Category Archives: Health Care in 2014

Feb 24 2014
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Generation Y’s Role in Making the Marketplaces Work and Advancing a Culture of Health

Sue No, RN, BSN, is a fellow in the Robert Wood Johnson Foundation Nursing and Health Policy Collaborative at the University of New Mexico (2013-2017). She is working toward her PhD in nursing with a concentration in health policy. This post is part of the “Health Care in 2014” series.

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Every New Year brings New Year’s resolutions. It is a time for reflection on years past and to develop actionable changes needed for a hopeful and productive new year. Clearly 2014 is no exception. With the New Year already in full swing, I encourage people—yes, this also includes you, Generation Y—to enroll in a health insurance plan and take advantage of the Affordable Care Act’s (ACA) current and new coverage opportunities in an effort to advance our nation’s culture of health.

You might be asking yourself a few questions such as: Who is Generation Y and why are they important? I am happy to provide answers.

The largest generation, Generation Y, or Millennials, consists of young adults born between 1977 and 1994. This important demographic is key to obtaining a sustainable health care exchange system with affordable insurance plans. Healthy Millennials must enroll in the marketplace to offset the high costs acquired by the disproportionate number of Americans with high medical costs. Unfortunately, only a small number of young adults have participated in the health care exchange since open enrollment. This isn’t surprising. 

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Feb 19 2014
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School-Based Health Centers: A Bridge to a Healthier Future

Elizabeth Dickson, MSN, RN, is a fellow in the Robert Wood Johnson Foundation (RWJF) Nursing and Health Policy Collaborative at University of New Mexico. Earlier in her career, she worked at a school-based health center (SBHC). This post is part of the “Health Care in 2014” series.

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As a public health nurse, I have worked with children in schools for much of my career.  From 2009 until 2013, I worked at a SBHC in New Mexico that was located in an alternative high school in southern Albuquerque. Although small, many students at this school came from families of mixed immigration status and had experienced high levels of street violence, alcohol and drug abuse and overdose, suicide, poverty and food scarcity, minimal health care access, and high teen pregnancy rates.

These kids saw and experienced more than many outsiders of the community could have imagined. The SBHC was open one day a week during school hours and employed a staff that included a nurse practitioner, a physician assistant, public health nurses, administrative staff, and mental health counselors. I worked with an incredible team that provided many health services and screenings, including mental health support, in the limited time that we had.

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Feb 14 2014
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Affordable Care Act Marketplaces Can Contribute to Health System Transformation!

Jay Himmelstein, MD, MPH, is a professor of family medicine and community health and chief health policy strategist at the Center for Health Policy and Research at the University of Massachusetts Medical School (UMMS). He serves as a senior advisor to the UMMS Office of Policy and Technology, and is a senior Fellow in health policy at NORC, University of Chicago. Himmelstein is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program, where he worked on the health staff of Senator Edward Kennedy. This post is part of the “Health Care in 2014” series.

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The nation's attention has focused in recent months on the politics and challenges related to the roll-out of state and federal health insurance marketplaces created by the Affordable Care Act (ACA). Despite website technical woes, significant numbers of Americans have already gained access to affordable insurance plans through the marketplaces and other provisions of the ACA, and it appears likely that the ‘marketplace’ concept will be successful over time in connecting consumers to health insurance and significantly decreasing the ranks of uninsured.

The better functioning marketplaces currently allow consumers to: 1) determine eligibility for subsidized health insurance, 2) use basic online shopping tools to compare and purchase health insurance plans based on four different "metallic tiers" (i.e., the platinum, gold, silver, and bronze tiers), and 3) make side-to-side comparisons between these plans on features such as deductibles, out-of-pocket cost limits, and number and proximity of doctors and hospitals. A few marketplaces also offer information about plan quality, the ability to search for health care providers and hospitals associated with specific plans, and rudimentary ‘cost calculators’ which estimate the total cost of plans inclusive of premiums, deductibles, and out-of-pocket costs.

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Feb 10 2014
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A New Nurse Promises to Focus on the Fundamentals of Providing Care During This Turbulent Time

Carli A. Culjat, BSN RN, is a staff nurse in the Emergency Department at Bryan Medical in Lincoln, Neb., and an alumna of the Robert Wood Johnson Foundation New Careers in Nursing program. She graduated with her BSN from the Creighton University School of Nursing. This post is part of the “Health Care in 2014” series.

