Now Viewing: Health Care Quality and Value

How SNAP Benefits Seniors—and Health Care's Bottom Line

Feb 1, 2018, 12:38 PM, Posted by David Adler, Ginger Zielinskie

New research shows that seniors who participate in the SNAP program are much less likely to be admitted to nursing homes and hospitals, demonstrating the power of investing in social services to reduce health care costs and improve health outcomes.

SNAP benefits for health care

The fresh fruit, frozen vegetables and salad Karen Seabolt eats help her “do more of what I need to do to live a better life,” she says. The 66-year-old from Tulsa, Oklahoma, has diabetes and is paralyzed on her right side from a stroke.

As a diabetic, Karen needs to eat the fresh fruits and vegetables her doctors recommend, and the $15 dollars per month she gets from SNAP—the Supplemental Nutrition Assistance Program—help her do that.

“It really comes in handy towards the end of the month. You may run out of money, but you always have your SNAP benefits. They’re for food only, so you’re not tempted to do without medicine to get food,” she told us.

SNAP benefits go far beyond a healthy meal. We now know that they can be a critical link to lower health care costs and better health for millions of seniors like Karen. A new study suggests—for the first time—that accessing SNAP benefits helps keep low-income seniors out of nursing homes and reduces hospital admissions

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Improving Community Health While Reducing Costs: Is it Possible?

Jan 19, 2017, 10:00 AM, Posted by Alexandra Chan, Elise Miller

Community Health Funds (CHFs) are a new way to make communities healthier while reducing costs and supporting collaboration. A new project is asking communities to share and spread lessons from CHF and other health partnership experiences.

Children and their parents participate in a family services activity.

Over 80,000 children in Massachusetts suffer from asthma which, when left unmanaged, can dramatically impact overall health, limit school attendance and physical activity. In many cases, uncontrolled asthma symptoms lead to costly emergency room visits. Treating this problem on a large scale will take more than inhalers—it requires coordinated community action. Through the Massachusetts Prevention and Wellness Trust Fund (PWTF), Lynn, Worcester, Holyoke, and other cities have formed community-based partnerships to address several chronic conditions, including childhood asthma. Thanks to these efforts, families receive education, care management and home visits to better manage childhood asthma and ultimately improve their daily lives.

Since underlying social, economic, and environmental factors influence community health issues, the solutions to these issues need a cross-sector approach. But this is sometimes challenging since stakeholders can lack funding and incentives to collaborate.

PWTF was created to address this dilemma. It is a Community Health Fund (CHF)—a financial trust to address local health priorities and promote prevention. CHFs have emerged as an innovative approach for coordinating strategy and shared, flexible funding that supports community stakeholders to work together.

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Better Health, Better Care, and Lower Costs–One State at a Time

Nov 14, 2016, 12:00 PM, Posted by Bechara Choucair

While the Affordable Care Act is known for its national reforms, it has given states the opportunity to transform and improve their health systems.

Two doctors standing in a corridor consult together over some paperwork.

The Affordable Care Act (ACA) has drastically accelerated change within the nation’s health care system. While the law is known for ushering in national reforms—policies that aim to better health, improve care, and lower costs across the United States—it has also fostered new opportunities for states to serve as incubators for health care transformation. Valuable lessons can be drawn from these early-innovator states and their commitment to payment innovation, restructuring care delivery systems, and efforts to build healthy communities that extend beyond traditional medical providers. Multi-state health systems are uniquely positioned to facilitate this innovation.

The Centers for Medicare and Medicaid Innovation (CMMI), an office created by the Affordable Care Act to drive change in the health care system, has awarded about $960 million to 34 states, three territories, and the District of Columbia to test comprehensive transformation plans through its State Innovation Model (SIM) initiative. At Trinity Health, we're supporting and studying nine SIM awardees: Connecticut, Delaware, Idaho, Iowa, Massachusetts, Michigan, New York, Ohio, and Oregon. We're committed to sharing early lessons and best practices in addition to obstacles identified within our own health system. This information can help states, CMS, and other stakeholders expedite their own innovation.

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How a Swedish Model of Care is Making an Impact in the U.S.

