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How Can We Measure High Value Care? Consider the Patient Point of View

Jun 29, 2015, 4:43 PM, Posted by Anne Weiss

Health care is centered around human relationships, which is why it's so important the voices of the people the system is designed to help—patients and their families—are heard by those defining and measuring care.  

Summer has come at last! Along with all the usual endings and beginnings that come with this time of year, there’s an important new opportunity for those of us who are passionate about improving health care. The Medicare Access and CHIP Reauthorization Act of 2015 threw out Medicare’s old rules for paying physicians and substituted a new system, one that’s  supposed to reward physicians for delivering high quality, high value care. This is a game-changer many years in the making, but as with any complex new law, the details matter. How will Medicare define and measure high quality, high value care? We can get some hints from CMS’ new strategic vision for physician quality reporting.

If I were granted just one wish by the people who are going to define and measure high value care, I know what I’d say: listen to our voices, the voices of patients and families, the ultimate health care consumers. Listening to patient voices and providing care that is patient-centered can improve clinical outcomes, reduce “waste” in health care by reducing unnecessary testing, and increase the overall care experience for both patients and providers. Health care is centered around human interactions and relationships—it is critically important that those defining and measuring care truly hear the voices of the people the system is designed to help—patients and their families.

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Crafting Win-Win Solutions with Health Impact Assessments

Jun 22, 2015, 3:01 PM, Posted by Pamela Russo

Health impact assessments are a powerful way to help communities think broadly about the health implications and equity aspects of policies and projects, so that a comprehensive approach to health becomes routine.

Prison Alternatives Boosted by Health Impact Assessment

Last week, almost 500 attendees arrived in the nation’s capital for the 2015 National Health Impact Meeting. The impressive turnout is a testament to the growing importance of health impact assessments (HIA) as a tool to improve community health outcomes.

As this year’s meeting attendees know, an HIA is a process that helps evaluate the potential health effects of a plan, project or policy outside of the traditional health arena. The findings from a completed HIA can provide valuable recommendations to help communities more effectively foster better and more equitable health among their citizens.

The use of HIAs has grown rapidly from just a few dozen in 2000 to more than 350 completed HIAs today. Dozens more are in the works. The earliest HIAs were mostly applied to the built environment, such as zoning, land use and transportation decisions. However, today the field has expanded to include such areas as energy policies, criminal justice and living wages.

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New Report: Shifts in the Supermarket Aisles as Demand for Low-Calorie Options Grows

Jun 16, 2015, 10:50 AM, Posted by Victoria Brown

Research shows that supermarkets are responding to the growing demand for lower-calorie options, and that healthier options are good for their bottom line.

Supermarket aisle of juice packs and juice boxes.

At a very basic level, obesity is about an imbalance. Calories in and calories out need to be balanced, and if they’re not, we run the risk of gaining unhealthy weight. Now, that sounds simple, but of course we know it’s not. There’s so much that goes into the choices people, particularly children, are able to make about what they eat and drink and how much they move. The neighborhoods we live in―and where we buy foods and beverages―play an enormous role.

U.S. customers spend over $638 billion in supermarkets every year, so these stores have a major impact on what we all eat and drink every day. A recent report shows that, in keeping with recent changes to consumer demand, supermarkets are increasing their sales of lower-calorie items, and seeing financial benefits because of it.

Between 2009 and 2013, lower-calorie foods and beverages drove the bulk of supermarket sales growth, 59 percent, compared with just 41 percent for higher-calorie items. They also made up 58 percent of total supermarket sales.

This is great news, as it shows supermarkets are responding to the growing demand for lower-calorie options, and that their business performance is benefitting as a result.

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Making the Grade: An Assessment of the Healthy Weight Commitment

Jun 15, 2015, 10:00 AM, Posted by Ginny Ehrlich

Members of the food and beverage industry are taking steps to ensure that their investments towards the Healthy Weight Commitment are making a difference.

A mother and her daughter pushing full shopping carts outside a supermarket.

The food and beverage industries aren’t typically viewed as leaders in the movement to address the obesity crisis and alleviate food insecurity in the United States.

For that reason, the work of a consortium of 16 major food and beverage manufacturers and distributors is particularly interesting. The Healthy Weight Commitment Foundation (HWCF)—which includes such heavy-hitters as General Mills Inc, Kraft Foods Inc, and Nestle USA—is pioneering an innovative way to assess members’ philanthropic programs that target healthful eating and active living, to see just how much impact they’re having. The companies are trying to ensure that their investments--anything from support for local food banks to sponsorship of a 10k race promoting children growing up at a healthy weight-- really make a difference.

The ambitious effort involves a public-private partnership called Commitment to Healthy Communities (CHC) that teams the HWCF with the City University of New York School of Public Health. Using a specially designed framework, CUNY researchers will spend this summer evaluating which practices do and don’t work, on the program, company, and community levels.

