Category Archives: Access and barriers to care

May 1 2014
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RWJF Clinical Scholars Video Podcast: Group Health CEO Scott Armstrong on Hospital Closures

In 1986, Scott Armstrong, MBA, joined Group Health Cooperative to manage the Washington- and Idaho-based health care organization’s hospitals. But as he explains in a new Robert Wood Johnson Foundation (RWJF) Clinical Scholar Policy Podcast, in his role as President and CEO of Group Health, he has led the organization in shuttering those same hospitals. He tells RWJF Clinical Scholar Elizabeth Brown, MD, that the move followed a successful push to reduce per member hospital utilization. Group Health now relies heavily on community hospitals, and focuses its providers’ attention on caring for patients leading up to hospital admission and after discharge. The move, he says, has lowered Group Health’s costs while helping local hospitals put otherwise unused capacity to work. Armstrong believes the Group Health experience foreshadows changes for the health care industry more broadly.

The video podcast is part of a series of RWJF Clinical Scholars Health Policy Podcasts, co-produced with Penn’s Leonard Davis Institute of Health Economics.

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

Apr 29 2014
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How to Address Disparities? Meet Patients Where They Are, Connect Health to Community Values.

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Elizabeth Gross Cohn, PhD, RN, an assistant professor at the Columbia University School of Nursing, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” Cohn is an RWJF Nurse Faculty Scholar.

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How can we get more people to think pro-actively about health and health care? One approach would be to identify what people value and think about how to fold health into that equation—especially for populations where disparities exist, like health screening for men. 

In the case of where I live, the answer was cars. Long Island loves cars: hot rods, customs, muscle cars, and classic cars. We are fascinated with antique fire apparatus and old motorcycles. Long Island Cruizin' for a Cure leverages this fascination. Now in its tenth year, with 600 cars, this event attracts, screens, and educates more than 3,500 men about prostate cancer. 

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Apr 29 2014
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How Can Health Systems Effectively Serve Minority Communities? Shift the Cost-Access-Quality Axis.

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Italo M. Brown, MPH, a rising fourth-year medical student at Meharry Medical College, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Brown holds a BS from Morehouse College and an MPH from Boston University, School of Public Health. He is an alumnus of the Health Policy Scholars Program at the RWJF Center for Health Policy at Meharry Medical College.

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In our domestic health care system, we nurture the drive to improve patient outcomes, and apply evidence-based knowledge to solve contemporary health care challenges. Yet, studies have demonstrated that minorities are disproportionately affected by chronic conditions, and on average are less likely to receive ongoing care/management of their comorbidities. In addition, public health experts have asserted that social determinants of health (e.g., education level, family income, social capital) directly impact the minority community, and effectively convolute the pathway to care. 

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Mar 26 2014
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Where Evidence Meets Policy—and Politics

Annik Sorhaindo, MSc, is a senior program researcher with the Population Council’s Reproductive Health Program in Mexico. A 1997 alumna of the Robert Wood Johnson Foundation-funded Project L/EARN initiative, she conducts research to provide evidence that helps inform government policy. This post reports on her work.

Fifty-five percent of all pregnancies in Mexico are unplanned.

That dramatic statistic, from a report by the Guttmacher Institute, can be mapped to the limited access women have to contraception.

“Many women can’t readily obtain contraceptive methods,” says Annik Sorhaindo. As part of a five-organization alliance working to improve reproductive health in the world’s 11th most populous country, the council directs research and analysis for the effort.

“My work focuses on answering research questions: Which occurrences in daily life impact women’s decisions about contraception? What are the impediments to preventing teen pregnancy? What are the challenges to using contraception post-abortion?”

Sorhaindo is quick to note that the council stays above the political fray. “We do the research and interpret the results, and the advocacy organizations address the politics,” she says.

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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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Dec 3 2013
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The “Next Best Thing” to Being There: Robots Expand Physicians’ Reach

Telepresence robots are expanding access to specialists in rural hospitals experiencing shortages of physicians, and in other hospitals throughout the country, reports the Associated Press.

Devices such as the RP-VITA, introduced earlier this year, can be controlled remotely with a desktop computer, laptop, or iPad, allowing physicians to interact with patients through video-conferencing via a large screen that projects the doctor's face. An auto-drive function allows the robot to find its way to patients' rooms, and sensors help it avoid obstacles. It also gives the physician access to clinical data and medical images.

Dignity Health, a hospital system with facilities in Arizona, California, and Nevada, started using telepresence robots five years ago to promptly evaluate patients who had potentially suffered strokes.  Dignity now has robots in emergency rooms and intensive care units at about 20 California hospitals, giving them access to specialists in areas such as neurology, cardiology, neonatology, pediatrics, and mental health.