Oct 5, 2016, 9:35 AM, Posted by Laura Leviton, Susan Mende

Disease registries designed to support clinical research can be reimagined to create a new and more effective kind of patient-centered care. Just take a look at Sweden.

The Karolinska Institutet building in Sweden. The Karolinksa Institutet in Solna, Sweden. Photo by Pelle Sten via Flickr.

Large-scale collection of patient data into disease-specific databases, or registries, is vital to research. These registries house standardized information on patients’ diagnoses, care, and outcomes, supporting large-scale comparison and analysis which can lead to better population health management and interventions. But can disease registries also help to move us closer to patient-centered care?

We’re learning from examples overseas that, with the help of new interactive technologies, they can.

Sweden created a disease registry for rheumatology that is much more than a data storage house. The Swedish Rheumatology Quality Registry (SRQ) is an interactive tool that helps patients and doctors prepare for and make better use of their office visits. It helps them to work like a team—to “co-produce” care together.

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Evaluating a Ten-Year Effort to Transform Health Care

Sep 21, 2016, 3:20 PM, Posted by Anne Weiss, Brian C. Quinn

An evaluation of RWJF’s quality improvement initiative, Aligning Forces for Quality, uncovers barriers that health collectives face and how successful cultural shifts have helped transform health systems.

AF4Q report map

I believe a unique opportunity for a philanthropic organization is to explore the big ideas. We have a freedom that few others have to really experiment and innovate. Even to take big risks in our grant making sometimes. Often, the rewards are insights they offer a glimpse of how our nation can address some of the most pressing challenges facing our society.  Aligning Forces for Quality is an example of this philosophy in action.”  —Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation 

In 2006, the Robert Wood Johnson Foundation (RWJF) launched a bold, ten year experiment that became one of its largest philanthropic investments—the Aligning Forces for Quality (AF4Q) initiative which sought to lift the overall quality, equality, and value of health care in 16 communities across the country.

In each AF4Q community, a regional alliance of doctors, patients, consumers, insurers, and employers worked collaboratively to transform their local health care system. Lessons from these transformations were then used to develop national models for reform. Alliances were tasked with addressing five “forces” to enhance quality while reducing costs:

  • performance measurement and reporting
  • quality improvement
  • engaging consumers in their health and health care
  • reducing health care disparities
  • reforming payment

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How Social Spending Affects Health Outcomes

Aug 17, 2016, 9:00 AM, Posted by Elizabeth H. Bradley, Lauren A. Taylor

The United States spends more on health care than any other developed nation, yet a recent study suggests social services could have a greater impact on health outcomes.

A hundred dollar bill. Modified image. Original photo by Ervins Strauhmanis.

In a blog post for The New York Times, Dr. Dhruv Khullar, a resident physician at Massachusetts General Hospital, detailed important—and importantly nonmedical—barriers to health that he had witnessed in his patients: a man who couldn’t fathom worrying about his blood pressure when he needed to find food and a place to sleep, a diabetic without reliable access to a refrigerator to store insulin, a mother fretting that mold and cockroaches in her apartment were exacerbating her son’s asthma. Medical care might be necessary for these patients. But that care alone is unlikely to be sufficient.

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Costs of Care: Getting the Patient-Provider Conversation Right

Jun 15, 2016, 9:00 AM, Posted by Emmy Ganos

Doctors and patients want to talk transparently about the costs and value of health care, but it’s easier said than done. A new funding opportunity from RWJF seeks to address this challenge by surfacing best practices.

A doctor asks a patient how he is feeling in a cartoon illustration.

Health care is too often the most stressful part of the American family's budget. In a 2015 survey from the Kaiser Family Foundation, 42 percent of respondents reported that it is somewhat or very difficult to afford health services. This difficulty ranked higher than monthly utilities, housing, food expenses and transportation costs. In the same survey, more than half of respondents said that making information about the price of medical appointments, procedures and tests more available to patients should be a “top health care priority” for the President and Congress.

