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Author Archives: Tara Oakman

Is More Always Better? Not Necessarily When It Comes to Health Care

Oct 19, 2015, 8:00 AM, Posted by Emmy Ganos, Tara Oakman

Health care professionals, patients, and allies across the nation are banding together to promote an understanding of what good medical care can and should be with RightCare Action Week.

Red buttons display the motto, "Right Care Right Now."

Sometimes, more is definitely better. Getting that extra hour of sleep can greatly benefit your mind, body and day. Cars that get more miles per gallon are cheaper and cleaner to run. And who would argue against more vacation time?

But when it comes to health care, more is not always better. Unnecessary diagnostic tests, treatments or hospitalizations can drive up health care costs, and in some cases, actually harm patients. For example, excess imaging increases exposure to radiation. Overuse of screening and diagnostic tests can lead to stressful false positives. And unnecessary treatments, drugs or procedures increase the risk of serious complications. In the larger picture, the estimated $200 billion spent on inappropriate care each year diverts resources away from services that are actually needed both within and outside of the health system—in mental health, housing, and infrastructure, for example—that can help all Americans lead healthier lives.  

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Retail Clinics Are Expanding Their Role Within the Health Care System

May 6, 2015, 3:38 PM, Posted by Tara Oakman

With convenient weekend and after-hours care, retail clinics have the potential to expand access to basic primary care and help address some non-clinical needs underlying the social determinants of health.

A CVS Retail Clinic at the corner of a street.

My husband had been suffering from a very painful sore throat for a couple of days when he finally decided to call his doctor. Just one problem: It was a Friday morning and the office was booked for the day. The doctor called back later in the afternoon and told my husband it sounded like a virus and he should simply “wait it out.” With the weekend approaching, the next available appointment—if needed—was on Monday. Rather than suffer all weekend with a raw throat, my husband followed the advice of a relative (who also happens to be a physician) and went to a clinic at our local CVS. Less than an hour later he was diagnosed with strep throat and started on antibiotic therapy he picked up at the pharmacy. By Saturday evening he was feeling a lot better.

Access to quick, convenient care on nights and weekends is one of the prime selling points of “retail clinics” based in pharmacies, groceries, and big-box retailers. With longer operating hours and no need for an appointment, these clinics, sometimes called “doc-in-a-box,” give patients more flexibility to avoid time away from work and family. Plus, a trip to a retail clinic costs about one-third less than a visit to a doctor’s office, and is far cheaper than an emergency room. Retail clinics usually accept private insurance, Medicare, and, in many cases, Medicaid; yet people without insurance or a personal physician also are using them for treatment of routine illnesses, basic health screenings, and low-level acute problems like cuts, sprains, and rashes.

New shopping list: Pick up milk, breakfast cereal, and toilet paper; get a flu shot and that weird rash checked out.

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When It Comes to What Consumers Value in Health Care, One Size Does Not Fit All

Feb 5, 2015, 9:00 AM, Posted by Tara Oakman

Pioneering the Use of Personal Health Data

My husband and I recently bought our first house in Princeton, N.J. We had looked at several houses, all within a similar price range. But price wasn’t the only factor, and simply having a roof over our heads wasn’t our only goal. We wanted a place that allowed us to walk to town and had a yard for the kids to play in, as well as a garage and storage space. We didn’t care so much about some things that might be important to other people, such as the size of the bedrooms or any particular architectural style. Figuring out what was most important to us, what would be a high-value house for us—the people who would be living in the house—was just part of the process.

Just as people have widely varying preferences when it comes to a home purchase, they also have very different preferences and priorities when it comes to their health care. For example, I might prefer a primary care doctor who has weekend and evening hours, whereas my mom might prefer one who has a reputation for spending more time with patients. At least right now, Mom and I just care about different things.

