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06/24/2015

"The Medical Industrial Complex": A Conversation with Rosemary Gibson (June 24th)

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With the health care industry now accounting for 18.5 percent of the nation's GDP, or a far greater percentage than any comparable nation, combined with ever continuing access, coverage (now possibly moreover the issue of under-insurance) and quality (including the frequency of patient or iatrogenic harm) health care policy students are left to wonder to what extent has health care delivery or legitimate health care delivery been compromised or even undermined by medical commerce.    

During this 27 minute conversation Ms. Gibson explains what's meant by the Eisenhower-inspired "medical industrial complex" and her use of the phrase "privatized gains and socialized losses" in this context.  She discusses the unwarranted influence of the health care industry in part by noting pharmaceutical industry behavior and the advent of so called "consumer directed health plans.  Ms. Gibson also evaluates to what extent the ACA will strike a better balance between health care and medical commerce or again the "medical industrial complex."  

Ms. Rosemary Gibson is a Senior Advisor at the non-profit Hasting Center, a research organization dedicated to addressing ethical issues in health, medicine and the environment.  Ms. Gibson is also Rosemary_gibson[1]an editor of JAMA Internal Medicine.  Previously, Ms. Gibson was a Program Officer at the Robert Wood Johnson Foundation where she addressed safety and quality issues particularly in palliative care.  Among other books Ms. Gibson is the author of Wall of Silence, The Untold Story of the Medical Mistakes That Kill and Injure Millions of Americans.  Ms. Gibson serves on numerous boards including the Consumers Union Safe Project and among others she received the Lifetime Achievement Award from the American Academy of Hospice and Palliative Medicine.  Ms. Gibson is a graduate of Georgetown University and the London School of Economics.

Information on Rosemary Gibson's book, noted during this interview (and coauthored by Janardan Prasad), The Battle Over Health Care, can be found at: http://www.amazon.com/The-Battle-Over-Health-Care/dp/144221449X

 

06/16/2015

The Re-emergence of Community Health Workers & Peer Support: A Conversation with Ed Fisher (June 15th)

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The use of community health workers (CHW) dates back to the 1800s.  The impetus for these workers today is to provide peer support largely in poor or under-served communities since these communities typically suffer disparities in health care access, in the quality of health care delivery and consequently experience higher morbidity and mortality rates.  The ACA via the Center for Medicare and Medicaid Innovation is supporting CHW demonstration projects, states are testing their use via Medicaid programming and various providers are using CHW to improve self management support among high health care service utilizers.   

During this 20 minute conversation, Dr. Fisher discusses the reasons why the use of CHW is increasing, who they are and how they're trained, in what provider setting they work, their level of success, how they're accepted by clinicians and patients and how their services are reimbursed.      

Dr. Edwin Fisher is a University of North Carolina Gillings School of Global Public Health Professor and HB-fisher_ed_2013serves as Global Director for the American Academy of Family Physicians Foundation's Peers for Progress program.  Peers for Progress promotes peer support in health, health care and prevention around the world.  From 2002 to 2009 Dr. Fisher served as National Program Director for the Robert Wood Johnson Foundation's Diabetes Initiative.  Dr. Fisher has published widely in prevention, chronic disease management and quality of life addressing asthma, cancer, cardiovascular disease, smoking and weight management.  He is past-president of the Society of Behavioral Medicine and has served as a board member for the International Society of Behavioral Medicine and the American Lung Association.  He was graduated from the SUNY, Stony Brook with a Ph.D. in Clinical Psychology.       

Information on Peers for Progress is at: peersforprogress.org

 

05/29/2015

Potential Republican Party Responses to King v. Burwell: A Conversation With Tevi Troy (May 28th)

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Shortly before the Supreme Court recesses in early July the Court will rule on David King v. Sylvia Burwell, the case where the plaintiffs argue the Affordable Care Act only allows for tax credit subsidies via state-run exchanges or only those, as the ACA states, "established by the state."  If the court rules in favor of the plaintiff an estimated 5 to 8 million newly insured will lose their coverage absent a subsidy because to date only 16 states plus the District of Columbia have set up state health insurance exchanges or marketplaces.  If this is the Court's ruling how might the Republican-controlled Congress react?   Regardless of the Court's decision the health care reform likely becomes a 2016 presidential campaign issue for the Republican party.  