Rising out-of-pocket costs helped shape these attitudes, and they are hitting patients in the U.S. at all levels. For people with job-based insurance, the number of individuals with plan deductibles—and the size of those deductibles—has grown rapidly in recent years. In 2015, the rate of covered workers enrolled in a plan with an annual deductible of $1,000 or more for single coverage was 63 percent, a significant jump from 10 percent in 2006. This year, deductibles in marketplace plans are even higher than employer insurance, averaging $3,064 for coverage in the popular "silver" tier. For low-income marketplace enrollees, they might qualify for cost-sharing reductions, but they aren’t completely shielded from out-of-pocket expenses.

How can we lower the burden of health care costs in the U.S.?

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The Next Phase of the OpenNotes Movement

Feb 2, 2016, 10:49 AM, Posted by Susan Mende

What happens when patients gain access to the notes their doctors and nurses take during a visit? A culture shift with empowered and motivated patients at the center.

Medical professions looking at patient records.

In December I was proud to announce an exciting partnership with three other foundations—the Cambia Health Foundation, Gordon and Betty Moore Foundation, and the Peterson Center on Healthcare—to take a bold step to expand access to clinical notes written by doctors, nurses, and other clinicians to 50 million patients nationwide. The $10 million in new funding to OpenNotes will allow the initiative to dramatically step up its efforts to create a new standard of care and set a new bar for patient-centeredness.

We know that physicians can help their patients become more engaged in their own care, and that this kind of patient activation can lead to improved outcomes and lower health care costs. Of course, that is easier said than done—especially when clinicians are already under pressure to adopt new technologies, implement new models for delivering health care, and make data on the quality of their care publicly available.

Health care innovators are unrelenting in their search for simple, scalable solutions to help both clinicians and consumers—and philanthropists can help put these bright ideas to the test to determine what works. OpenNotes is one such solution.

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Do-It-Yourself Health: How the Maker Movement is Innovating Health Care

Nov 16, 2015, 11:14 AM, Posted by Anna Young

MakerNurse is changing the game for nurses by tapping into their natural problem-solving skills and bringing the spirit of invention, creativity, and innovation into medical settings.

MakerNurse co-founder Anna Young speaks at TEDMED 2015.

Anyone who has spent time in a hospital knows that—more often than not—nurses are the professionals who catch the little problems with your care: the uncomfortable IV tube, the bandage that doesn’t quite fit, the pill bottle that’s hard to open.

Nurses are natural problem solvers. They cut down bandages to fit preemies. They fashion a plastic cup around an IV site to stop it from snagging clothes. They roll up two hospital blankets and wrap them in tape to make a “cough pillow”—something to clutch against your stomach to ease the pain of laughing or coughing after abdominal surgery. These DIY medical devices are made by nurses every day in hospitals.

Nurses are uniquely positioned to spot such problems. So, why not encourage nurses to continue devising their own solutions, then give them the tools to create them?

With MakerNurse, that’s exactly what we’re doing.

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What Right Care Means to Me: The Physician’s View

Oct 21, 2015, 1:11 PM, Posted by Kathleen Grimm, Vikas Saini

Two physicians describe how they are mobilizing patients, providers and others, to change the culture of overuse in health care, to one that is individualized, compassionate and just.

Two doctors standing in a corridor consult together over some paperwork.

The end of life can be fraught with emotion and excruciating decisions for families. It is a time when overuse of treatments and interventions occurs far too frequently. The culture of medicine teaches physicians to “do everything you can” to keep patients alive, with an underlying message that more is better when it comes to treatments and interventions. For doctors, patients and their families, making the decision to refuse extraordinary measures can feel like giving up.

As physicians who are active in the Lown Institute’s RightCare Alliance, we are dedicated to changing this culture. We know that a range of practices persist as standards that don’t improve the length or quality of life. Overuse and inappropriate care are baked into how we do things to the point that they are almost invisible. From frequent blood draws in the hospital to unneeded imaging for a normal pregnancy and futile chemotherapy in end-stage cancer, our goal is to keep patients safe from unnecessary diagnosis, treatment, and ultimately, harm. We think that it is critical to combine an understanding of the true benefits and risks of procedures and therapies with a respect for a patient’s wishes. Such a thoughtful approach that individualizes care, promotes doing more for the patient and less to the patient.

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