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Oct 16 2013
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Illinois Governor Declares “Carmen Velásquez Day”

For nearly 25 years, Robert Wood Johnson Foundation Community Health Leader Carmen Velásquez, MA, has helped members of Chicago’s immigrant community access the health care they need. She founded the Alivio Medical Center in 1988, which has now grown to six locations that serve 25,000 patients annually. Two more clinics are slated to open later this year.

In recognition of her work, Illinois Governor Pat Quinn proclaimed October 2, 2013 “Carmen Velásquez Day.” At an event celebrating Latino Heritage Month at the National Museum of Mexican Art in Chicago, Quinn called Velásquez “a true pioneer in public health policy and health care affordability.”

“As the immigrant population in the Pilsen neighborhood grew in the 1980s, Carmen Velásquez was among the first to see the crying need for a health clinic, so she went out and built Alivio Medical Center,” he said. “Hundreds of thousands of Illinoisans are alive today thanks to her, proving that one person truly can make a difference.”

Read more about Velásquez’ work.
Read a news release about “Carmen Velásquez Day.”

Aug 27 2013
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Report Finds No Drop in Physicians Treating Medicare Beneficiaries

The U.S. Department of Health & Human Services (HHS) last week released a report that looks at Medicare patients’ access to care before and after the enactment of the Affordable Care Act. The report from HHS’s Office of the Assistant Secretary for Planning and Evaluation finds that Medicare beneficiaries’ access to care has remained high and stable in recent years.

The percentage of office-based physicians accepting new Medicare patients remained stable from 2005 to 2012, at approximately 90 percent. That rate is “quite similar” to the number of physicians accepting new privately insured patients during the same time period, the report says.

The report also finds that the number of providers participating in and billing Medicare steadily increased during those years.

“Based on multiple data sources, Medicare beneficiaries’ access to care appears to be excellent: it has been stable over the past five years and is comparable to or better than access reported by privately insured individuals,” the report says.

Read the HHS report.

Aug 14 2013
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U.S. Needs Primary Prevention, Especially for the Poor and Underserved

Adrian L. Ware, MSc, is a third-year graduate student in public health at Meharry Medical College. He holds a BSc in biology from Alabama Agricultural and Mechanical University, and an MSc in biology and alternative medicine from Alabama Agricultural and Mechanical University. He is a Health Policy Scholar at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College.  He aspires to become a Christian psychiatrist serving the poor and underserved. Read all the blog posts in this series.

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With innovation, brilliance, passion, and robust planning, public health students and practitioners ask: How can we protect the health of the nation? According to the Centers for Disease Control and Prevention, seven out of ten deaths in the United States are caused by chronic disease. The need for more cost-effective, comprehensive care has never been greater. Within the world of public health, there are three levels of prevention: primary, secondary, and tertiary.

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Primary prevention reduces both the incidence and prevalence of a disease, because the focus is on preventing the disease before it develops. This can change the health of the nation for the better. Secondary and tertiary prevention are also significant.

It is well known that emergency care is vastly important, given the sheer complexity of episodic clinical cases that present to the emergency room in “life or death” situations. These “provisions” are necessary for the United States to uphold its high ideals of liberty and justice for all. Adequate, culturally competent, comprehensive health care for all citizens is a social justice issue, and a fundamental right. To this point, our health system’s extreme emphasis on tertiary care is amongst the most fiscally irresponsible ways to improve the health of the nation.

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Aug 13 2013
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Right, Privilege—or Tragedy of the Commons?

Matthew M. Davis, MD, MAPP, is associate professor of pediatrics, of internal medicine, and of public policy at the University of Michigan in Ann Arbor and co-director of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program. In February, he coauthored a commentary in the Journal of the American Medical Association that asked, to paraphrase: Why does the United States ensure universal access to basic, life-saving treatment in emergency rooms but not to more cost-effective, comprehensive, and preventive treatment, and how can it achieve the latter? The RWJF Human Capital Blog asked Davis and his coauthors, both RWJF Clinical Scholars, as well as others from RWJF programs, to respond to the question. Davis’ response follows. Read all the blog posts in this series.

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The debate about whether health care is a right or a privilege is familiar and polarized. A quick online search in this topic area yields strong statements, deeply held convictions, and stern admonishments for those who hold opposite views.

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As RWJF Clinical Scholars Kate Vickery, MD, and Kori Sauser, MD, (2012-14) point out in their recent blog posts, primary care physicians and emergency physicians can agree that the Emergency Medical Treatment and Active Labor Act (EMTALA)—by focusing exclusively on assuring access to emergency care—fails to ensure that health care is a right for all individuals in the United States across all health care settings. 

As the three of us wrote in a Journal of the American Medical Association commentary earlier this year, the Patient Protection and Affordable Care Act (PPACA) will likely fall short of ensuring health-care-as-a-right-for-all as well.[1] That’s largely because one-to-two dozen Americans (or more) will likely remain uninsured even with implementation of all of the coverage provisions of the PPACA. Congress did not have the appetite for even broader coverage initiatives that were considered in PPACA discussions but ultimately left out of the legislation.

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