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?

View Full Post

Aligning Measures to Improve Quality

Feb 11, 2014, 4:51 PM, Posted by Gerry Shea

Doctors go over a patient's charts in the emergency room.

The quest over the last decade and a half to define and quantify “quality” in health care in the United States has resulted in widespread use of quality measures. Unfortunately, the alignment of these measures among entities in both the private and public sectors has been secondary to the efforts to identify and use good measures. This failure has resulted in a tremendous lack of comparability between quality improvement efforts.

While not surprising, the near total lack of alignment has become a major obstacle in the effort to improve care for patients. It leads to significant burdens for those looking to improve, wastes valuable (and finite) resources and is a drag on overall quality improvement efforts. Additionally, it creates a considerable barrier to efforts encouraging value-based decision making by consumers and others.

View Full Post

We Are All in This Together

Feb 11, 2014, 4:41 PM, Posted by Risa Lavizzo-Mourey

presidents_message_billboard_v0.1

Building a culture of health means recognizing that while Americans’ economic, geographic, or social circumstances may differ, we all aspire to lead the best lives that we can.

For the Foundation, it also means working hand-in-hand with all Americans to inform the dialogue and build demand for health by pursuing new partnerships, create new networks to build momentum, and stand on the shoulders of others striving to make America a healthier nation.

Learn more in our President’s Message
Risa Lavizzo-Mourey, MD, MBA, is president and CEO of the Robert Wood Johnson Foundation

 

 

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.

View Full Post

On the Way to Better Health, a Call to Educate the Consumer With Complete and Useful Information

Jan 24, 2014, 2:41 PM, Posted by Tara Oakman

“An educated consumer is our best customer...”

A big sign with these words welcomed me and others into the local department store, Syms. I’m definitely not the only one who noticed. In fact, an educated consumer of this blog would know that it resonated with Susan Dentzer as well.

As a child, this statement baffled me. On the plus side, pondering its meaning gave me something to do during seemingly interminable shopping expeditions with my parents. Why, I wondered, does a department store care about how much consumers know? Don’t they just want them to buy clothes?

Now I get it.

View Full Post

Simple, Small Changes Can Lead to Healthier Food Choices

Jan 21, 2014, 11:20 AM, Posted by Deborah Bae

traffic light graphic border

At this time of year, many of us find ourselves trying hard to stick to that New Year’s resolution to eat healthier. Here is some good news: simple changes in our environment can have meaningful, sustained effects on our ability to make healthy food choices.

Committing to a healthier diet and trying to lose weight is hard, and many people believe they can do it as long as they have the right motivation and attitude. We’ll say things like, “I’m going to eat better” or “I’m going to eat fewer unhealthy foods.” But that commitment can be tough when people face a variety of unhealthy choices and just a few healthy ones. Or when it’s hard to tell which is which.

Researcher and physician Anne Thorndike and her colleagues at Massachusetts General Hospital tested a novel idea: if all healthy food and drinks sold in the hospital cafeteria were labeled green, and all unhealthy items had red labels, would people make healthier choices?

View Full Post

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.

View Full Post

And the Winner is … Streetlights, for Applying Big Data to Community Health

Jan 15, 2014, 12:41 PM, Posted by Paul Tarini

Cropped Streetlight project

Big data, the buzzword of choice these days in information technology, holds the promise of transforming health care as programmers and policy-makers figure out how to mine trillions of ones and zeros for information about the best (and worst) health practices, disease and lifestyle trends, interconnections, and insights. The problem is, where to start? To jump start the process, the Robert Wood Johnson Foundation joined in a Knight News Challenge: Health and issued its own call to developers to come up with innovative ways to combine public health and health care data, with a $50,000 prize to the best idea.

The results are in. When the John S. and James L. Knight Foundation announced the winners of its News Challenge for ideas focused on unlocking the power of health data on January 15—you can see the list here—we also announced the winner of our companion prize for the best entries who combined public health data with data from health care to improve the health of communities. Our first place winner is the Streetlights Project from Chicago.

View Full Post

The Smoking Generation

Jan 13, 2014, 11:06 AM, Posted by Jeff Meade

Chuck and Jean on their wedding day Chuck and Jean on their wedding day

When I was a little kid growing up in Norwich, N.Y., I earned candy money by helping out at Saturday night bingo, held in the basement hall of St. Bartholomew Church.

By "helping out," I mean taking orders (and collecting tips) from the little old ladies who were so focused on their bingo cards that they could not leave the table long enough to get themselves a drink or a snack.

Virtually all of those old ladies smoked. A blue-gray haze hung over the room like a dingy veil. I might as well have been chain-smoking Lucky Strikes the whole night.

When those old ladies placed their orders, their vocal chords coarsened by decades of smoking—“Get me a meatball sandwich, will ya, hon?" —they sounded to my impressionable young ears like the tough-guy character actor Broderick Crawford. (The little mustaches, perhaps, completed the illusion.)

