Five Takeaways from the National Transparency Summit: An Issue Whose Time Has Come

Dec 9, 2013, 4:33 PM, Posted by Susan Dentzer

RWJF Senior Health Policy Adviser Susan Dentzer RWJF Senior Health Policy Adviser Susan Dentzer
  1. Transparency is an idea whose time has come—in large part because U.S. consumers are feeling so much pain from higher health costs. Health economists have long noted that U.S. health care prices are out of whack and that hospital chargemasters are nonsensical. Recent media coverage of these phenomena has captured widespread attention, perhaps because consumers are being hit so hard in the pocketbook. Since 2000, rising prices of hospital charges, professional services, drugs, devices and administrative costs, are responsible for 91 percent of the increases in health spending. Meanwhile, consumers’ out-of-pocket spending on health care, estimated at $329 billion this year, is projected to rise to $411 billion in 2020—a 25 percent increase. Almost three in five workers in small firms, and one in three workers in larger firms, are in a health plan with a deductible of at least $1,000 for single coverage, and in 2012, nearly one of five U.S. adults was contacted by a collection agency over unpaid medical bills.

    It’s well established that much of this money is being spent on health care of questionable value. With so much of their money—and their well-being—now at stake, “People are going to impose transparency on the health care industry,” predicted Leah Binder, a conference participant who heads the Leapfrog Group.

  2. Consumers and patients deserve to know far more about the costs and quality of care, but unless the two are linked, the public may continue with its longstanding delusion that the more expensive the care, the better the quality. Francois de Brantes, executive director of the Health Care Incentives Improvement Institute, noted that this widespread consumer misapprehension constitutes a “perverse incentive” for providers to continue to raise prices. Meanwhile, evidence of poor quality abounds. Martin Makary, a Johns Hopkins University physician and author of Unaccountable: What Hospitals Won’t Tell You And How Transparency Can Revolutionize Health Care, reminded the conference that preventable adverse events in hospitals are now the nation’s third leading cause of death annually. Many highly esteemed medical centers that end up routinely on “best hospital” lists don’t make the Joint Commission’s tally of top performers on basic quality and safety measures.

    Conference speakers agreed that there’s a pronounced need to combat these trends by developing more and better quality measures—especially those capturing care outcomes, and in particular, the outcomes that are most important to patients. Providers’ scores on these measures should then be funneled to purchasers and the public. “When consumers can really start to see that this hospital is better than this other hospital, or this doctor is better than that doctor, they will start to move,” said Bill Kramer, executive director for national health Policy at the Pacific Business Group on Health.

    Promising prototypes of the platforms that could communicate such information include winners of the RWJF Hospital Price Transparency Challenge—for example, Consumer Reports’ Hospital Adviser: Hip & Knee, which combines hospital quality rankings with Medicare cost data to help consumers pinpoint high value institutions where they could obtain surgery.

  3. Fostering greater transparency will be a long process, but there could be relatively quick “wins.” Many contracts between health insurers and providers contain “gag clauses” that bar both parties from disclosing claims data or prices paid for care. The clauses appear to serve both parties’ interests—helping to protect health plans’ proprietary interests in the provider networks they’ve established, and providers’ desire not to disclose how little they are willing to be paid. California has outlawed such clauses in health plan contracts, and many conference attendees agreed that other states should follow suit.

    What’s more, a total of 16 states have set up mandatory or voluntary all-payer claims data bases (APCDs) to pool statewide data on diagnoses, procedures, care locations, and provider payments. Conference participants agreed that more states should enact mandatory APCD’s, or use the regulatory authority in state insurance laws to compel insurers to issue payment and pricing data, as was done in Rhode Island.   More states could also follow the lead of Maine Quality Counts, the private, independent nonprofit organization that leads the RWJF-sponsored Aligning Forces for Quality coalition in the state, and which has aggregated health plan data for purchasers, consumers and providers to promote transparency on quality and cost.

