providers during 2012, what do we really know—or have—that we didn’t have previously? Information alone isn’t knowledge or, for that matter, insight.

For consumers, the slew of raw data ultimately may be useful if it can be packaged into applications that help them compare the way physicians practice—as the Office of the National Coordinator for Health Information Technology now proposes in a newly announced challenge. Private payers, such as insurers, may also find the Medicare data useful, as they can the information to better understand the practice patterns of providers they include in their networks.

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County Health Rankings: Five Key Elements of The Picture of Health

Mar 28, 2014, 10:16 AM, Posted by Susan Dentzer

Behind the County Health Rankings: What makes a county healthy or unhealthy?
Skip Rope

Paint a portrait of a healthy county, and you’d show the features that contribute to good health: high incomes and levels of education; access to health care; plentiful healthy food, and ample places to exercise.   

Paint a portrait of an unhealthy county, and the palette becomes darker: higher rates of joblessness; more children in poverty; high rates of smoking, obesity and physical inactivity; and more people living in sub-par housing that they may struggle to afford. 

Those, in fact, are the real portraits emerging from the 2014 County Health Rankings, newly released by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

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Bridging Health and Health Care: Confessions of an "Upstreamist"

Mar 20, 2014, 8:40 AM, Posted by Susan Dentzer

The Upstream Doctors

A key aspect of the Robert Wood Johnson Foundation’s new “culture of health” focus is “bridging” the two worlds of population health and health care. One component of that bridge—arguably, its abutment—rests in the nation’s more than 100 academic health centers (AHC’s).

These schools of health and medical professional education, linked with owned or affiliated teaching hospitals and health systems, have long concentrated on the invention and provision of intensive, costly, and high-tech medicine. But now some of these centers are also building bridges upstream—focusing on incomes, housing, transportation, and other social forces that are the primary drivers of health.

Leaders in this movement recently convened at Georgetown University in Washington, D.C., for the third national conference of Academic Health Centers and the Social Determinants of Health.

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If Patients Are Flipped Out by Today's Physician Encounters, Why Not "Flip" The Clinic?

Mar 3, 2014, 5:34 PM, Posted by Susan Dentzer

“I am stressed.”

“I am feeling pressured.”

“I have been through all this before.”

“Why is it taking so long?”

If you’ve ever had any of these feelings while biding your time in a doctor’s office, you’re not alone.  There are a myriad ways in which the classic physician visit can often be sub-optimal: Spending a long time in a waiting room before a too-short doctor’s visit; barely understanding or absorbing what the physician says before he or she rushes off to see the next patient.

The experience could try the patience of the most self-confident of patients—and positively overwhelm the more nervous among us.  Small wonder that some patients experience “white coat syndrome,” or elevated blood pressure during a clinical encounter.  It’s believed to be brought on by some combination of apprehension about a potential disease or diagnosis, or even intimidation at the sight of the doctor in a white coat.

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Getting Ready for the Oscars: Three Things that the Movie “Gravity” Has in Common with Health Insurance Exchanges

Feb 18, 2014, 10:32 AM, Posted by Susan Dentzer

Sandra Bullock in "Gravity"

The Academy Awards are just a few short weeks away, much as is the end of this year’s open enrollment period for the health insurance exchanges. We health policy geeks who also love movies can now give out our own award—for the film that most closely resembles the rollout of the marketplaces under the Affordable Care Act.

As far as I’m concerned, there’s only one real candidate: “Gravity,” the science-fiction space drama directed by Mexican-born Alfonso Cuaron and starring the actors Sandra Bullock and George Clooney.

The film wins because its big themes are the same ones reflected in the experience of the exchanges: the omnipresence of Murphy’s Law and human perseverance overcoming calamity. What’s more, gravity—the real star of “Gravity”—is a universal force that can’t be overcome (and is one of the few scientific aspects of the movie that the critics agree the filmmakers got right). Is it too much to see a parallel to the Affordable Care Act’s coverage expansion, which is inching forward despite the formidable odds stacked against it?

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Investing in Children to Improve the Nation's Health

Jan 27, 2014, 6:28 PM, Posted by Susan Dentzer

RWJF recently convened a panel of distinguished guests for a Google+ Hangout to examine targeted interventions that could help America’s youngest children live healthier, happier, and safer lives. Here's an archived version of the Hangout.

"It is easier to build strong children than to repair broken men," wrote Frederick Douglass, the 19th century African-American social reformer, writer and orator. A century and a half later, to improve the health of Americans, it's essential to start with kids.

That’s a preeminent conclusion of the new report of the RWJF Commission to Build a Healthier America called Time to Act: Investing in the Health of Our Children and Communities. The report focuses on ways to influence the upstream determinants of Americans' generally poor health, including low levels of education and incomes, unsafe environments, and non-nutritious food. Of the panel's three top recommendations, the first is distinctly child-centric: "Invest in the foundations of lifelong physical and mental well-being of our youngest children." Were he alive today, Douglass would surely agree.

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Reforms in Oregon’s Medicaid Program and Emergency Department Use

Jan 16, 2014, 5:23 PM, Posted by Susan Dentzer

 Inter Professional Nursing

“Past performance is no guarantee of future results,” goes the boilerplate warning on financial investments. The caution is worth keeping in mind in the wake of a recently published study that found that expanding Oregon’s Medicaid program in 2008 led to a 41 percent increase in emergency department (ED) use by many of those newly covered by the program.

The study, by an esteemed group of researchers (some of whom are affiliated with the National Bureau of Economic Research) is the latest to emerge from the Oregon Health Insurance Experiment. This series has focused on the effects of 2008-2009 policy changes that led thousands of previously uninsured Oregonians to enroll in Medicaid. The latest study found that costly visits to the ED rose across the board over a two-year period, including for relatively simple conditions, such as headaches, that could easily have been treated in primary care settings.

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