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Mapping a Path to Longer and Healthier Lives Across Atlanta

Jun 10, 2015, 2:52 PM, Posted by Dwayne Proctor

The Atlanta skyline on a sunny day. Image via City Clock Magazine

Two Atlanta neighborhoods, Buckhead and Bankhead, are separated by a mere five miles. Even their names are just two small letters apart. And yet the high-end shopping mecca dubbed Buckhead boasts an average life expectancy of 84 years, while in Bankhead—a neighborhood in transition that’s home to a newly burgeoning arts community—its residents face a life expectancy that’s a full 13 years shorter.  

This map of Atlanta—one of a series from the Center for Society and Health at Virginia Commonwealth University (VCU), funded by RWJF, shows that our zip codes might be a better predictor of health than our genetic codes. Why? Because where we live affects our health and wellbeing in complex ways. Among them, according to VCU, are a scarcity of jobs and quality schools, and fewer opportunities to access healthy affordable foods and safe places to be active.

This isn’t the first time Atlantans have bore witness to to inequity in their community, and today, community leaders are drawing inspiration from their past. Here in the city that served as the capitol of the Civil Rights Movement, community leaders are responding just as previous generations once did—by bringing together a diverse coalition to advance health equity and serve as a model for communities far beyond the Peachtree State.

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Expanding Opportunities for Rural Communities to Get Quality Care

Jun 9, 2015, 4:58 PM, Posted by Susan Hassmiller

Initiatives like the Future of Nursing and Project ECHO are expanding opportunities for more communities to get quality health care and lead healthier lives regardless of ZIP code.

Buncombe Farm Land

I read recently in The New York Times about Murlene Osburn, a cattle rancher and psychiatric nurse, who will finally be able to start seeing patients now that Nebraska has passed legislation enabling advanced practice nurses to practice without a doctor’s oversight.

Osburn earned her graduate degree to become a psychiatric nurse after becoming convinced of the need in her rural community, but she found it impossible to practice. That’s because a state law requiring advanced practice nurses to have a doctor’s approval before they performed tasks—tasks they were certified to do. The closest psychiatrist was seven hours away by car (thus the need for a psychiatric nurse), and he wanted to charge her $500 a month. She got discouraged and set aside her dream of helping her community.

I lived in Nebraska for seven years, and I know firsthand that many rural communities lack adequate health services. As a public health nurse supervisor responsible for the entire state, I regularly traveled to small, isolated communities. Some of these communities did not have a physician or dentist, let alone a psychiatric nurse. People are forced to drive long distances to attain care, and they often delay necessary medical treatment as a result—putting them at risk of becoming even sicker, with more complex medical conditions.

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Building Healthier Places In Birmingham and Beyond

Jun 1, 2015, 11:46 AM, Posted by Susan Dentzer

How a section of Birmingham, Alabama is redeveloping and offering greater opportunities for people at multiple income levels. The secret? Engaging the community throughout the process.

With its elegant homes, pleasant park and bustling stores, the Woodlawn section of Birmingham, Alabama was described in a 1950 news article as “a really great section of Birmingham...typical of the fine things in life." Then came the racial unrest of the 1960s, disruption from urban renewal gone awry and white flight to Birmingham’s suburbs. Joblessness and poverty took root; the housing stock decayed. Today, median income in Woodlawn is just $21,000, less than half the level for Birmingham as a whole.

But now Woodlawn is in the midst of a turnaround, aiming to become not just a neighborhood that prospers economically, but also one where people live healthier lives.

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What’s the Airbnb for Health? Pioneering Ideas Podcast Episode 9

May 27, 2015, 4:47 PM, Posted by Lori Melichar

The rise of the sharing economy could surface new innovations in health and health care. The latest episode of the Pioneering Ideas Podcast explores this idea and more.

RWJF Pioneering Ideas Podcast Editorial Art

Could the ideas behind Airbnb — a service that lets people share their homes with strangers — transform health and health care?

Airbnb is just one example of a company that’s emerged as part of the sharing economy (also referred to as the “collaborative” or “peer” economy), an ecosystem of companies all over the world that are fueled by collaborative consumption:

Named by TIME as one of the “10 Ideas That Will Change the World”, collaborative consumption describes the shift in consumer values from ownership to access. Together, entire communities and cities around the world are using network technologies to do more with less by renting, lending, swapping, bartering, gifting and sharing products on a scale never before possible. From Airbnb to Zipcar to Taskrabbit, collaborative consumption is transforming business, consumerism and the way we live for a more fulfilling and sustainable quality of life.” – collaborativeconsumption.com

Rachel Botsman, an expert on the sharing economy whose TED talk on the subject has been viewed nearly a million times, recently visited the Foundation as part of our What’s Next Health series of conversations with pioneering thinkers. In an email to staff after her visit, she observed that, “to date, there has been a lack of dialogue and actionable insights on the potential to apply sharing/collaborative economy principles to different aspects of health.”

