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A Portrait of Women with Health Insurance

Feb 19, 2015, 2:21 PM, Posted by Susan Dentzer

2015 Health Care Coverage Billboard Woman Image

For the second year running, more women than men have signed up for coverage in health insurance marketplaces during open enrollment under the Affordable Care Act. According to the Department of Health and Human Services, enrollment ran 56 percent female, 44 percent male, during last year’s open enrollment season; preliminary data from this year shows enrollment at 55 percent female, 45 percent male—a 10 percentage point difference.

What gives? An HHS spokeswoman says the department can’t explain most of the differential. Females make up about 51 percent of the U.S. population, but there is no real evidence that, prior to ACA implementation, they were disproportionately more likely to be uninsured than men—and in fact, some evidence indicates that they were less likely to be uninsured than males.

What is clear that many women were highly motivated to obtain coverage under the health reform law—most likely because they want it, and need it.

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Looking Back, Looking Ahead: Banding Together to Fight for Health Care Value

Feb 13, 2015, 5:06 PM, Posted by Anne Weiss

L1032033_JHW Key health care stakeholders have joined forces to work toward improved quality of health care available to the rural, low-income population of Humboldt and Del Norte Counties, Calif. (AF4Q)

Sometimes it feels like we take one step forward, two steps back when it comes to making sure that we are getting the best quality health care for the tremendous amount our society invests in it. Maybe sometimes it’s one step forward, three steps back.

But then I think about Aligning Forces for Quality—RWJF’s signature initiative to lift the quality and equality of care in 16 regions around the country—and my hope returns. While progress is slow, it is still progress.

More than 10 years ago, RWJF’s leadership suggested to me that we change course in our health care quality improvement strategy. Instead of testing single interventions in widely scattered sites, they asked, why not focus on a limited number of target communities where we could go deep with multiple approaches? We knew health care is essentially local, though shaped by state and federal policy.

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A New Approach to Eliminating Health Disparities

Feb 10, 2015, 2:13 PM, Posted by Dwayne Proctor

Spokane Adverse Childhood Experiences Last year, Spokane County received the Foundation's Culture of Health Prize for improving community health by addressing the critical link between poverty, education, and poor health. Here, children play at St. Anne's Center in Spokane, where teachers are trained to catch and address early warning signs that may indicate future problems in school.

I, like many others, have made a commitment to living healthier this year. I am resolved to find and eat a new fruit and vegetable each month, decrease my consumption of meat to a few times a week, and drink at least a half-gallon of water each day. I also plan to laugh more and spend more time outdoors. My personal goals aside, I also find myself more hopeful than at the start of many past years about the state of health in our nation as a whole.

  • More Americans than ever before have access to the health care they need because of the Affordable Care Act;
  • States throughout the nation are making significant progress in helping kids achieve a healthy weight;
  • The disparities gap between black and white Americans’ life expectancies is narrowing.

These bright spots indicate that America is heading down the road to better health—but they only begin to address the challenges many Americans continue to face in accessing good health. As highlighted in a recent article in the New England Journal of Medicine, significant gaps and unmet needs remain.

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We Must All Play a Role in Ending Childhood Obesity

Feb 5, 2015, 1:00 PM, Posted by Sen. Bill Frist, MD

A mother walking with her daughters on sidewalk

We all want our kids and grandkids to grow up happier and healthier than we did. Instead, today’s children are the first generation of young Americans to face the prospect of living their entire lives in poorer health and dying younger than previous generations.

The reason is no mystery. Too many of our children – one in three, according to studies – are overweight. We are allowing, and in some ways encouraging, our kids to consume more calories, more sugar, more fat, more sodium. At the same time we’re enabling a more sedentary lifestyle. Running, jumping, skipping, dancing, biking – today’s children simply don’t move as much as they once did, making it that much harder to keep off the pounds.

The childhood obesity epidemic is having a devastating affect on too many families. Obese and overweight children are sick more often. They too often endure prejudice and bullying at school, leaving them embarrassed and depressed. They miss more school. When they grow up, they have more difficulty leading productive work lives. And they are more likely to suffer from chronic illnesses directly linked to obesity, such as diabetes and heart disease. 

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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 - Banner

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.

Entering the Final Stretch

Feb 3, 2015, 6:15 PM, Posted by David Adler

2015 Affordable Care Act ACA Enrollment Website Screen

As we head into the final weeks of this year’s open enrollment season, we can all be proud of the progress that’s been made. New numbers released last week show 9.5 million Americans signed up for health coverage through marketplaces across the country. Behind each number is someone who now has quality, affordable health coverage with access to health care when they need it and protection from financial ruin if they get sick.

But there are still millions more who are eligible for coverage this open enrollment period. RWJF and our partners are doing all we can to get as many people enrolled as possible before the February 15 deadline. These collective efforts focus on breaking down the biggest enrollment barriers for people to get covered. Our research shows that consumers are more motivated to enroll when they understand the benefits of coverage, believe they can afford the cost, and know they can find enrollment support to complete the process.

