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4 posts from September 2013


What Progress Did the Congressionally-Appointed Long Term Care Commission Make: An Interview with Judy Feder (September 30th)

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As part of last year's "fiscal cliff" agreement the Congress created a Long Term Care/LTC Commission tasked to make recommendations to improve LTC delivery.   (The Commission was created largely as a result of the demise of the ACA's CLASS Act.  See the related August 5th interview with Connie Garner.)  Today more than 12 million Americans rely on LTC services and this number will grow dramatically as baby boomers age.  Currently however only impoverished older Americans and the disabled are covered via state Medicaid programs and because few companies offer LTC policies (and because annual premiums are expensive), only about 8 million Americans have private LTC insurance.  As a result LTC services are provided moreover informally by 42 million Americans at an AARP estimated out-of-pocket cost of $450 billion annually.  In mid-September the 15-member LTC Commission voted 9-6 in approving 28 recommendations.  The six dissenting votes were largely due to Commission's failure to address the most substantive LTC issue, how best to pay for LTC services. 

During this 22-minute interview Prof. Feder discusses the Commission's findings generally.  Moreover she details how/why the Commission failed to address structural financing for LTC.  She also discusses the views of the six Republican-nominated commission members, how/why private insurance policies are limited and/or inadequate, what a publically funded LTC insurance policy would look like and prospects for future work conducted by a subsequent national committee and the Congress.                

Judy Feder is a Professor of Public Policy at the Georgetown Public Policy Institute.  Prof. Feder began her career at the Brookings Institution, continued at the Urban Institute, and, since 194[1]1984 has worked at Georgetown University.  She served as Staff Director to the Congressional Pepper Commission in 1989-90, served as Principal Deputy Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services in President Bill Clinton’s first term; as a Senior Fellow at the Center for American Progress and today as an Institute Fellow at the Urban Institute.  Prof. Feder is an member of the Institute of Medicine, the National Academy of Public Administration, the National Academy of Social Insurance, she's a former chair and board member of AcademyHealth, the Hamilton Project’s Advisory Council and a senior advisor to the Kaiser Commission on Medicaid and the Uninsured.  She received her B.A. from Brandeis University and her master's and Ph.D. from Harvard University.

The Commission's report can be found via: http://www.ltccommission.senate.gov/.  Prof Feder, et al., recommendations can be found at: http://www.medicareadvocacy.org/wp-content/uploads/2013/09/LTCCAlternativeReport.pdf.





How Safe Are Medical Devices: A Conversation with Diana Zuckerman (September 25th)

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Medical devices, everything from tongue depressors to pace makers and defibrillators, are regulated by the FDA.  How competently or effectively the FDA regulates these products has been questioned for several years in part due to the substantial increase in recent years in product recalls, for example the recall of certain hip implant devices.  More specifically is the question whether the FDA's 510(k) process, that reviews or “clears for the market” medical devices, is adequate.  An IOM study of the topic released in July 2011 reached the unanticipated and controversial conclusion that since, in part, 510(k) determines only “substantial equivalence” in clearing devices for the market, i.e., it does not evaluate device safety and effectiveness, the process should be scrapped and replaced.  (Listeners will recall Dr. Zuckerman was interviewed last December about the excessive use of anti-pshychotics in nursing homes.)

During this 26-minute discussion, Dr. Diana Zuckerman defines what's meant by "substantial equivalence" and the three FDA classes of medical devices, she assesses what assurance the public has in knowing approved devices are safe, comments on her 2011 findings published in the Archives of Internal Medicine (see the link below) and the IOM report and what progress the FDA has made over the past two years in improving its medical device review process particularly in post-market surveillance. 

Diana Zuckerman, Ph.D., has since 1999 been the President of the National Research Center for Women and Families, a nonprofit, nonpartisan research and advocacy organization promoting adult and child Diana zhealth and safety. After academic careers at Yale and Harvard, Dr. Zuckerman worked for many years as a Senate, House and Department of Health and Human Services staffer and as well serving as a senior policy advisor for First Lady Hillary Rodham Clinton and the White House Office of Science and Technology Policy. Presently, Dr. Zuckerman is also a fellow at the University of Pennsylvania Center for Bioethics and serves on the board of directors for two nonprofit organizations: the Congressionally mandated Reagan-Udall Foundation; and, the Alliance for a Stronger FDA.