This is not to say that there aren’t examples of collaborative consumption addressing aspects of our lives that are related to health. Take the example Rachel shared with me of Landshare, a company in the United Kingdom that matches people who want to grow food with people who have the space for a garden. Imagine transforming vacant lots in some of the poorest areas of our country into places to grow fresh fruits and vegetables; the sustained effect on Americans’ health and wellbeing could be profound.

The founders of another company, Cohealo, observed that so much health care equipment sits idle for over half of its lifetime, accessible only to a finite group of professionals working in a single location. By encouraging sharing within and across facilities, Cohealo has the potential to decrease costs and waste.

Rachel joins us in the latest episode of our Pioneering Ideas podcast to explain the rise of the sharing economy and to brainstorm how new additions to the movement may help solve some of the thorniest challenges in health and health care. Could your company apply the sharing economy to the ongoing challenge of helping others lead healthier lives?  What are you willing to share to help build a culture of health in America?

Listen below or on iTunes – and, in the spirit of the episode, we hope you’ll share it, too, with anyone you know who’s passionate about building a Culture of Health.

More stories in this episode:

  • Reimagining Medical Education: Discover how emerging technologies and approaches are powering collaboration within and between medical schools;
  • Exploring Agile Science: Explore how “agile science” seeks to rapidly discover and test the most effective paths to healthy behavior change;
  • A Personal Essay on Personal Data: Learn why grantee Gary Wolf of Quantified Self believes access to our personal health data is essential to building a true Culture of Health.

After you listen, share your thoughts below, or join the conversation on Twitter at #RWJFPodcast. And if you have cutting-edge ideas to share about building a Culture of Health in this country, I hope you’ll reach out to me at @lorimelichar or consider submitting a proposal.

Be well.

Lori Melichar

Lori Melichar, a labor economist, is a director at the Robert Wood Johnson Foundation where she focuses on discovering, exploring and learning from cutting edge ideas with the potential to help create a Culture of Health. Read her full bio.

One Cure for the World’s Toughest Challenges? Bold Leaders, Connected

May 19, 2015, 9:00 AM, Posted by Herminia Palacio

Change leadership means thinking big about impact, responding to urgent needs, and actively tolerating risk. This is the kind of big, bold way of working—together—that will get us to a Culture of Health.

Members of the Camden Coalition make home visit to patients around Camden, NJ.

Just over a year ago, I started in a new role at the Robert Wood Johnson Foundation. Not long after, my colleagues and I began the exciting, challenging, and collaborative process of co-designing four new programs that will develop, train, and network change leaders who will help build a Culture of Health.

You may be wondering – What is change leadership? How do we know it when we see it? And, why is it essential for achieving RWJF’s vision?

>>Could your organization serve as a National Leadership Program Center? View the call for proposals.

Here's the type of challenge our nation's leaders often face:

For a half-century, charities, nonprofits and local and federal governments have poured billions of dollars into addressing the problems plaguing [many] Americans. But each issue tends to be treated separately – as if there is no connection between a safe environment and a child’s ability to learn, or high school dropout rates and crime. –The Wall Street Journal, September 2013

Now here's an example of what change leadership looks like:

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Clearing the Air in Louisville through Data and Design

May 13, 2015, 12:44 PM, Posted by Alonzo L. Plough

Louisville, Kentucky ranks among the poorest in air quality and highest in asthma rates among U.S. cities. A new art installation from Propeller Health shows residents real-time changes in the city's air quality, equipping them with the data to reach their goal of becoming one of the healthiest cities by 2020.

Airbare air quality installation in Louisville, Kentucky

I stand in front of an intriguing art installation on a busy street corner in downtown Louisville, KY, and visualize the invisible. It’s a bright orange steel kiosk outfitted with an interactive touch screen that allows passersby to “see” how air pollution levels change around the city in real time while also learning how these pollutants impact the severity of asthma symptoms. Called AirBare, the installation project was funded by RWJF and represents a unique collaboration between visual artists, big data analysts and local health advocates. By “popping” virtual bubbles on the screen, users find out what causes air pollution and what it will take to reverse it. This is relevant information for residents of Louisville, a city that consistently ranks among the lowest in air quality in the nation and has one of the highest rates of asthma and other respiratory conditions.

My visit to the AirBare installation coincided with a conference held in Louisville in March that brought together economists, health policy folks, food experts and, remarkably, Charles, the Prince of Wales, to examine the issue of air quality and the larger concept of sustainability in this Ohio River Valley city. The Prince, a longtime advocate for environmental issues with connections in Louisville, added star power to the Harmony & Health conference, sponsored by the non-profit Institute of Health Air Water & Soil. But there is plenty else to be excited about in Louisville. Under the leadership of Mayor Greg Fischer, city agencies have collected reams of data on air quality, health outcomes, life expectancy, income inequality, and unemployment, among many other measures. What has emerged is a far better picture of the tough environmental and socioeconomic issues impacting the health and wellbeing of Louisville’s 600,000 residents, and a serious and concerted commitment to build a culture of health.

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