During this 21-minute discussion, Dr. Tevi Troy outlines possible responses by the Republican controlled Congress to a Court's decision in favor of the plaintiffs, how Republican presidential candidates may shape the race's health care reform debate (moreover if the Court rules in favor of Burwell) and he addresses major aspects of the ACA that remain contentious, i.e., the employer mandate, the Cadillac tax and Medicaid reform.

Dr. Tevi Troy is currently President of the American Health Policy Institute and Adjunct Fellow at 220px-Tevi_David_Troy_HHS_2007the Hudson Institute.  Previously he served as Deputy Secretary at the Department of Health and Human Services under President George W. Bush, as Deputy Assistant and Acting Assistant to the White House Domestic Policy Council, as Policy Director for Senator John Ashcroft and as Senior Domestic Policy Adviser and Domestic Policy Director for the House Policy Committee.  Still previously he was a Researcher at the American Enterprise Institute.  His numerous writings include,"What Jefferson Read, Eisenhower Watched and Obama Tweeted, 200 Years of Popular Culture in the White House," and "Intellectuals and the American Presidency," Philosophers, Jesters or Technicians?"  Dr. Troy earned his Ph.D. in American Civilizations from the University of Texas as Austin.     

Information on Dr. Troy's latest book, "Shall We Wake the President," can be found at: http://www.amazon.com/Shall-We-Wake-President-Disasters%C2%97/dp/1634504542/ref=sr_1_1?s=books&ie=UTF8&qid=1432899186&sr=1-1&keywords=shall+we+wake+the+president

 

 

05/14/2015

What Is Risk Adjustment and How Is It Accomplished Under MA: A Conversation with Robert Book (May 13th)

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Risk adjustment is a statistical method by which payers can reasonably predict how much a patient's care needs are expected to cost in any given year.  In so called Fee-For-Service Medicare this matter is essentially moot since since providers are simply paid for the reimbursable services they provide their patients.  However, health care payment is rapidly moving towards fixed or pre-arranged reimbursement models.  For example, Medicare Advantage plans are paid a pre-determined or fixed per member per month fee and ACOs are incented to spend less annually than a pre-determined benchmark that amounts to an ACO's patients' historical costs risk adjusted.  Therefore, risk adjustment, or getting risk adjustment right, becomes critically important.  

During this 23 minute discussion Dr. Book explains the theory behind risk adjustment, how it's calculated for Medicare Advantage plans using hierarchical condition categories (HCC) codes and demographic data, the phenomenon known as "up coding," what CMS has done to address the issue and whether predicted costs tend to be lower than actual costs for high cost beneficiaries is a problem.

Dr. Robert Book is a Health Economist and Senior Research Director at the Health Systems  Robert_A_Book_147x220_cl
Innovation Network.   (His paper discussed during this interview was authored via his work with the American Action Forum.)  Dr. Book's work primarily focuses on modeling of the effects of the ACA.   He has also expertise in a wide variety of related issues including Medicare and Medicare Advantage pricing, provider incentives, employer-sponsored insurance, drug regulation and the economics of medical research.  Dr. Book earned his Ph.D. in economics and his MBA at the University of Chicago, an MA in computational and applied mathematics at Rice and his undergraduate in mathematics at Duke.     

Dr. Book's primer on Medicare Advantage risk adjustment is at: http://americanactionforum.org/research/primer-medicare-risk-adjustment.

For a discussion on Medicare Advantage pricing more generally see the May 6, 2013 interview with Dr. Brian Biles.   

05/08/2015

Mt. Sinai's Hospital At Home Demonstration: A Conversation with Dr. Jeffrey Farber (May 7th)

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Beyond hospital care's considerable expense and at times questionable quality, it can be often times unnecessary.  We spend over $900 billion, or one-third of all health care spending, on hospital care annually. Despite these costs the quality of hospital care can be poor if not harmful.  A 2013 study published in the Journal of Patient Safety concluded between 210,000 and 440,000 patients hospitalized annually are fatally harmed. Beyond cost and quality, according to federal Agency for Healthcare Research & Quality (AHRQ) approximately ten percent of all hospital admissions for certain chronic and acute conditions are avoidable.

During this 21 minute discussion Dr. Jeffrey Farber explains the impetus for Mt. Sinai's hospital at home or mobile acute care demonstration.  How it's funded, what patients with what diagnoses are eligible, the range of services they receive, the importance of carefully screening these patients before admission and the demonstration's anticipated results.     