People younger than I am probably can't imagine what it was like to live in that world, a world in which smoking was ubiquitous.

View Full Post

A Portrait of Hope

Dec 16, 2013, 4:46 PM, Posted by Jeff Meade

Artist Chuck Connelly Artist Chuck Connelly and his monumental remembrance of the children of Sandy Hook

I first came to know Chuck Connelly in April of last year. He’s a gifted, famous and often controversial artist, whose work has appeared in countless galleries, including the Metropolitan Museum of Art. He’s very much his own man, and that man can be difficult. A writer once described Connelly as “Norman Rockwell on acid—a maverick narrative painter pushing the limits of myth into a modern malaise all his own.”

It’s a left-handed compliment, but there’s no getting around the undeniable truth: Chuck Connelly is an extraordinary talent. He may come across as a rumpled, dark-witted cynic, but on the inside, he is a luminous soul.

So here’s how I came to know Chuck Connelly. He’s an Irish-American who lives in Philly's East Oak Lane neighborhood, and I co-author a blog devoted to Irish culture in Philadelphia. So for our purposes, Connelly was grist for the mill.

And so it was that I found myself on the topmost floor of a ramshackle barn one dreary day last April, gazing upon Connelly’s most recent magnum opus: twenty painstakingly detailed oils on canvas, each one bearing the likeness of a first grader murdered by a lone gunman at Sandy Hook Elementary School on December 14, 2012. All of the paintings were clustered in a simple 10- by 12-foot wooden frame. The entire assembly towered over us. It was a breathtaking, shattering remembrance.
 

When news of the shooting broke, Connelly reacted as the rest of us did, with horror, frustration and anger. A couple of days later, he started painting a portrait of one of the young victims, 6-year-old Emilie Parker. At first, he wasn’t sure where the project was taking him. At that point, it really wasn’t a project. “I started to do the one, Emilie, when it first happened,” Connelly explained to me. “Her face was everywhere. I just thought ... what a tragedy. So I painted her. Then I made Dylan (Hockley), and then I thought ... you know what? I gotta do them all.”

Last week, Connelly’s “Children of Sandy Hook” went on display at Villanova University to commemorate the one-year anniversary.

As that anniversary arrived last weekend, I thought about Chuck Connelly’s heartfelt tribute. It caused me to wonder, probably for the millionth time, when we’re ever going to come to grips with the problem of gun violence. Every shot fired wounds us all.

Here at RWJF, we have devoted a great deal of effort toward understanding gun violence and how to prevent it. One well-known example of our work in this area is grantee Cure Violence, formerly Ceasefire.

Here’s how we describe the program:

Cure Violence uses a public health model to reduce gun violence. By treating violence as a learned behavior that can be “unlearned,” Cure Violence offers a solution to a problem that had been seen as unsolvable.”

Obviously, gun violence is one aspect of a much broader and disturbing picture. It’s not an exaggeration to suggest that violence of all kinds is a plague in the United States, and from our description of Cure Violence, you can begin to understand our response to it. We approach violence as a critical public health issue, and that point of view determines our course of action.

A recent example of our work to curb violence further illustrates that particular approach. It revolves around the issue of adverse childhood experiences, or ACEs. That’s a wonky term, but it is meant to describe and encompass the horrors routinely visited upon children, mostly in the form of abuse and neglect. Many of these children live a nightmarish existence.

Some might say we’re swimming against the tide on this one, but we are, as my colleague Susan Promislo wrote in this space a few months ago, “witnessing a health revolution.” Childhood trauma was the subject of a recent summit in Philadelphia, a confab that garnered a great deal of national attention. Throughout the country, more and more experts are turning their expertise to the problem of ACEs, and many of them are doing pioneering work to understand the problem’s causes, document its long-term emotional and physical damage, and develop creative and effective long-term solutions.

From our work, we know that there are no simple answers to countering childhood trauma—or any other kind of violence. Just a few weeks after the Newtown tragedy, a report by Kevin Freking in the Huffington Post cited a particularly painful statistic: “The United States has about six violent deaths per 100,000 residents.”

I find myself pondering those damning numbers. Can we really do what we want to do? Can we really make the country a better, less violent place? Sometimes it seems impossible. But if there’s one thing I have come to know about this place, it’s that most of us are incredibly hopeful. You can’t work here and not be an optimist at heart. It would be easy to throw up our hands and give up, but no one here gives up.

If the tragedy of Newtown tells us anything, it’s this: When it comes to the challenge of violence in America, if we are to prevail, we must be guided by hope. And to paraphrase one of my favorite Winston Churchill quotes: We can never, never give up.

Jeff Meade is a senior writer/producer for rwjf.org.