  4. Transparency in the hands of consumers could be powerful—but in the hands of providers, even more so. Health care providers themselves often lack information about the quality and costs of their care. In particular, transparency can focus attention on the extreme amount of variation among providers in the care they provide. Glenn Steele, president and CEO of Geisinger Health System, described how Geisinger’s physicians came together to define “best practices” across a dozen hospital episodes of care, including heart bypasses, hip replacements, and gastric bypass surgery. As physicians in the system adhered to these guidelines, spending fell, by 20 percent  because doctors narrowed the indications for which they agreed that the procedures were warranted, and 15 percent by reducing unnecessary variation.
  5. Transparency is a necessary but insufficient tool for health system transformation. Openness about price and quality alone is “not going to be enough” to achieve the goals of the Triple Aim, observed Steven Brill, whose Time magazine article in March 2013 gave renewed focus to the issue. Payment reforms and “culture change” that shift providers from a volume-based to-value-based approaches remain critical. What’s more, consumers need to have health insurance benefit designs beyond high-deductible health plans that encourage them to make wise choices, such as “value-based” benefits” that help nudge them toward cost-effective care delivered by low-cost, high quality providers. Others at the conference warned that regulators must stay attuned to unintended consequences of health system transformation, such as the consolidation of health care providers that could lead to attempts to jack up prices.

    In the end, “We don’t win the game until the care gets better,” observed Jay Want, CEO of WantHealthcare. The nation also must ensure “that the transparency we seek will serve to change the way we think about health and wellness,” said RWJF president and CEO Risa Lavizzo-Mourey. “We need to use our skills, our imagination, our influence, and, yes, our hearts, to transform our nation into one that considers being healthy part of what it means to be an American.”

    To that end, transparency about the choices we face as a nation on the costs and quality of health and health care can give our society a critical lens to look within.

Putting the Great in Grateful

Dec 9, 2013, 11:31 AM, Posted by Joan Barlow

Photo courtesy of Mercer Street Friends Photo courtesy of Mercer Street Friends

We all have the ability to do something great, even if it’s in the smallest gesture.

I love Thanksgiving because it’s “four days, no presents.” There is no need to get caught up in the grind of competitive decorating, shopping ‘til you drop, or agonizing over finding the right gift for that special person. It’s food, family, fun—and, of course, gratitude. After all, you can’t say Thanksgiving without the thanks.

I was lucky to learn at an early age how fortunate I’ve been and I try  to express my gratitude as much as possible. To be healthy, surrounded by family is a true blessing, even when coupled with difficult times. In recent years, I’ve been especially thankful for the opportunity to work at the Robert Wood Johnson Foundation (RWJF). My extended family at work is made up of warm, caring people who are passionate about our mission to ensure that all Americans have an opportunity to lead healthy and fulfilling lives—those same opportunities that I’ve been afforded.

In addition to the Foundation’s national efforts, RWJF makes a special effort in its home state of New Jersey. So last week, several colleagues and I volunteered at Mercer Street Friends Food Bank in Trenton—the largest source of government- and privately-donated food in Mercer County. The Food Bank channels 3 million pounds of food annually to the various food pantries, soup kitchens and shelters.

During our day there, we sifted and sorted, checked expiration dates on donated foods, and, because of the time of year, loaded up bags of Thanksgiving fixings for distribution for many of the 25,000 people at risk for hunger in Mercer County. These are families who go without what many of us often take for granted. It was interesting to me that the cellphones never appeared; there wasn’t that tug to keep checking email or follow Twitter feeds. It wasn’t spoken, but I think we all realized that what we were doing was too important, and deserved all our respect and attention. Even though our effort was small—after all, it was only one day—in someone else’s eyes it might be seen as something great.

As we worked, it brought to light for many of us the sheer volume of food needed, as well as what it takes to put together healthy offerings and supplies for the working poor, children in low-income households, the elderly, disabled, and homeless. I also reflected that, while Thanksgiving is a day when we do recognize what others do without, we don’t often remember that these families live in poverty and need our help—not just around Thanksgiving—but all year long. And not having basic everyday necessities, like nutritious food, can severely impact the health of families, particularly children.

So maybe Thanksgiving shouldn’t come only once a year. After all, aren’t we thankful for the things we have every day? The power of gratitude should be recognized as a challenge to be great—even in the smallest of efforts. Maybe that’s the magic about it.

