Beyond the problem of an estimated 600,000 Americans being homeless each night (and 1.5 million in any given year), homelessness or unstable housing is strongly correlated with high rates of chronic illness, unmet healthcare needs and mortality. Inadequate housing impedes access to health care and an ability to stay healthy such as caring for injuries or disease and taking medications. For the chronically homeless mortality is four to nine times higher than for the general population. Though current federal Medicaid rules do not allow states to provide supportive housing, it appears the health care industry is nevertheless beginning to close the gap between health care and housing by recognizing and addressing the fact it is a key social determinate of health.
During this 20 minute interview Ms. Morely discusses the work of the National Center for Healthy Housing, the magnitude of the housing "famine," how housing serves as a health care "vaccine," why health care providers have been slow to recognize its importance as a key social determinate of health and opportunities to better intergrate supportive housing and health care.
Rebecca Morley is the Executive Director of the National Center for Healthy Housing (NCHH), a national non-profit dedicated to creating healthy and safe housing for children. Among other
things Rebecca spearheaded NCHH's recovery work in the Gulf Coast after hurricanes Katrina and Rita and she led the development of the National Health Homes Training Center. She is the author of numerous publications including the new book, "Healthy & Safe Homes: Research, Practice and Policy." Before joining NCHH, Ms. Morley worked with ICF Consulting on affordable housing and related issues, at HUD as a Presidential Management Fellow and as a Legislative Fellow for Senator Jack Reed. She serves on numerous boards and commissions including Health Housing Solutions. Ms. Morley was graduated from Nazareth College (in Rochester, NY) with an undergraduate degree in environmental science and from the Georgia Institute of Technology with a master's in public policy.
For more on the National Center for Healthy Housing go to: http://www.nchh.org/
Despite signifcant press coverage over the past four and a half years many provisions of the Affordable Care Act remain largely unknown to the American public. Polling data shows slightly less than half of Americans know the ACA is still law, over half said they've heard nothing about the state marketplaces and over a third do not know there's a penalty for not having health insurance. More generally, researchers have found Americans have a low health insurance literacy rate. Less than half of those polled were unable to describe an insurance deductable. None of this is surprising when you realize how complicated health care financing and delivery is. For example, the recently published final rule that describes changes to how Medicare will pay physicians in 2015 was well over 1,000 pages.
During this 20 minute interview Dr. Moore discusses the reasons he and Dr. Askin wrote the book, some of their findings, what he was surprised to learn and how health care is delievered in the US, how research and writing the volume changed his practice, reaction to, and use of, the work and changes in the soon-to-be-released second edition.
Nathan Moore is an resident physician in internal medicine at Barnes-Jewish Hospital in St. Louis. When he and his colleague Elisabeth Askin were in medical school at Washington University, they wrote The Health Care Handbook, A Clear and Concise Guide to the United States Health Care System. To date, approximately 60 medical schools and hospital residency programs have incorporated this handbook into their core curriculum. Dr. Moore has been a featured speaker at dozens of medical schools, universities and health professions conferences and is currently working on the 2nd edition of the Handbook. The 2nd edition is anticipated to be released this month.
While it appears obvious a person's health status is directly related to their life circumstances the health care industry has been slow to recognize an individual's bio-psycho-social factors or characteristics in planning and delivering an individual's care. This critcism is typically phrased as clinicians being over attentive to the "patient" and under attentive to the "person". For various reasons having in part to do with utilization/cost, reimbursement and population health concerns this is changing. That is the health care industry is developing a greater appreciation and more sophisticated understanding of the non medical predictors of health care risk.
During this 21 minute interview Dr. Alkema discusses why the health care industry has been slow to adopt socioeconomic factors in care planning and delivery, non-medical factors that correlate with higher care utilization, how these factors or characteristics can be used for predictive purposes and related related issues.
Dr. Gretchen Alkema currently serves as Vice President of Policy and Communications for The SCAN Foundation. Prior to joining SCAN Dr. Alkema was the 2008-09 John Heinz Health and Aging Policy Fellow serving in the office of Sen. Blanche Lincoln. Dr. Alkema earned her PhD at the University of Southern California’s Davis School of Gerontology and and completed her post-doctoral training at the VA Greater Los Angeles Health Services Research and Development Center of Excellence. Her academic research focused on evaluating innovative models of chronic care management and translating effective models into practice. She is a Licensed Clinical Social Worker and has practiced in government and non-profit settings including community mental health, care management, adult day health care, residential care and post-acute rehabilitation.
Listeners will recall in August 2013 Dr. Alkema discussed the relationship between Medicare utilization and cost and beneficiary (declining) functional status.
