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RWJF Pioneering Ideas Podcast: Episode 6 | What if? Shifting Perspectives to Change the World

Oct 20, 2014, 9:00 AM, Posted by Pioneer Blog Team

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Welcome to the sixth episode of RWJF’s Pioneering Ideas podcast, where we explore cutting edge ideas and emerging trends that can help build a Culture of Health. Your host is Lori Melichar, director at the foundation.

Ideas Explored in This Episode

Sharing Health Care Providers’ Notes (3:08) OpenNotesTom Delbanco and Jan Walker talk with RWJF’s Emmy Ganos about why they decided getting health care providers to share their notes with patients was an essential innovation–and where their work is headed next. Here’s a hint: what if the  3 million patients who now have easy access to their clinician’s notes could co-write notes with their providers?

Rethinking How We Solve Poverty (18:46) – Kirsten Lodal, founder and CEO of LIFT, talks with RWJF’s Susan Mende and shares some simple ideas with the potential to revolutionize our approach to helping people achieve economic stability and well being. In a thought-provoking conversation, Lodal connects the dots between improving the well being of those living in poverty and building a Culture of Health.

A Historian’s Take on Building a Culture of Health (27:58) – Princeton historian Keith Wailoo and RWJF’s Steve Downs discuss how deeply held cultural narratives influence our perceptions of health, and how today’s “wild ideas” are often tomorrow’s cutting edge innovations.

Sound bites

...On opening up health care providers’ notes and what’s next:

“What I would like to do is spread the responsibility for health beyond the health care system. The health care system is good; I hope that it gets better, but there are so many other parts of our lives that contribute to our well being.” – Jan Walker, OpenNotes 

“It will be a very different world in the future. And we do think that OpenNotes is kind of giving people a peek into it. It's a first glimmer that this kind of transparency, this kind of approach to things, while it's passive now, it just opens up an enormous amount of possibilities for the future. And that's what really excites us.” – Tom Delbanco, OpenNotes

...On rethinking how we solve poverty:

“People's lives are like rivers... they flowed before coming into contact with us, and they will flow after having contact with us. And so the opportunity that we have, the privilege that we have is of most positively affecting the trajectory and the velocity of that flow. But if we forget that–if we get too swept up in having to own everything that happens in a person's life–then we won't build the best solutions, because we won't build solutions that provide people with the support they need to navigate the flow of that river over the long term.” – Kirsten Lodal, LIFT

...A historian’s take on building a Culture of Health: 

“Our concern with aggregate trends is an important one in tracing the shifting demographics of health in our country, but to understand what health actually means involves actually putting the data aside and thinking about lives and thinking about individuals and thinking about what these trends mean on an individual level.”– Keith Wailoo, Princeton University

Your Turn

Now that you’ve listened – talk about it! Did anything you heard today get you thinking in new ways about how you can help build a Culture of Health? Do you have a cutting-edge idea you’d like to discuss? Comment below or tweet at me at @lorimelichar, or consider submitting a proposal. Be sure to keep the conversation and explorations going at #RWJFpodcast.

Join the Conversation

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‘Virtual’ Dental Exams Help the Underserved: Q&A with Jenny Kattlove, The Children’s Partnership

Oct 9, 2014, 1:07 PM

Recent data out of California has shown that close to 90,000 children go to the emergency room for dental care each year. Although the cost of those visits is tens of millions of dollars, often little more is done than prescribing antibiotics to control infections. While that is important, after such a visit a child’s teeth remain decayed, posing significant risks for adult dental health problems, which can lead to illnesses, deaths, huge out of pocket costs and reduced job opportunities if teeth are noticeably missing.

But California is now also the first state in the nation to permit dentists to take care of underserved kids and adults virtually. A law passed at the end of September vastly expands the Virtual Dental Home, a demonstration project that uses telehealth technology to bring dental services directly to patients in community settings, such as preschools, elementary schools and nursing homes.

Under the program, dental hygienists and assistants perform preventive care and provide patient information electronically for review by an off-site dentist. Under the direction of the dentist, the providers can also place temporary fillings—no drilling required—which can last for years, according to Jenny Kattlove, an oral health policy analyst for The Children’s Partnership, a children’s advocacy group. Patients who need more advanced care are referred to a dentist, and often they’re the dentist who worked with their technician.

A recent Pew study examined how the Virtual Dental Home worked at an elementary school in Sacramento, where the program provided cost-effective services to low-income children who did not have a regular source of dental care. Care under the Virtual Dental Home is paid for under California’s Medicaid program.