Dr, Jeffrey Farber is an Associate Professor in the Brookdale Department of Geriatrics and Farber photoPalliative Medicine at the Icahn School of Medicine at Mount Sinai, he also serves as the Chief Medical Officer at Mount Sinai Health Partners, as VP of Hospital Services Utilization and as Chief Executive Officer of Mount Sinai Care, Mt. Sinai's Accountable Care Organization.  Dr. Farber completed a residency in Internal Medicine at New York Presbyterian Hospital, Columbia Campus and a fellowship in Geriatric Medicine at Mount Sinai School of Medicine.  His career interests include research in models of care for older adults, as well as clinical documentation and the medical interface with hospital finance.  He is a recipient of a federal Geriatric Academic Career Award and his research has been published in The Annals of Internal Medicine and The Journal of Hospital Medicine.

CMS's summary of Mt. Sinai's Mobile Acute Care Team (MACT) demonstration is at: http://innovation.cms.gov/initiatives/Participant/Health-Care-Innovation-Awards-Round-Two/Icahn-School-Of-Medicine-At-Mount-Sinai.html 

 

05/01/2015

The State of Alzheimer's Funding and Research: A Conversation with Robert Egge (April 30th)

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Alzheimer's Disease accounts for approximately 70% of all dementia diagnoses.  The disease affects over five million Americans or upwards of 35 million worldwide.  Disease burden is currently estimated to grow to 16 million patients in the US by 2050 with projected costs estimated at over $1 trillion.  Patients diagnosed with Alzheimer's survive three to nine years. The disease kills 500,000 deaths annually, making it the 6th leading cause of death.  The risk of the disease is believed to be largely genetic.  There are currently no treatments or medications to stop, reverse or modify its progression - the only major disease with this distinction.  

During this 23 minute discussion Mr. Egge discusses the work of the Alzheimer's Association, the current state of curative research and the development of a blood test to diagnose Alzheimer's before symptoms appear, the adequacy of federal funding to fight the disease, the federally-legislated "National Alzheimer's Plan" and what's being done to improve care for patients currently suffering from Alzheimer's and other forms of dementia.   

Robert Egge is the Chief Public Policy Officer and Executive Vice President of Government Affairs Eggefor the Alzheimer's Association.  Mr. Egge also serves as the Executive Director of the Alzheimer's Association's sister organization, the Alzheimer's Impact Movement.  Prior to joining the Alzheimer's Association Mr. Egge served as Executive Director of the Alzheimer's Study Group.  Prior still he served as a Project Director for the Center for Health Transformation and as Vice President for Government Affairs for the JC Watts Companies.  Mr. Egge's writings have appeared in The New York Times, the Financial Times, in Health Affairs and he has provided testimony to both US House and Senate health care committees.

For more on the work of the Alzheimer's Association go to: www.alz.org.

 

04/20/2015

Care Provided by Visiting Nurses: A Conversation with Tracey Moorhead (April 20th)

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Visiting nurse services have been delivering home-based health care since the late 19th century providing everything from maternal and child health to geriatric care.  Today their services are more frequently being sought due to an ever-increasing emphasis on keeping patients out of the hospital (and emergency department), improving care coordination, comprehensiveness and patient satisfaction and paying for care that improves quality and care outcomes and that is more cost efficient.  

During this 19 minute discussion Ms. Moorhead discusses the goals of VNAA and its members, services its visiting nurses and other home health providers deliver, health care outcomes achieved and a range of federal Medicare policy options currently under discussion to improve care in the so called "post acute" care setting.   (One factual correction: Medicare spending on post-acute care in 2013 was $59 billion.)

Tracey Moorhead is President and Chief Executive Officer of the Visiting Nurse Associations of TraceyMoorhead_webonlyAmerica (VNAA).  VNAA educates, advocates and promotes nonprofit providers of home-based care services including home health, palliative care and hospice. Previously,  Tracey served as CEO of the Care Continuum Alliance.  Prior roles also include serving as Executive Director of the Alliance to Improve Medicare (AIM), a bipartisan coalition advocating comprehensive Medicare improvements through the Medicare Modernization Act of 2003 and Vice President, Government Relations for the Healthcare Leadership Council (HLC). She was graduated from The George Washington University.  

For more about the VNAA go to:  www.vnaa.org.