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As a new graduate and a young person, I am very eager to see what will happen to my country, my career, and my own future with the changes taking place in the U.S. health care system.  As I walked across the stage receiving my diploma, my emotions developed and they included excitement, relief, and fear of the unknown.  I believe our county is facing similar emotional complexity. As a new graduate and new employee – change can bring forth so many emotions, especially on the large scale that is taking place in health care today.

The media covers the controversy of the situation and as a former student, my class still uses social media to reach out and develop opinions on the changes and their possible effects.  Fear creates controversy and with this, we see so many different perspectives and reactions.  Even still, I believe our country is excited for a change and ready for the health care system to evolve into a system that we can be proud of and utilize.

There are many who are relieved, myself included. I am relieved that employment is an option at this time in this changing system, I am relieved that our country has taken the initiative to address a need, and I am relieved that I have an education and position that I can use to assist, in the best way a single person can, in health care reform—as a frontline person, a staff nurse in an Emergency Department.

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Feb 7 2014
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A Call for Better Measures: The Well-Being of a Population is Consequential

Cary Gross, MD, is a professor of medicine and co-director of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program at Yale University. Carley Riley, MD, MPP, is an RWJF Clinical Scholar and Brita Roy, MD, MPH, MS, is an RWJF/U.S. Department of Veterans Affairs Clinical Scholar. This post is part of the “Health Care in 2014” series.

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As a new year begins, we are inundated with information summarizing the prior year: the top 10 movies, most newsworthy moments, and worst Hollywood breakups. Yet the topic that draws the most attention is the economy and our financial health. We gather a tremendous amount of information to assess this. The Census Bureau randomly selects 60,000 households each month, unleashing a swarm of 2,000 field representatives to track down the selected participants and assess their employment status. The Bureau of Labor Statistics surveys 500,000 businesses to estimate job creation. Approximately 5,000 “consumers” are surveyed each month to gauge their confidence. And so on.

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So there you have it: we know that in 2013, the unemployment rate decreased from 7.9 percent to 6.7 percent, about 2.1 million new jobs were created, consumer confidence increased, and the Dow Jones index rose by 26.5 percent. Certainly, the health of the national economy is important, but is this the type of health that really matters most? When envisioning a healthy life, many people think about the sort of health that allows us to engage in enjoyable activities, maintain strong interpersonal relationships, and feel that our lives have purpose. A full assessment of health—of individuals, communities, and the country—should assess these dimensions.

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Aren’t we already awash in data about health and well-being? Yes and no. There are abundant data concerning insurance status, prevalence of diseases, and utilization of health care. Additionally, large national survey efforts through the Centers for Disease Control and Prevention gather information on disease risk factors and health behaviors.  But well-being is not captured by these data. Well-being is a comprehensive construct accounting for interwoven facets—such as physical, mental, and social health—that together comprise a global assessment of true health. It refers to a positive state of health that allows for the pursuit of meaningful activities, formation of a cohesive social network, planning for the future, and coping with, overcoming, and even growing from negative events.

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Feb 5 2014
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Be Heart Smart: Addressing the High Burden of Cardiovascular Disease Among African-American Women

Nadia Winston, MSPH, is a graduate student at the University of Illinois at Chicago, School of Nursing, pursuing dual nurse practitioner studies in family practice and occupational health. She has a master of science in public health degree from Meharry Medical College and is a former scholar with the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College. This post is part of the “Health Care in 2014” series.

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Cardiovascular disease is the number one killer of African American women. It has become imperative for the nation to take back the reins of its health status and educate the public about this threat. The statistics are alarming. Black women are twice as likely to suffer from cardiovascular disease as women of other ethnicities. And according to the American Heart Association, cardiovascular disease kills nearly 50,000 African-American women annually. The reason for this disparity can be attributed to a lack of health knowledge, being overweight or obese, and lack of physical activity. Early intervention and action has been identified as the key to reducing this population’s risk of mortality from cardiovascular disease and related diagnoses.

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Addressing and raising awareness of the health risks associated with cardiovascular diseases for African American women has been quite challenging. Recognizing this issue, Vanessa Jones Briscoe, PhD, MSN, then a Health Policy Associate at the Center for Health Policy at Meharry Medical College, developed and implemented a culturally appropriate health education program to educate minority populations about unhealthy lifestyles. It is called the “Be Heart Smart” program.

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Jan 31 2014
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Resolve to Address Violence Against Women and Girls

Abigail L. Reese, CNM, MSN, is a fellow with the Robert Wood Johnson Foundation Nursing and Health Policy Collaborative at the University of New Mexico. She received her undergraduate degree from Princeton University and her master of science in nursing at the Yale School of Nursing. She has worked at a birth center on the U.S./Mexico border, and coordinated a federal women’s health grant in Vermont. This post is part of the “Health Care in 2014” series.