Dr. Zuckerman's article noted above, "Medical Device Recalls and the FDA Approval Process," can be found at: http://archinte.jamanetwork.com/article.aspx?articleid=227466.




Do Workplace Wellness Programs Work and For Whom: A Conversation with Helen Darling (September 23rd)

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Today nearly all large employers offer a workplace wellness programs and most small employers that offer health benefits also offer at least one wellness program.  Typically these programs consist of health risk assessments, biometric screenings, health coaching and lifestyle management education.  Program popularity is not surprising considering the epidemic in what's termed "lifestyle diseases" due to, in part, poor nutrition and tobacco use.   To encourage employee participation in these programs the Affordable Care Act will allow beginning in 2014 employers to discount up to 30% of successfully participating employee's insurance premiums and up to 50% if the additional 20% is due to a reduction in employee tobacco use.  However, do these programs work and more pointedly do they shift health care costs from healthier employees to those considered less healthy? 

During this 22-minute podcast, Ms. Darling briefly describes workplace wellness programs, their rationale, funding, program incentive payments (including loss aversion policies) and the difficulties in determining wellness programming effectiveness.  She also addressess cost shifting criticisms of wellness programs and other related issues.  The interview concludes with her thoughts concering whether employers will begin to drop employee benefits in 2014.         

Ms. Helen Darling is President of the National Business Group on Health, a national non-profit, representing large employers' perspective on national health policy issues.  Its over 300 members, including 64 of the Fortune 100, purchase health and disability benefits for over 55 million employees, retirees and dependents.  Ms. Darling also currently serves on numerous boards including the Institute of Medicine's Roundtable on Evidence-Based Medicine, the Board of the National Mail[1]Quality Forum, the VHA Health Foundation Board and the Board of the Congressionally-created Reagan-Udall Foundation.  She is widely quoted in The New York Times, Wall Street Journal, The Economist, Washington Post and numerous other periodicals.  Previously, Ms. Darling worked at Watson Wyatt Worldwide, the Xerox Corporation, at William W. Mercer and served as an advisor to Senator David Durenberger.  Ms. Darling received her Master's and Bachelor's of Science fom the University of Memphis.

For more on the debate regarding the effectiveness of wellness programs see, for the example, the debate between Ron Goetzel and John DiNardo via the Health Affairs Blog, at: http://healthaffairs.org/blog/


Implementing (and Improving) the ACA: A Conversation with Professor Len Nichols (September 13th)

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During this 21-minute interview, Professor Nichols discusses the reasons for the decline in health care cost growth and whether its slowing will persist, alternative payment models (to fee for service) that contribute to this decline, how worrisome or not health care market consolidation is as well as the prospect of employers dropping employee health care coverage, why Congressional Republicans (moreover House Republicans) oppose the ACA, ways of improving the law via moroever price transparency provisions and whether states, specificallly Virginia, will take advantage of the ACA and expand its Medicaid coverage in 2014.

Since 2010 Dr. Len Nichols has been Professor of Health Policy and the Director of the Center for Health Policy Research and Ethics at George Mason University.  Previously, Dr. Nichols served as the Director of the Health Policy Program at the New America Foundation, as Vice President of the Center for Studying Health System Change, as a Principal Research Associate at the Urban Nichols[1]Institute, as a Senior Advisor for health policy at the Office of Management and Budget during the Clinton Administration's health reform effort, and as Chairman of the Economics Department at Wellesley College. He has advised the World Bank and the Pan American Health Organization, as well as various state governments and departments of the US Government.  Because of his reputation as an honest and knowledgeable health policy analyst, Dr. Nichols has testified on numerous occasions before Congress and is frequently interviewed by major media outlets including The New York Times, The Washington Post, The Wall Street Journal, Congressional QuarterlyNational Public Radio, the British Broadcasting Service and ABC, CBS and the NBC's nightly news He received his Ph.D. in economics from the University of Illinois at Champaign-Urbana.

Professor Nichols most recent Congressional testimony was before the US Senate Budget Committee this past July 30th, see: http://www.budget.senate.gov/democratic/index.cfm/files/serve?File_id=4dd8a8b5-c123-44e6-b13e-34b6e825c3f0

Among other noted publications Prof. Nichols co-authored (with John Bertko) in 2009 "A Modest Proposal for a Competing Public Health Plan".  See: http://www.newamerica.net/files/CompetingPublicHealthPlan.pdf