According to research by the University of the Pacific Arthur A. Dugoni School of Dentistry, which operates the Virtual Dental Home pilot program, more than 30 percent of Californians are unable to meet their oral health needs through the traditional dental care system. More than half of California’s Medicaid-enrolled children received no dental care in 2012 and even fewer received preventive care services.

NewPublicHealth recently spoke with Kattlove about the new law and its potential as a model for dental care for low income individuals across the country.

NewPublicHealth: What is the most significant advantage of the Virtual Dental Home?

Jenny Kattlove: The Virtual Dental Home is a way to diversify or disperse the workforce so that all the professionals are working at the top of their skills and expertise. By putting dental hygienists in a community setting and having them take care of the majority of the care that the child needs, the dentist can be in the clinic or in their dental office taking care of the more complex needs and supervising the hygienist. 

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Lack of Coverage for Undocumented Patients Puts Pressure on the Health Care Safety Net

Sep 26, 2014, 9:00 AM, Posted by Michael K. Gusmano

The nation’s 11 million undocumented immigrants constitute a “medical underclass” in American society. [1,2] Apart from their eligibility for emergency Medicaid, undocumented immigrants as a population are ineligible for public health insurance programs, including Medicare, Medicaid, the Child Health Insurance Program (CHIP), and subsidies available to purchase private health insurance under the Patient Protection and Affordable Care Act (ACA) of 2010, because they are not “lawfully present” in the United States. [3] Federal health policy does provide undocumented immigrants with access to safety-net settings, such as an acute-care hospital’s emergency department (ED), or a community health center (CHC). Since 1986, the Emergency Medical Treatment and Active Labor Act (EMTALA) has required that all patients who present in an ED receive an appropriate medical screening and, if found to be in need of emergency medical treatment (or in active labor), to be treated until their condition stabilizes. CHCs such as Federally Qualified Health Centers and other nonprofit or public primary care clinics serving low-income and other vulnerable populations trace their origins to health policy that includes the Migrant Health Act of 1962. [4]

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Reading, Writing and Hands-Free CPR: AHA Calls for More CPR Training in Schools

Sep 16, 2014, 1:12 PM

The American Heart Association (AHA) is working with dozens of state legislatures this year to develop laws that would add cardiopulmonary resuscitation (CPR) classes to middle or high school curricula. Nineteen states require in-school training for high school students, and more are expected to consider or implement the training in the next few years. In Virginia, for example, Gwyneth’s Law—named for a little girl who went into cardiac arrest and died waiting for an ambulance with no one with CPR training able to step forward to try to help—goes into effect in two years and makes CPR mandatory for high school graduation, unless students are specifically exempted.

The AHA says that by graduating young adults with the knowledge to perform CPR—now taught as a hands-only skill, with no mouth-to-mouth resuscitation so as to keep the emphasis on chest compressions—they can vastly reduce the number of Americans, currently 420,000, who die of cardiac arrest outside a hospital each year. The numbers are highest among Latinos and African-Americans, according to the AHA, largely because too many members of those communities have not been taught CPR. AHA surveys find that people who live in lower-income, African-American neighborhoods are 50 percent less likely to have CPR performed.

New AHA grants are helping fund the training in underserved areas. A 2013 study in Circulation: Cardiovascular Quality and Outcomes studied several underserved, high-risk neighborhoods to learn about CPR barriers. The researchers found that the biggest challenges for minorities in urban communities are cost (including child care and travel costs), fear and lack of information.

“Our continued research shows disparities exist in learning and performing CPR, and we are ready to move beyond documenting gaps to finding solutions to fix them,” said Dianne Atkins, MD, professor of Pediatrics at the University of Iowa. “School is a great equalizer, which is why CPR in schools is an integral part of the solution and will help increase bystander CPR across all communities and save more lives.”

The AHA has received funding from Ross, the national clothing store chain, for a program called CPR in Schools, which teaches hands-free CPR to seventh and eighth graders. As a way to increase training for minority students, AHA is partnering local Ross stores with nearby public schools where at least 50 percent of students receive free or reduced lunches.

>>Bonus Links:

  • Read a NewPublicHealth story about a pilot kiosk CPR trainer to teach hands-free CPR in the Dallas/Fort Worth Airport. The pilot program will expand to other locations in 2015.
  • Watch hands-only CPR training videos from the American Heart Association. Tip: First learn to hum “Staying Alive” by the Bee Gees. The beat is almost precisely the rhythm needed for effective CPR chest compressions. 

This commentary originally appeared on the RWJF New Public Health blog.