What does “value” in health care mean to consumers generally—and not just consumers overall, but consumers of many different backgrounds and perspectives? What matters to people when they are choosing their health plan, which doctor to go to, or whether to go to a retail clinic, and what might make for a high-value experience in different health care settings? It’s hard to know, because today value is typically measured more from the perspective of payers and providers.

So that is why, this week, the Robert Wood Johnson Foundation and AcademyHealth, released a call for proposals to better understand what factors are most important to consumers when they make health care decisions.  

In building a Culture of Health, we realize “value” won’t mean the same thing for everyone, any more than it does when you’re buying a house. But unlike in home buying, we don’t have many tools and supports in place to help people make their own high value decisions. In health care, we don’t have enough information about what people care most about. This is what we want to find out.

Tara Oakman

Tara Oakman, PhD, is a senior program officer at the Robert Wood Johnson Foundation focusing on strengthening vulnerable children and families and working to improve the value of national investments in health and health care. Read her full bio

Why Empathy is Essential to a Culture of Health

Apr 11, 2014, 11:34 AM, Posted by Tara Oakman

Peace activist Zak Ebrahim speaks at TED 2014.

Everyone knows it is hard to get 2-year-olds to do anything on a schedule. They want to do everything their way, on their own time. As you can imagine, trying to get my twins out the door each morning—let alone take a bath or eat a meal, can be quite a challenge. After trying a number of different parenting methods, I have discovered that the one way I can usually motivate them is to talk about feelings, and get them to recognize how their actions affect their sibling. Just yesterday, the only way I could get my son out of the bath was by telling him that his sister was sad and lonely waiting for him. And then, and only then, did he move.

Building empathy has been a critical strategy in my household of late—not only because it helps motivate them, but also because it is an important part of their social development. Lately I have been thinking about empathy on a larger scale, beyond my household, and how critical it is to building a Culture of Health.

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ACOG Issues New Guidelines to Curb Overuse of C-Sections

Feb 27, 2014, 5:27 PM, Posted by Tara Oakman

Tara Oakman holding her twin babies. Tara Oakman

While I knew that having children would turn my world upside down, I assumed that this transition would be more metaphorical than literal. Ha! Moments before I was discharged from a Maryland hospital a few days after my twins were delivered by c-section, the ground shook violently. My husband had just left the hospital room to get the car, so I was alone with two newborns and a painful surgical wound. All I could think was ... “This is an earthquake! I have two babies. And I can’t move!

One of the scariest parts of the experience was that I couldn’t respond to my maternal instinct to quickly pick up and protect my babies because I had just had major abdominal surgery. Granted, managing in an earthquake is not a common part of recovery from a C-section, but there can be many other dangerous complications that occur more frequently, such as infection, emergency hysterectomy or heavy blood loss. It can also lead to greater difficulty with breastfeeding. C-sections are also very costly, even if there are no major complications. They are much more expensive than vaginal delivery.

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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.

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When it Comes to Health Care, We’ve Been Living in the Land of Oz for Too Long

Sep 6, 2013, 4:30 PM, Posted by Tara Oakman

Cost Report April 2013

“Pay no attention to the man behind the curtain! The Great and Powerful Oz has spoken!” 

In some ways, our health care system has traditionally functioned much like the fantastic land of Oz depicted in one of my favorite movies.  Consumers and purchasers are expected to be passive consumers, doing what they are told and paying whatever price is levied based on a high degree of trust and limited information. This model seems increasingly ridiculous. We now face an urgent need to improve the quality and efficiency of our health care system.

But to do that, we need information, a lot of information. Health professionals, purchasers, consumers—basically anyone who comes in contact with health care—need timely, accurate, comprehensive information on cost and quality if they are to make smart decisions. Without such information, not even a wizard could do the trick. But right now, such information is usually unavailable, or, when it is accessible, too often indecipherable. In fact, the Institute of Medicine estimates that $105 billion is wasted every year in the U.S. because of a lack of competition and excessive price variations in health care, and a lack of information on the price of health care services plays a large role in this waste.

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