Enroll America, an RWJF grantee, is addressing the need for in-person help head on—operating grassroots efforts in 11 states and connecting consumers to enrollment tools and help nationwide. Their connector tool, allows consumers to schedule appointments for in-person help right away. Drawing from lessons learned from the first open enrollment period we know this one-on-one support will be critical for many consumers during these final weeks.

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Journey Towards Becoming a Mindful Leader

Feb 2, 2015, 11:35 AM, Posted by Teri Pipe, PhD, RN

Mindfulness zen garden

In our fast-paced, overcommitted world, our typical automatic first response—to be better multitaskers and problem solvers—often leads to increased stress and reduced satisfaction. As leaders—especially in the high-stakes, quickly changing health care sector, we focus our attention outwardly on the well-being of others. We’re faced with a number of competing priorities, interruptions, and distractions that too often get the best of us. It seems that, for many, the noisy world has taken up residence within us.

As a nurse focusing on gerontology and oncology, I learned to help others find what was most important during times of bittersweet transition, prioritizing where and how their energy was spent. Through my clinical research experiences, I learned that the perception of stress, rather than a specific circumstance, could just as easily lead to physiologic consequences. I also observed how some people used their challenges to become more resilient, while others weakened.

Because of these experiences, the ideas of resiliency, mindfulness, and caring began shaping my research questions and investigations. My research and my work with my nursing colleagues showed me that teaching self-awareness, compassion and attention-focusing practices can reduce stress, build resilience and extend the positive impact of nurses and other leaders, including their ability to care for patients, strengthen communication, mentor others and lead successful organizations.

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Roadmaps Out of Fantasyland: RWJF’s Outbreaks Report and the National Health Preparedness Security Index

Jan 30, 2015, 5:47 PM, Posted by Susan Dentzer

Outbreaks 2014

“When you hear hoofbeats, think of horses, not zebras,” the late Theodore Woodward, a professor at the University of Maryland School of Medicine, cautioned his students in the 1940s. Woodward’s warning is still invoked to discourage doctors from making rare medical diagnoses for sick patients, when more common ones are usually the cause.

And while many Americans have worried about contracting Ebola—in viral terms, a kind of “zebra”—more commonplace microbial “horses,” such as influenza and measles viruses, continue to pose far greater threats. For instance, a large multistate measles outbreak has been traced to Disneyland theme parks in California—while this year’s strain of seasonal flu has turned out to be severe and widespread.

One obvious conclusion is that many microbes remain a harmful health menace, expected to kill hundreds of thousands of Americans this year. Another—speaking of Disneyland—is that much of America appears to live in a kind of fantasyland, thinking that it is protected against infectious disease.

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Some Unconventional Approaches to Stress: Pioneering Ideas Podcast Episode 7

Jan 29, 2015, 7:00 PM, Posted by Lori Melichar

(Please note that this podcast player might not work in some versions of Internet Explorer. Please view this page in another browser, such as Chrome, Firefox or Safari. You may also access the episode via SoundCloud.)

A man asking for money on the subway this week told me how Hurricane Sandy led to a series of events that left him stressed out by the challenges of putting food on the table for his children.

Recessions, hurricanes, violence—how many ways can we count that add stress to our lives? Whether dealing with economic stress, the stress of caring for an aging parent, or even the stress of keeping up with email, research shows that all of it affects our health. As Alexandra Drane, a guest in the latest episode of RWJF’s Pioneering Ideas podcast, puts it: “When life goes wrong, health goes wrong.”

This episode of the Pioneering Ideas podcast explores unconventional approaches to tackling stress­—and other health problems—with energizing possibilities that could also transform health and health care. From monitoring electricity use as a way of helping the elderly stay in their homes, to measuring the indirect health effects of social services (what if heating assistance led to greater medication adherence?), these conversations offer cutting-edge ideas for building a Culture of Health.

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Field Notes: What Cuba Can Teach Us about Building a Culture of Health

Jan 29, 2015, 9:54 AM, Posted by Maryjoan Ladden, Susan Mende

MaryJoan Ladden and Susan Mende Trip to Cuba

Ever since President Obama announced the restoration of diplomatic ties between the United States and Cuba, there’s been growing excitement over the potential for new opportunities for tourism, as well as technology and business exchanges. Most people assume that the flow will be one-sided, with the United States providing expertise and investment to help Cuba’s struggling economy and decaying infrastructure.

That assumption would be wrong. America can—and already has—learned a lot from Cuba. At RWJF, we support MEDICC, an organization that strives to use lessons gleaned from Cuba’s health care system to improve outcomes in four medically underserved communities in the United States—South Los Angeles; Oakland, Calif.; Albuquerque, N.M.; and the Bronx, N.Y. Even with very limited resources, Cuba has universal medical and dental care and provides preventive strategies and primary care at the neighborhood level, resulting in enviable health outcomes. Cuba has a low infant mortality rate and the lowest HIV rate in the Americas, for example—with a fraction of the budget spent in the United States.

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