 

04/14/2015

Street Sense's Effort to End Homelessness in DC: A Conversation with Brian Carome (April 14th)

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Street Sense is a tabloid newspaper that has been sold biweekly by the District of Columbia's homeless residents for the past 12 years.  The publication's focus is on homelessness and related issues confronting the poor.  DC has one the highest rates of homelessness in the country with over 2,000 individuals and families sleeping on the streets on any given night, a quarter of whom are veterans.  Unemployment, obviously a major cause of the problem, is 7.8 percent in the nation's capital or one and a half times the national average.  For DC's African Americans unemployment is 10 percent. Nearly 20 percent of DC's residents live in poverty.  Beyond homelessness, Street Sense vendors typically face a long list of health issues.  Recently however a city inter-agency council on homelessness unanimously endorsed a plan, that DC's new mayor supports, to end homelessness over the next five years.

During this 18 minute discussion Brian Carome discusses the purpose and success of Street Sense to date, it's vendors, the health and social issues they confront and his outlook for finally solving DC's homelessness problem.

Brian Carome has served as Executive Director of Street Sense since 2011.  Previously he was Unnamed[1]Executive Director at Housing Opportunities for Women, Project Northstar and A-SPAN.  He has also worked at new Hope Housing, Sasha Bruce Youthwork, the Washington Legal Clinic for the Homeless and the Father McKenna Center.  He has lectured on homelessness and at risk populations at the Catholic University of America's School of Social Service and Georgetown University Law School.  Brian was graduated from Boston College with a BA and earned an Executive Certificate form the Georgetown University's Center for Public and Non-Profit Leadership.  

To learn more about Street Sense go to streetsense.org.

  

 

03/18/2015

What's the Status of "Pay for Value" Contracting: A Conversation with David Muhlestein (March 18th)

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Health care payment is solidly moving, or moving once again, toward pay for value or value-based contracting.  This means a health care provider's reimbursement is incented or tied to a predetermined (typically annual) financial amount and/or is based on attaining certain quality care metrics.   The Medicare Shared Savings Program and private sector "accountable care organizations" are both endeavoring to lower health care cost growth and improve quality and patient outcomes via these value or performance-based contracts.  

During this 21-minute discussion Dr. David Muhlestein describes the various types of pay for value contract arrangements including use of quality metrics, what types of providers sign these contracts, what have the results been to date, the keys to success or what are the challenges in succeeding under these agreements and potential downsides for providers and/or patients .   

David Muhlestein is the Senior Director of Research and Development at Leavitt Partners (LP).  He David Muhlestein 2014 directs LP's study of pay for value and accountable care contracting through LP's Center for Accountable Care Intelligence and leads the firms' quantitative evaluation of health care markets. He is an expert in using policy analysis, predictive modeling and applied analytics to understand the evolving health care landscape.  His insights have been quoted by publications including The Wall Street Journal, The Seattle Times and Modern Healthcare.  David earned his Ph.D. at Ohio State University and his JD at Ohio State's Moritz College of Law.   

For information regarding Leavitt Partners' related work see: http://leavittpartners.com/solutions/.

 

 

02/19/2015

What Health Care Coverage Do Immigrants Get?: A Conversation with Angel Padilla (February 19th)

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Over 20 million immigrants live in the US, approximately half of whom, or 11 million, are undocumented.  Because immigrants are frequently employed in low-wage jobs they largely lack health care coverage.  Legally residing residents are able to acquire coverage via the ACA's state marketplaces however they are typically required to wait five years to apply to qualify for Medicaid. Undocumented immigrants are neither able to buy marketplace coverage even if they pay the full premium nor are they typically allowed Medicaid coverage.   Last November the President announced a pathway to citizenship for undocumented immigrants but whether this will improve their ability to obtain health insurance is unclear.

During this 23-minute discussion Mr. Padilla explains the genesis of the five-year waiting period for legal immigrants to apply for Medicaid, why undocumented immigrants are unable to purchase marketplace insurance at full cost, where (and how) immigrants typically get health care services and moreover what, if any, effect will the President's executive order actions announced last November have in providing health care coverage for undocumented immigrants.      

Angel Padilla is a Health Policy Analyst at the National Immigration Law Center (NILC) where APadilla Pic (1)he works to develop and implement NILC's federal immigrant health policy agenda.  Prior to joining the NILC in 2014 he was an immigration policy consultant at the National Council of La Raza.  Prior still he served as a Legislative Assistant to Rep. Luis Guiterrez (D-IL).  Mr. Padilla also interned at the Department of Homeland Security.  He holds an undergraduate degree from the University of California at Berkeley and a graduate degree form the Princeton University's Woodrow Wilson School of Public and International Policy.

The National Immigration Law Center website is at: http://www.nilc.org/.