The Ebola Response: Q&A with Laurie Garrett, Council on Foreign Relations

Sep 9, 2014, 11:56 AM

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Almost every day brings reports of new cases of Ebola, the often-fatal virus now impacting multiple countries in West Africa. According to the U.S. Centers for Disease Control and Prevention (CDC), the 2014 Ebola outbreak is the largest Ebola outbreak in history. Spread of the disease to the United States is unlikely—although not impossible—and efforts are underway to find vaccines and cures, including scale-ups of drug development and manufacturing, as well as human trials for vaccines both in the United States and around the world. However, in West Africa the epidemic is impacting lives, economies, health care infrastructure and even security as countries try a variety of methods—including troop control—to get citizens to obey quarantines and other potentially life-saving instructions.

Late last week, NewPublicHealth spoke with Laurie Garrett, senior fellow for global health at the Council on Foreign Relations. Garrett has written extensively on global health issues and was on the ground as a reporter during the Ebola outbreak in Zaire in 1995.

NewPublicHealth: What are your key concerns with respect to the current Ebola outbreak?

Laurie Garrett: My main concern has been about the nature of the international response, which could be characterized as non-response until very recently. And now that the leadership of the international global health community has finally taken the epidemic seriously, it’s too late to easily stop it. We’ve gone through the whole list of all the usual ways that we stop Ebola and every single one of them was initiated far too late with far too few resources and far too few people—and now we’re in uncharted territory. We’re now trying to tackle a problem that has never reached this stage before and we don’t know what to do. The international response is pitiful, disgusting and woeful.

NPH: How do you account for such a poor response?

Garrett: First of all, the World Health Organization (WHO) is a mere shadow of its former self. When I was involved in the Ebola epidemic in 1995 in Kikwit, Zaire, the WHO was recognized worldwide as the leader of everything associated with outbreaks and infection, and it acted aggressively. It didn’t have a huge budget, but it still was able to take the problem very seriously and the resources that were needed were available, and more importantly a very talented leadership team combining the resources of the U.S. Centers for Disease Control and Prevention; WHO; Medicin San Frontiers (Doctors Without Borders); and the University of Kinshasa, Zaire, came together. They respected each other. They were on board together. They worked very closely with the local Red Cross, and they were able to conquer the problem pretty swiftly. 

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Better Health, Delivered by Phone: Q&A with Stan Berkow

Sep 4, 2014, 2:36 PM

Recently NewPublicHealth shared an interview from AlleyWatch, a Silicon Valley technology blog about SenseHealth, a new medical technology firm that has created a text message platform that health care providers can use to communicate with patients. In May, SenseHealth was picked to be part of the New York Digital Health Accelerator, which gives up to $100,000 in funding to companies developing digital health solutions for patients and providers. The accelerator is run by the Partnership Fund for New York City and the New York eHealth Collaborative. SenseHealth engaged in a clinical trial last year that used the technology to help providers engage with patients who are Medicaid beneficiaries.

Health conditions supported by the SenseHealth platform range from diabetes to mental health diagnoses, while the messaging options include more than 20 customizable care plans, such as medicine or blood pressure monitoring reminders. There are also more than 1,000 supportive messages, such as a congratulatory text when a patient lets the provider know they’ve filled a prescription or completed lab work. The platform couples the content with a built-in algorithm that can sense when a user has logged information or responded to a provider, and providers are able to set specific messages for specific patients. Early assessments show that the technology has helped patient manage their conditions, with data showing more SenseHealth patients adhered to treatment plans and showed up for appointments than patients who didn’t receive the text program.

We received strong feedback on the post, including a question from a reader about whether Medicaid beneficiaries lose contact with their providers if they disconnect their cell phones or change their numbers, a common occurrence among low-income individuals who often have to prioritize monthly bills. To learn more about SenseHealth and its texting platform, NewPublicHealth recently spoke with the company’s CEO and founder, Stan Berkow.

NewPublicHealth: How did SenseHealth get its start?

Stan Berkow: We got started about two to two-and-a-half years ago. I met one of the other founders while I was working at the Columbia University Medical Center in New York City. We were both clinical trial coordinators and were seeing—first hand—the difficulties in getting participants in our studies to actually follow through on all the exercise and nutritional changes they needed to make in order to complete the research project. That led us to step back and look at the bigger health care picture and recognize the challenges for providers to help patients manage chronic conditions, and recognizing that there’s a huge time limitation on the providers. That pushed us toward finding a way through technology to help those providers help the patients they work with more effectively to prevent and manage chronic conditions.