I was proud—no, I was grateful—to work at Mercer Street Friends, and I will do it again. So as we enter the holiday season, count your blessings each and every day and let gratitude drive you to greatness.

Joan Barlow is the Foundation's Creative Services Manager.

Sprinting Toward Workplace Wellness

Dec 6, 2013, 2:25 PM, Posted by Ari Kramer

Graciela Ruiz

Lots of things can turn a person into a health and fitness nut. For many, it might be influence from friends, or a life episode that demonstrates the pitfalls of focusing too little on health.

For Graciela Ruiz, it was just a matter of landing a job at the right place.

When Ruiz started working at Wakefern Food Corp., the merchandizing and distribution arm for ShopRite and PriceRite stores, she was eating lots of processed foods, and exercise figured very little into her routine. She particularly hated running. “I wouldn’t run unless someone was chasing me,” she says.

One day, the organizer of Wakefern’s run/walk club signed her up for the Jersey Shore Relay Marathon. He gave her the race’s shortest leg, a 5K, and she trained hard and did better than expected. Fast forward five years, and Graciela is now highly active in the club and numerous other wellness programs at the company. She says she will “run for two hours and be happy about it,” and has changed her eating habits to a point where “I’ll eat vegetables all day long.”

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A New Holiday Tradition—Tasty Recipes that are Healthy, Too

Nov 26, 2013, 5:01 PM, Posted by Cathy Arnst

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Thanksgiving is almost upon us, ushering in a month-long season of holiday parties, groaning boards of food, favorite family recipes, cookie swaps, and an extra five pounds around the waistline. Instead of just giving in to the excess and making January the month of dieting, perhaps we could make a few adjustments. I’ve asked around the Foundation staff for some healthy holiday recipes instead of the usual green bean casserole and cream-laden sides. Here are some tried and true alternatives, that are kid–friendly as well!

In fact, why not invite any children about the house (or adults who are still kids at heart) to help whip up some of these dishes. Children love to grate, stir, and shake, and the older ones will go at chopping with a vengeance. It’s never too early to teach them to cook, as discussed on this blog a few days ago.

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“An Educated Consumer is Our Best Customer:” Four Things to Know About Transparency In Health Care Prices, Costs and Quality

Nov 26, 2013, 10:14 AM, Posted by Susan Dentzer

Watch our December 6, 2013, FirstFriday Google+ Hangout archive on transparency in health care.

Panic about high health insurance premiums. Fears about high-cost health-care providers being cut out of health plan networks. Worries that the health plans now available through health insurance exchanges won’t cover the care that patients need.

Welcome to the rollout of Obamacare....right?

Actually, with the exception of the new health insurance exchanges, all of the phenomena described above have a long history. Similar concerns were voiced loudly in the late 1980s and 1990s, when “managed care” in health insurance became a dominant force on the health care and health insurance landscape.

What’s amazing to people who lived through both of these eras—then and now—is how little has changed.  

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Get Out of the Drive-Thru Lane. Learn to Cook!

Nov 22, 2013, 1:32 PM, Posted by Cathy Arnst

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Some statistics worth pondering: According to the U.S. Bureau of Labor Statistics, the average American spends only 33 minutes a day on food preparation. Just over half of Americans bother to cook every day. On the other hand, 33 percent of children and 41 percent of teenagers eat fast food, every single day.

These fast food children are consuming 126 additional calories, and the teens 310 extra calories, than if they had avoided the chains, says Fast Food Facts 2013, a new report by the Yale Rudd Center for Food Policy & Obesity and funded by RWJF. Most of these children are eating adult meals, too, not the smaller-portioned children’s meals on offer. Not that it would matter, since less than one percent of all kids’ meal served at fast food chains meet recommended nutrition standards.

It’s not much of a stretch to link the lack of home cooking, a diet of fast food, and the fact that a third of U.S. children and adolescents are obese. So, what’s a parent to do? Well for one thing, we could learn to cook.

