Category Archives: Health reform

Dec 18 2013
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RWJF Clinical Scholars Podcast: NY Health Commissioner Discusses Health Reform

In his first two years in office, New York State Health Commissioner Nirav Shah, MD, MPH, has been deeply engaged in the state’s ambitious Medicaid redesign process. Shah oversees the $50 billion state public health agency and has been praised for his health system reform efforts. Moving forward, he is focusing on issues such as securing federal funding for “supportive housing” to offer chronically ill, low-income individuals subsidized living quarters in building complexes that also contain in-house medical and social services.

Shah, an RWJF Clinical Scholar alumnus, discusses this and more in the latest Robert Wood Johnson Foundation (RWJF) Clinical Scholars Health Policy Podcast, a monthly series co-produced with Penn’s Leonard Davis Institute of Health Economics and hosted by RWJF Clinical Scholar Chileshe Nkonde-Price, MD.

The video is republished with permission from the Leonard Davis Institute.

Nov 8 2013
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Lessons from Around the World at the APHA Annual Meeting

Michelle L. Odlum, BSN, MPH, EdD, is postdoctoral research scientist at Columbia University School of Nursing in nursing informatics. She has more than ten years of experience as a disparities researcher working on a variety of research, evaluation, and health promotion initiatives affecting vulnerable populations. Odlum is a recent recipient of the Robert Wood Johnson Foundation’s (RWJF) New Connections Junior Investigator award. 

Michelle Odlum Michelle L. Odlum

At this time when our nation’s health care reform is promoting new approaches to primary care, an exploration of health care models from around the globe is essential. With my interest in the transformative role of nursing care, I decided to attend the scientific session [at the American Public Health Association’s annual meeting] entitled: Think Global, Act Local: Best Practices Around the World.  Panelists presented on a variety of interesting care models from Europe to Central America.

As we explore initiatives to improve care coordination, it was interesting to hear Erin Maughan, RN, PhD, APHN-BC, an RWJF Executive Nurse Fellow, talk about Scotland’s care coordination approach to children’s health. Maughan discussed home visitors, who provide care to children from birth to five years of age. An important aspect of the relationship forged with children and families is to allow for early identification of developmental needs, thus allowing for timely utilization of resources and services to address these needs. Interestingly, to support effective care outcomes for children with chronic illnesses over the age of five, each family is assigned a district nurse who is a chronic disease specialist.   

Scotland has also coordinated health forms utilized by police, schools, and health care facilities; this is a team-centered approach for identifying and working with at-risk children. Scotland’s pediatric care model demonstrates the effective utilization of public health nurses and the implementation of inter-agency care coordination. We, as a nation, can certainly benefit from further understanding of these approaches. 

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Nov 4 2013
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Stimulating Primary Care Transformation

Michael Hochman, MD, MPH, is medical director for Innovation at AltaMed Health Services, a 43-site federally qualified health center in Southern California.  He completed the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program at the University of California, Los Angeles, and the U.S. Department of Veterans Affairs in 2012.  While a Clinical Scholar, Hochman co-led a primary care demonstration that was published last month in JAMA Internal Medicine.  He recently published, 50 Studies Every Doctor Should Know.

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Primary care in the United States is at a crossroads.  As health care becomes increasingly disjointed and costs continue to rise, primary care providers face increasing pressure to take charge of the health system.  Indeed, we know that health care systems with more developed primary care infrastructures are more efficient and of higher quality than those with a weaker primary care foundation.

But at the same time, more and more health care professionals are shying away from careers in primary care.  Not only is the work challenging (late-night phone calls, numerous tests and studies to follow up on, ever-increasing regulatory requirements), but the pay is lower than in other fields of medicine.

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Oct 18 2013
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Who Will Benefit From Medicaid Expansion and What Will it Mean for These Patients?