For more on predictive analytics related to high-risk Medicare beneficiaries see: http://www.thescanfoundation.org/sites/thescanfoundation.org/files/identifying_high_cost_benefits_fact_sheet_1_1.pdf
Half of the US adult population suffers one or more chronic illnesses and two-thirds of the Medicare population suffers three or more. Largely for this reason, i.e., the prevalenece of chronic conditions, health care delivery, by necessity, is becoming ever increasingly more team based. Providing care particularly for the chronically ill therefore places a premium on enhanced relational coordination between and among clinicians of all types (and as well those providing social support services) and by all-too-typically siloed provider organizations.
During this 22 minute interview Professor Gittell discusses how she developed the relational coordination model or tool, what are its seven elements, how it's applied in improving coordination and communication in health care delivery and patient outcomes, how it's measured and examples of its application both in US health care delivery and health care overseas.
Jody Gittell is a Professor at Brandeis University's Heller School for Social Policy and Management and an expert on relational coordination and organizational performance. She founded the
Relational Coordination Reserach Collaborative in 2011 and co-founded Relational Coordination Analytics Inc. in 2013. Her most recent work is "Transforming Relationships for High Performance (Stanford University Press, forthcoming). Before joining Brandeis, Professor Gittell taught at Harvard for six years. She has published widely in numerous scholarly journals and among other awards was the winner of the Best Book Award from the Alfred P. Sloan Foundation. Professor Gittell serves on several boards including the Academy of Management Review's editorial board. She earned her Ph.D. from MIT Sloan School of Management and her MA from The New School.
For more on relational coordination go to: http://rcrc.brandeis.edu/.
Despite recent efforts to improve care delivery for mental health and substance use conditions, for example, passage in 2008 of the Mental Health Parity and Addiction Equity Act, mental health and substance use conditions remain both woefully under-diagnosed and treated. For example, one recent study of emergency department patients showed psychiatric illnesses were under-diagnosed in 75 percent of patients. Compounding under diagnosis is the fact that these conditions are highly correlated with common chronic conditions such as heart disease and diabetes - making successful treatment for these illnesses far more difficult and costly. With major healthcare delivery and financial reforms now being tested under the Affordable Care Act, for example the Primary Care Medical Home and the Accountable Care Organization, there exists today an opportunity to improve substantially diagnosis and treatment for these conditions.
During this 22 minute interview Joyce Wale discusses the prevalence of mental and substance use conditions and the extent to which they're undiagnosed, efforts (motivated largely by ACA reforms) currently underway to improve care (moreover in the primary care setting) for these patients and what good mental and behavioral healthcare looks like.
For the past 18 years Ms. Joyce Wale has served as Chief Behavioral Health Officer and Senior Assistant Vice President of New York City's Health and Hospitals Corporation where she is
responsible for behavioral health services at over 10 acute care hospitals and numerous diagnostic treatment centers and long term care facilities throughout New York City. Prior to Joyce served as the Regional Director to the Bronx Mental Health Center and prior still worked for the Bureau of Children's Services at the New Jersey Division of Mental Health and Hospitals. Joyce has received numerous awards over her thirty-five year career as well as has served on an equal number of professional boards and committees related to mental and behavioral health. Ms. Wale is a Licensed Clinical Social Worker having been graduated from the University of Louisville with a Masters of Social Work.
Health care insurance plans and policy makers are constantly working toward improving cost management. Recently two techniques to do so have reemerged in this effort: narrow networks and reference pricing, techniques that have enjoyed success in the past. Likely the largest (de facto) user of narrow networks is the integrated health plan Kaiser and CalPERS (the California Public Employees's Retirement System) has saved millions in its use of reference pricing. What are these practices, to what extent are they successful in saving money (and improving health care quality) both for payers and patients and what are the real and/or potential downside risks associated with these practices.
During this 21-minute interview Dan Mendelson defines these two cost savings techniques, i.e., how do they work or why they are attractive to plans, do they improve health care quality both within and beyond the ACA insurance marketplaces and how or why these techniques might not be in the best interests of patients (and possibly providers as well).
Dan Mendelson is CEO of Avalere Health, a DC-based health care research and policy consulting firm. Dan leads the organization's operations and engages in strategic advisory work for major clients in life sciences, managed care and in many provider segments. Prior to founding Avalere in 2000, Dan served as Associate Director for Health at the White House Office of Management and Budget. Dan also presently serves on the board of two public companies: HMS Holdings; and, Champions Oncology. He previously served on the boards of Coventry Healthcare and Pharmerica. Dan is also on the faculty at the Wharton School of Business at the U. of Penn. He holds a BA in Economics and Viola Performance from Oberlin College and a MPP from the Harvard Kennedy School of Goverment.
