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2 posts from August 2013


Improving Chronic Care Means Improving Functional Status: A Conversation with Dr. Gretchen Alkema (August 13th)

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The most expensive Medicare beneficiaries are not those with multiple chronic conditions.  They are those with chronic conditions AND functional impairment (i.e., those needing help with routine life activities).  For example, the 15% of Medicare enrollees with both chronic conditions and functional limitations disproportinally account for one-third of Medicare spending.  Alternatively, Medicare enrollees with three or more chronic conditions but no functional impairment (48%) account for roughly the same percent of spending (51%).  The challenge therefore both in improving quality care for the chronically ill and reducing costs (via, for example, reduced hospitalizations) is in improving long term care supports and services (LTSS). 

During this 26-minute podcast Dr. Alkema defines "functional limitation" and "care coordination", explains the current lack of care coordination for Medicare patients with chronic conditions and functional limitations, describes three exemplary models of care coordination and what Medicare can or should do to improve care for these patients.

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 Gretchen Headshot resized[1]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.

For background information concerning this topic see this paper by Georgetown's Harriet Komisar and Judy Feder: http://www.cahpf.org/docuserfiles/georgetown_trnsfrming_care.pdf  See also too SCAN's "10 Conversations to Plan for Aging with Dignity and Independence" at: http://www.thescanfoundation.org/10-conversations-plan-aging-dignity-and-independence.


Will the FDA Ban Menthol-Flavored Cigarettes? A Conversation with Dr. Andrea Villanti and Ms. Diane Canova (August 6, 2013)

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In 2009 the Congress overwhelmingly passed landmark legislation (commontly termed the "Tobacco Control Act") that included banning flavored cigarettes - except menthol.  Instead, the Congress called upon the FDA to first study the use of menthol before taking action.   In 2011 the FDA released an initial report, the conclusions of which were widely interpreted.  Two weeks ago the FDA released a subsequent report again finding the menthol/mint flavor helps people acquire the tobacco/nicotine addiction but did not increase the risk of disease compared to smoking non-menthol cigarettes.  Neither report recommended banning or restricting the use of menthol. 

During this 24-minute podcast Andrea Villanti and Diane Canova discuss why menthol was exempted in the 2009 legislation, the findings of the 2011 Tobacco Products Scientific Advisory Committee, why the FDA chose to follow up with a report of their own (released July 23rd) and what it found, various confounding factors including an international trade dispute concerning the importation of clove cigarettes and ultimately their take on whether and when the FDA will either ban or regulate menthol's use.       

Dr. Andrea Villanti is an Associate Director for Regulatory Science and Policy at the Schroeder Institute for Tobacco Research and Policy Studies at Legacy Foundation and holds an adjunct faculty Mail[1] (3)appointment in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health.  Her work concerns translational research to improve tobacco control policy and program decision-making with a specific focus on young adult cessation.  Since the passage of the 2009 Family Smoking Prevention and Tobacco Control Act, she has been actively engaged in research on the impact of menthol cigarettes on tobacco use behaviors.  Dr. Villanti received her doctorate in Social and Behavioral Sciences the Johns Hopkins Bloomberg School of Public Health and she received both her Master’s in Public Health and BA in Medical Ethics from Columbia University.

Ms. Diane Canova is currently Vice President of Government Affairs at the Legacy Foundation. Mail[2]Previously, Diane served as Vice President of Policy and Programs with the Partnership for Prevention.  Prior still she served as Vice President of Advocacy for the American Heart Association and as Director of Government Relations for the American Red Cross.  Ms. Canova is a founding board member and immediate past chair of the Center for Lobbying in the Public Interest (CLPI) and frequent lecturer on nonprofit leadership and advocacy.  She received her JD from the Brandeis School of Law at the University of Louisville and her BS in Education from Kent State.