Tammy Chang, MD, MPH, MS, is an assistant professor in the Department of Family Medicine at the University of Michigan Medical School and an alumnus of the Robert Wood Johnson Foundation Clinical Scholars program.

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Over kitchen tables as well as on Capitol Hill, the discussion continues over the Affordable Care Act including who will benefit and what it means for everyday Americans.

To shed light on this debate, my co-author Matthew Davis, MD, MAPP, and I recently published a study that describes the characteristics of Americans potentially eligible for the Medicaid expansion under the Affordable Care Act.  The study, published in the Annals of Family Medicine, uses a national source of data used by many other researchers who look at national trends—such as high blood pressure and obesity—called the National Health and Nutrition Examination Survey (NHANES).

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Aug 22 2013
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Human Capital News Roundup: Lead exposure and behavior problems, debt's impact on health, health exchange 'navigators,' and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

More Americans are dying from obesity than previously thought, according to a new study by Ryan Masters, PhD, an alumnus of the RWJF Health & Society Scholars program. In recent decades, 18 percent of deaths of Americans ages 40 to 85 can be attributed to obesity, NBC News, USA Today, and the Los Angeles Times report, which is much higher than the often cited 5-percent toll.

Pennsylvania Governor Tom Corbett last week signed a new health care law based on a plan designed by RWJF Community Health Leader Zane Gates, MD, the Philadelphia Inquirer reports. The measure will provide $4 million to community health centers in rural and underserved areas.

Children exposed to lead are nearly three times more likely to be suspended from school by the 4th grade than their non-exposed peers, according to a study co-authored by Health & Society Scholars alumna Sheryl Magzamen, PhD, MPH. “We knew that lead exposure decreases children's abilities to control their attention and behavior, but we were still surprised that exposed children were so much more likely to be suspended,” she told Science World Report.

WHYY (Philadelphia) spoke to RWJF Executive Nurse Fellows alumna Cheri Lee Rinehart, BSN, RN, about grants to train "navigators" to assist people as they purchase insurance through health exchanges. Rinehart is president of the Pennsylvania Association of Community Health Centers, one of five groups in the state that are receiving the federal funds.

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Jul 31 2013
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Implementing the Affordable Care Act: Getting Beyond Drama to the Real Deal on Health Reform

Linda Wright Moore, MS, is a senior communications officer at the Robert Wood Johnson Foundation (RWJF).

Linda Wright-Moore

The swirl of controversy and nonstop debate around the Patient Protection and Affordable Care Act  (ACA) is like a play that never ends: Every time you think you’re coming to the finale, another character or plot twist crops up—and the production drags on … and on.

So it goes with the ACA: Last year, the U.S. Supreme Court ruled the new law to be mostly sound, but fudged on the state mandate to expand Medicaid just enough to keep the drama twisting and turning—and to make many poor and uninsured people ineligible for government subsidies.

Meanwhile, repeated attempts to repeal the law—at least 38 to date—have contributed to a jarring statistic: 42 percent of Americans are unaware that the ACA is the law of the land. In light of the lack of knowledge that the health reform law is the law—it’s no surprise that half of the public admits to not having enough information to understand the likely impact of the ACA on themselves and their families.

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Jun 25 2013
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HealthCare.gov

This week, the U.S. Department of Health and Human Services is rolling out a new website that provides educational tools designed to help people understand their insurance choices and select coverage that best suits their needs when open enrollment begins on October 1st.  With 99 days to go until then, the new effort includes a consumer call center that will offer help to consumers in more than 100 languages. It will eventually employ 9,000 people, who will answer questions from the public 24 hours a day.

HealthCare.gov is designed to be the destination for the new Health Insurance Marketplace, also called exchanges. The new website will add functionality over the next few months so that, by October, a consumer will be able to create an account, complete an online application, and actually shop for an insurance plan.

For Spanish speakers, CuidadoDeSalud.gov offers the same information and functionality in Spanish.