Medicare billing fraud is pervasive. It's estimated at $50 to $60 billion annually or approximately 10% of all of Medicare spending. While billing fraud is committed in numerous ways from never performed procedures to fake patient care, it's possibly no more prevalent than in home health care, an industry of 12,000 providers whom bill Medicare $18 billion annually. For example, a 2010 DHHS Office of the Inspector General report found one in every four home health agencies had unusually high billing. In one example, federal officials in 2012 arrested a Texas-based home health provider accusing him and his colleagues of running a $375 million home health scam.
During this 21 minute interview Sherill Mason defines home health, discusses how home health is reimbursed, how fraud or improper billing is committed via for example upcoding and over utilization, where, the prevalence of the problem, what CMS is doing to try to curb fraudulent behavior, rule making solutions and whistle blower (qui tam) suits.
Sherill Mason is currently Principal, Mason Advisors, where she provides strategic planning, program development and operations analysis for post acute care providers including senior living and nursing home facilities, home health, hospice, long term acute care hospitals, in patient rehabilitation facilities, and long term care pharmacy. Previously, Sherill she served as a Vice Presient to the Marwood Group, a healthcare industry consultant, as Senior Vice President at Sunrise Senior Living and as a Director at KPMG. Among other current professional activities Sherill currently is a Guest Lecturer at the University of Pennsylvania School of Nursing. She received her RN diploma and training at the Englewood Hospital School Nursing and a BA in American Studies from Eckerd College.
A few years ago the federal Agency for Healthcare Research and Quality sponsored billboard ads that stating simply "this year thousands of men will die from stubbornness." The message was intended to encourage moreover middle age men to seek preventive health screening since they are 25 percent less likely than women to visit a doctor in any one year and 30 percent more likely to be hospitalized for a preventable condition. While prostate cancer is largely survivable, aside from non-melanoma skin cancer, it is the most common cancer among men (most prevalent among African Americans) particularly men over age 50, it usually presents without any symptoms and men "stubbornly" ignore being (routinely) tested. Nearly 200,000 cases are diagnosed annually causing over 28,000 deaths. While the value of PSA testing is debated, a digital rectal exam, while incomplete, evaluates the back of the prostate where 85% of prostate cancers arise.
During this 21 minute discussion Guido shares his personal experience, i.e., how he came to be diagnosed, his treatment (still ongoing) and his efforts to public raise awareness. Another prostate cancer survivor, Howard Topel, comments on his treatment and survival - that he owes to hearing Guido's "get screened" presentation.
For the past 30 years Guido Adelfio has managed his family's custom travel business (Bethesda Travel Center, LLC) in Bethesda, Maryland. After a happenstance conversation with a friend about preventive health screening, Guido scheduled a prostate screening exam. The exam determined he had Stage IV metastatic prostate cancer. His diagnosis was determined to be fatal. Fortunately Guido was able to enroll in a NIH experimental treatment therapy program that saved his life.
Howard Topel is a 66 year old retired communications attorney. He represented radio and television station owners for 38 years. Through the early detection of a PSA test, he was diagnosed at the age of 55 with highly aggressive form of prostate cancer. The early detection saved his life, and he now fully enjoys retirement with his wife Andria and watching his children Fred and Melanie and infant granddaughter Celia grow and thrive.
For more on prostate cancer and screeing see the related CDC information at: http://www.cdc.gov/cancer/prostate/.
Late last year Gilead Sciences received FDA approval for its Hepatitis C drug Solvaldi. Hepatitis C (Hep C) affects three to four million Americans and can have serious health consequences. Gilead priced the drug at $1,000 a pill or between $84,000 and $168,000 for the full, curative treatment (effective in approximately 90% of patients). However as priced if every Hep C patient received Solvaldi the cost would equal the combined annual spending amount for all drugs sold in the US.
During this 21 minute podcast Chris discusses how and why this drug's pricing effects all of health care financing and delivery, the work the DC-based Campaign for Sustainable Rx Pricing is doing to try to mitigate Solvaldi's cost, when and if similar Hep C drugs entering the market will force Gilead to lower its price and why past efforts to moderate pharmaceutical drug pricing, e.g., authoring Medicare to negotiate drug prices it pays, have proved unsuccessful.
Through this past April Chris Dawe was the Health Care Policy Adviser for the White House National Economic Council. Previously, Chris served as Director of Delivery System Reform at the US Department of Health and Human Services. Before joining the administration in 2011 Chris served as a Professional Staff member for the US Senate Finance Committee under Chairman Max Baucus. From 2007 to 2008, Chris served as Health Policy Adviser to Senator John Kerry. Prior still Chris was a Legislative Analyst at Jennings Policy Strategies in DC, while there he served in 2006 as the Deputy Director for Global Health at the Clinton Global Initiative. Before coming to Washington, DC, Chris was a Market Analyst at Partners Healthcare, Massachusetts' largest hospital system. Chris is a Massachusetts native and a magna cum laude gratudate of Bowdoin College.