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My resolution for the U.S. health care system in 2014 is to make strides in addressing one of the greatest health disparities affecting women and girls in this society and the world over: the experience of interpersonal and sexual violence. The Centers for Disease Control and Prevention (CDC) tells us that, in this country, one out of every five women has experienced rape or attempted rape. One in four has experienced “severe physical violence” at the hands of an intimate partner. Furthermore, the evidence tells us that victimization and its consequences begin early. Nearly half of all women who experience rape are assaulted before the age of 18, and 35 percent will be re-victimized during their lifetime.

Those of us who provide health care services to women are first-hand witnesses to the health-related consequences of interpersonal and sexual violence. These women are at greater risk for a range of potentially devastating health problems including: debilitating depression and anxiety, substance use disorders, sexually transmitted infections, unwanted pregnancies, and giving birth to preterm or low birth weight infants. They have higher reported rates of frequent headaches, chronic pain (including chronic pelvic pain), diabetes, asthma, and irritable bowel syndrome, among other conditions. Therefore, many of the symptoms and conditions that bring women into our care are related to their experiences of violence.

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Jan 29 2014
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Serious Illnesses Changed Our Perspectives for 2014 and Beyond

Taura Barr, PhD, RN, is an assistant professor at the West Virginia University School of Nursing. Timothy Landers, PhD, RN, CNP, is an assistant professor at The Ohio State University College of Nursing. Both are Robert Wood Johnson Foundation Nurse Faculty Scholars. This post is part of the “Health Care in 2014” series.

Taura Barr Taura Barr and her family.
Timothy Landers Timothy Landers and his family.

This is the time of year when people consider how they are doing with their new year’s resolutions. The three most common resolutions are lose weight, improve finances, and exercise more. Two out of three of those resolutions involve health.

Sadly, most of these resolutions will fail.

While we rate our physical, emotional, and spiritual health as a top priority, in practice we often fall short. This seems to be especially true for us as health care providers and our health care system.

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Jan 27 2014
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A Year of Dramatic Increase in Insurance Coverage

Michael Geruso, PhD, is a Robert Wood Johnson Foundation Scholar in Health Policy Research at Harvard University and an assistant professor of economics at the University of Texas at Austin. This post is part of the “Health Care in 2014” series.

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2014 marks the start of coverage for those who are newly insured via the health insurance exchanges. In general, healthy behaviors and lifestyle are probably the most important inputs to health, especially for those of us free of serious chronic conditions. But for those of us who are sick, quality health care and access to drugs is crucial for health and happiness. We will soon know to what extent the health insurance exchanges have overcome their implementation problems and have connected previously uninsured Americans to health care.
 
When markets for health insurance work efficiently, they can deliver access to crucial health services to those who need and want them most. Unfortunately, free, unregulated markets for health insurance rarely function efficiently. The market failures in health care have long been noted by economists, most famously by Nobel Prize winner Kenneth Arrow, MA, PhD. In my view, one the most important changes that the Affordable Care Act (ACA) brings with it is an attempt to address and correct market failures via the exchanges.

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Jan 24 2014
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Better Health, Better Care, and Lower Costs Through Telehealth

Kristi Henderson, DNP, NP-BC, FAEN, is the chief advanced practice officer and director of telehealth for the University of Mississippi Medical Center, where she holds dual appointments in the School of Medicine and School of Nursing. She has an administrative and clinical practice as a family and acute care nurse practitioner, and is a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow. This post is part of the “Health Care in 2014” series.

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As we ring in the New Year, do any of these scenarios ring true for you or your family?

  • There is someone who suffers from diabetes but lives an hour from a diabetes specialist. They can’t stay in the community where they live for treatment and an already-taxing diagnosis becomes a burden to treat. What if there was a way that the diabetes specialist, diabetes educator, pharmacist, ophthalmologist, and nutritionist could all be brought to this patient virtually by way of today’s technology? What if there was a way for a treatment plan to be customized to each patient and adjusted in real-time from information uploaded from a smartphone?

  • There is someone who has heart failure and for every ‘flare up’ the only option is to go to the local emergency room (ER). Medication and check-up regimens are followed every year but the ER visits are the only way to see a health care provider at a moment’s notice. What if health stats, vital signs, and symptoms could all be tracked by the health care provider to identify subtle changes early on, or when symptoms begin to worsen, and interventions could avoid an ER visit? Imagine if symptoms, vital signs, weight and medication side effects were monitored while a patient with heart failure goes about their day, not just at their scheduled check-ups.

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