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Shielding Young Brains from the Effects of Toxic Stress

Nov 13, 2013, 3:45 PM, Posted by Kristin Schubert

Child First

Before the science on addiction was developed, we blamed smoking on bad choices. Once we understood how the brain worked, we were able to devise strategies to change behavior, and smoking plummeted. 

As David Bornstein points out in two outstanding recent New York Times columns, the science of toxic stress is setting the stage for another health revolution that is just as far-reaching. It is forcing us to rethink the way communities deliver services─health care, education, and more─to our most vulnerable.

Read the first column

Read the second column

Every day, there are young children who are abused. Who witness violence in their homes or neighborhoods. Who are malnourished. Or who have parents who struggle with drug or alcohol use. We now know that those adverse experiences change the way their young brains develop, and affect their mental and physical well-being later in life. These children are more likely to have heart disease, cancer, and hypertension as adults. They are more likely to use drugs, suffer from depression, and commit suicide. They are more likely to drop out of school, spend time in prison, and be homeless. 

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Engaging Communities of Faith to Help Americans Gain Health Insurance

Nov 13, 2013, 2:46 PM, Posted by John R. Lumpkin

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With the opening of health marketplaces and the Affordable Care Act’s partial expansion of Medicaid, our nation has an opportunity to substantially expand health insurance coverage for all Americans, and ultimately, to significantly reduce racial disparities in access to affordable coverage.

But to achieve that goal, communities of color must attain robust enrollment gains. That’s why RWJF is working with religious leaders and their congregations to help make sure that all who are eligible enroll.

The Problem

According to United States Census data for 2012, approximately 48 million Americans are uninsured. It is a problem that cuts across all racial and ethnic groups, but is most acute in two, resulting in 19 percent of African Americans and more than 29 percent of Hispanics living without health insurance.

In 2009, the Institute of Medicine documented what many suspected: The uninsured are much less likely to obtain preventive care; get timely diagnoses for illnesses, including cancer; receive treatments for chronic illnesses such as diabetes and asthma; and take prescription medications as recommended by physicians.

Beyond the health consequences of uninsurance, there are steep costs for our economy. We all pay the bill for indirect fiscal burdens associated with the uninsured—including illness and injury, decreased workforce productivity, developmental and educational losses among children, and shorter life spans, costing the U.S. economy between $100 and $200 billion each year.

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Communities Need More Ladders, Fewer Chutes

Nov 8, 2013, 1:33 PM, Posted by Katie Loovis

GSK IMPACT Grants GlaxoSmithKline supports some urban redevelopment projects because they lead to healthier communities—this piece of artwork, for example, inspires community members to bike around town. (Photo: GSK)

Katie Loovis is director of U.S. community partnerships and stakeholder engagement for GlaxoSmithKline, the global health care company. In this role, Katie is responsible for providing leadership and shaping strategy for GSK’s U.S. community engagement and philanthropic activities at the national, state, and local levels, and building relationships.

Chutes and Ladders—one of the greatest board games in human history—is a game of rewards and consequences. You make a move and are met with a benefit (ladder to a higher level) or a detriment (chute to a lower level). All the while, you’re aiming for the top, journeying toward the blue ribbon finish.

Living a long and healthy life is kind of like a game of chutes and ladders. You might go along thinking that by visiting your doctor every year (ladder) and choosing to nosh on lots of veggies (ladder) that you are on-track, but ... sorry! Your neighborhood lacks a grocery store stocked with healthy foods (chute), it doesn’t have any safe parks or green spaces to exercise (chute), you live in a house full of smokers (chute); and to top it all off, you just lost your job in this tough economy (chute !).

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Enrollment through Health Insurance Exchanges Lagging, but Humming Along In Medicaid in Many States

Nov 4, 2013, 1:22 PM, Posted by Susan Dentzer

Susan Dentzer Susan Dentzer

Amid the attention focused on technology flaws of the nation’s new health insurance exchanges, a happier story has received less attention:  the relative ease with which many Americans newly eligible for an expanded Medicaid program are now enrolling in coverage in many states. There’s a lesson in this story for all of us—that governments at many levels can, and often do, get things right. But sometimes it takes years of effort, policy changes, big dollar investments, and improved know-how to make all the processes work.

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