Jun 18 2013
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Where Supply Meets Demand: Why Medical Students Should Aim Their Sights at Primary Care

Italo M. Brown, MPH, is a third year medical student at Meharry Medical College. He holds a BS from Morehouse College, and an MPH in epidemiology and social and behavioral sciences from Boston University, School of Public Health. He is a Health Policy Scholar at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College.

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In an ad-hoc poll among classmates, I recently inquired about the most important date (in 2013) to a second year medical student. The overwhelming majority of respondents cited their respective STEP 1 exam dates as most important, followed closely by the season finales of ABC’s Scandal and Grey’s Anatomy. While the top three responses are noteworthy, the one date that should bear the most gravity in the minds of medical students across cohorts is October 1st.

This October marks the launch of open enrollment for health insurance exchanges, a much-anticipated provision of the Affordable Care Act (ACA). The ACA seeks to reduce the number of nonelderly uninsured Americans by half; in other words, a projected 20 million new patients will enter the health care system over the next 18 months.

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Mar 29 2013
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Facing What May Be the Affordable Care Act’s Ultimate Challenge: The Gap Separating Evidence from the Policy-Makers Who Need It

David Grande, MD, MPA, is an assistant professor of medicine at the University of Pennsylvania's Perelman School of Medicine, a senior fellow at the Leonard Davis Institute of Health Economics, associate director of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program and an alumnus of the RWJF Health & Society Scholars program. This is part of a series of essays, reprinted from the Leonard Davis Institute of Health Economics’ eMagazine, in which scholars who attended the recent AcademyHealth National Health Policy Conference reflect on the experience.

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It’s a time of unprecedented upheaval in U.S. health care. Big changes are bursting through on virtually every front. Legislators and administrators in Washington and 50 state capitals struggle daily to reinvent their health care systems even as they lack an exact blueprint for the new things they’re supposed to be building.

This was nowhere more evident than at the recent AcademyHealth National Health Policy Conference, where state and federal officials and interest groups lined up to present long lists of policy questions that confront them as they grapple with implementation of the Affordable Care Act and mounting public budgetary pressures.

Managing 'Churn'

For instance, in the “Opportunities & Challenges for State Officials” session, New Mexico’s Medicaid Director Julie Weinberg described the unknowns surrounding how “churn” between private and public coverage will change and how new Medicaid eligibility standards will impact enrollment processes.

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Mar 22 2013
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A ‘Goldilocks’ Theorem of Shared Savings and ACOs

Brendan Saloner, PhD, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar in residence at the University of Pennsylvania and a senior fellow at the Leonard Davis Institute of Health Economics. This is the first in a series of essays, reprinted from the Leonard Davis Institute of Health Economics’ eMagazine, in which scholars who attended the recent AcademyHealth National Health Policy Conference reflect on the experience.

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Like Goldilocks wandering through the house of the Three Bears, policy-makers in search of a health care payment model have found it difficult to settle on an option that is "just right."

Fee-for-service—paying doctors separately for each service they provide—leads to too much unnecessary and duplicative care (too hot!). Capitation—paying doctors a fixed fee for caring for patients—leads doctors to skimp on care and avoid costly populations (too cold!). A "just right" payment model should give providers incentives to provide all the clinically necessary care to patients while keeping costs low.

Shared savings models—allowing providers to keep a portion of the money they save caring for patients—have been touted as one method for aligning the incentives of providers and payers. Most prominently, shared savings is a central element of the Affordable Care Act's Accountable Care Organizations (ACOs).

An ACO is a network of providers that have agreed to accept a bundled payment for treating patient populations, and in return stand to gain incentive payments for meeting performance targets (or to lose money for missing targets). In the "happily ever after" version of ACOs, groups of providers will finally have a business case for coordinating patient medical records, reducing costly visits to the emergency room, and improving patient compliance with chronic disease therapies without leading to excessive procedures or gaps in care. Healthy patients, healthy profits.

But will it work?

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