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High-Quality Care in Low-Income Communities: Q&A with Steven Weingarten, Vital Healthcare Capital

Aug 11, 2014, 3:45 PM

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Vital Healthcare Capital (V-Cap) and the Robert Wood Johnson Foundation (RWJF) have announced a $10 million investment in Commonwealth Care Alliance (CCA), based in Boston, Mass., to help fund the organization as it rapidly expands its model of care for patients who are dually eligible for Medicare and Medicaid.

The non-profit care delivery system provides integrated health care and related social support services for people with complex health care needs covered under Medicaid and for those eligible for both Medicaid and Medicare. CCA’s expansion comes as Massachusetts continues to pioneer integrated, patient-centered care for people who are eligible for both Medicare and Medicaid though the newly created “One Care: MassHealth plus Medicare” program, one of several financial alignment initiatives for people with dual eligibility established by the Affordable Care Act (ACA) that are launching nationwide.

The loan—the first to be made by Vital Healthcare Capital, a new social impact fund based in Boston, through support from RWJF—provides funds needed by CCA for financial reserves required by the Commonwealth of Massachusetts as the agency expands the number of beneficiaries in its programs.

According to CCA Director Robert Master, the social impact goals are to:

  • Scale a person-centered integrated care model for high-needs populations.
  • Demonstrate what are known in public health as “triple aim” outcomes in health status, care metrics and cost effectiveness.
  • Train, develop and create frontline health care workforce jobs, including health aides, drivers and translators.
  • Create innovations in health care workforce engagement in coordinated care plans to better integrate into the care plan the staff members who most directly touch the lives of its members.

Over the next five years, Vital Healthcare Capital plans to establish a $100 million revolving loan fund, leveraging $500 million of total project capital for organizations working on health care reform for patients in low-income communities.

NewPublicHealth recently spoke with Steven Weingarten, CEO of Vital Healthcare Capital, about the inaugural loan and the firm’s expansion plans going forward.

NewPublicHealth: How did Vital Healthcare Capital get started and what are its overarching goals and investment criteria?

Steven Weingarten: Vital Healthcare Capital has been formed as a new non-profit financing organization to invest in quality health care and good health care jobs in low-income communities. The organization came about after a couple of years of research and development with funding from the Robert Wood Johnson Foundation, as well as from the Ford and Rockefeller Foundations and support from SEIU, the health care union. Healthcare reform is really part of a broader restructuring of health care that has enormous implications for low-income communities, and for the health care providers and plans that have been focused on these communities. Having financial capital to be able to transform health care to a better delivery model will be a critical challenge in upcoming years. So we are coming in to serve that need.

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Communities of Color and Mental Health

May 21, 2014, 9:00 AM, Posted by David Fakunle

David Fakunle, BA, is a first-year doctoral student in the mental health department of The Johns Hopkins Bloomberg School of Public Health. He is an alumnus of Project L/EARN, a project of the Robert Wood Johnson Foundation and the Institute for Health, Health Care Policy and Aging Research at Rutgers University.

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It is always interesting to speak with my relatives when an egregious act of violence occurs, such as the shooting at Sandy Hook Elementary School back in December 2012. They are always so disheartened about the mindset of an individual who can perpetrate such a horrible act. When I mentioned that this particular perpetrator, Adam Lanza, suffered from considerable mental disorder including possible undiagnosed schizophrenia, the response was something to the effect of, “Okay, so he was crazy.”

That’s it. He was crazy. I love my family dearly, but it saddens me as to how misinformed some of my relatives are about mental health. Notice that I say “misinformed” as opposed to “ignorant” because to me, being ignorant means you are willingly disregarding the information provided to you. But that is the issue: communities of color, in many cases, are not well-informed, if informed at all, about mental health. That is what drives the negative stereotypes that are highly prevalent within communities of color.

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New Participants in RWJF Health & Society Scholars Program to Study Determinants of Population Health

May 16, 2014, 10:00 AM

The Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program has announced the selection of 12 new scholars who will investigate how connections among biological, genetic, behavioral, social, economic, and environmental conditions impact the population’s health.

“We’re pleased to announce our newest class of Health & Society Scholars. These new scholars will continue to advance the program’s decade-long mission to answer the questions critical to guiding health policy and improving our nation’s health,” said Jo Ivey Boufford, MD, co-director with Christine Bachrach, PhD, of the national program office for the Health & Society Scholars program, and president of the New York Academy of Medicine.

The program seeks to improve the nation’s health by better understanding and acting on the determinants that can reduce population health disparities. Among many topics, the new scholars will study social factors underlying infectious disease transmission, as well as possible interventions designed to improve urban health. Previous cohorts of scholars have researched how health is influenced by civic engagement, discrimination, human happiness, work environment, public health policies, and many other societal factors.

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

May 1, 2014, 9:00 AM

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.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.