A.J. 6:25pm. Sarah:
NEJM carried a paper that looked at a comparison between states that
expanded medicaid and others that did not....the population health
outcomes clearly favored the states that expanded medicaid.
Sarah's response to a
question about changing human behavior..is it possible with the
current emphasis on education ex. calorie labels being affixed to fast
foods? Would making a big mac more expensive be the true way to
change behavior and therefore manage health outcomes...Humana is
presently looking at making healthier choices easier and incentivised to
affect human behaviour.
A.J. 6:18 pm. Audience member question: There are many demonstration projects and pilots going on...how do they all fit together?
I don't know how they are going to fit together, however with everyone
moving towards value based, high quality care, the hope is that it moves
people along in a positive direction which will effect positive change.
(Dr. Sanchez): We have the highest number of uninsured people in
Texas....just like we have a lot of bats...and our Senator has announced
that Texas does not need to expand medicaid. However, a reputable
economist is soon to refute his position with strong evidence to the
until the election happens. Right now it is easy to say these things,
but should President Obama be re-elected, there will be a powerful force
for change afoot.
Ben 6:16pm. Sarah taking questions now. This has been a good (and fast)
plenary. I am thankful that there are really smart policy people out
there who can write (and talk) about this. The information that Sarah
brought was grounded in evidence and rationale in its delivery. There
are very few out there covering health policy that do it as well as
Sarah Kliff. Using up to the date research (and amazing graphs), Sarah
helps explain some of the most complicated issues around healthcare
policy in a very easy to understand way. For example, here write up last
week on "Increased obesity is wiping out most health benefits of less
smoking” used one graph to describe this phenomenon and why it is
happening. This is one blog to have in your RSS feed (plus, how many
reporters will integrate the Simpson’s into their work?). Thank you Sarah for an excellent plenary session.
A.J. 6:13pm. Closing
anecdote: Doctors salaries were tethered to quality of care
determinants. A check list of deliverables were developed. In the first
month 3 doctors got bonuses, then 12 ...etc, etc. It set up a positive
competition amongst the group of surgeons that stayed, and it was felt
that this shifted direction. Sort of like atheletes being paid for
A.J. 6:09pm. In all fairness, the subject matter is dry and full of numbers! Study after study after study after study.....mind numbing!
Is it any wonder, we glaze over like donuts after some time?
Ben 6:06pm. Sarah discussing the state of Oregon and
healthcare innovation. However, a state, very similar to Oregon is
Colorado. In Colorado, we have a wonderful innovative community known as
Grand Junction. To really know why Grand Junction matters, you have to look under the hood and examine the engine.
in most communities, where doctors are paid less for Medicaid patients
than insured ones, physicians here agreed among themselves to charge a
little less for regular patients and a little more for Medicaid
patients. That way doctors would be happy to treat all comers.’”In
effect, we created a community health system,’ said Steve ErkenBrack,
president of Rocky Mountain Health Plan.”
engine in this case is a nonprofit health plan willing to take some
risks to delver better care. The reasons of this may be lost on many
initially, but think about it for a second and I will return to this.
And again, we are back to the need for transformation in our payment systems.
A.J. 6:05pm. Organizations
are stepping forward and taking on the challenge to reform provision of
services...and they are "sticking" out their necks it seems and taking
on risks. How come? Because at the micro, meso and macro level,
"everybody knows" (check out Leonard Cohen's song...very apt) that the
current system is doomed. So, those that want to be saved and save their
systems of care are strapping on the parachute of "Obamacare" and
jumping before the aircraft crashes...
A.J. 6:00pm. 2014 heralds
the start of the affordable care act...the biggest expansion to medicare
since 1965. A new set of acronyms to define unicorns it seems,
creatures that no one has seen before?
the act seeks to lay down new foundations (no matter how boring and
dull they sound) that will grow new outcomes. Because it is more
strategic, more comprehensive, much more grounded in the reality of the
population health issues that face 314 Americans every day.
Ben 5:56pm. Sarah just brought up the magical unicorn, ACOs. Accountable Care Organizations are partnerships between healthcare providers designed to be accountable
for the quality and cost of the healthcare they provide in return for
financial incentives. How these partnerships are implemented may vary,
with some focused purely on primary care, while others include
sub-specialists and hospitals. In all cases, primary care is expected to
form the core of these organizations, the center of the wheel, and base
for the ACO.
are risk-bearing entities and require capitalization. To this end,
hospitals and other healthcare professionals like physician groups are
partnering with insurers to form these entities. The partnerships that
participate in the MSSP will likely cross over into commercial plans,
and Medicare will not be the only health insurer to benefit from the
cost reductions realized by ACOs.
There are indeed interesting opportunities within ACOs for collaborative care.
Ben 5:51pm. Sarah just nailed one of the most important points about healthcare
– we have an irrational system that rewards bad behavior in healthcare.
We have a system that pays for healthcare through fee for service that
often rewards behaviors whether or not they work. As Dr. Peek has taught us, we must change healthcare in three worlds simultaneously (clinically, operationally, and financially).
Health care spending is the primary driver of the National debt. But
despite spending more, fewer people are covered for health care needs.
Covering fewer people with more money, is NOT the objective for the
The rate of insurance has actually gone down because of the affordable health care act policies...for those younger than 26.
kindergarten approach expecting all health care providers to cooperate
is an important element that needs to happen in order for silos of care
roles are determined by how the system of care is set up and they
follow them...however, what is irrational is how they don't work in
unison! What gives?
A.J. 5:44pm. The
affordable health care act asks fast food places to post the calorie
labels on their food. When Sarah asked a consumer of fast food at
MacDonalds what their reaction was towards this, he remarked that this
made sense and should be part of what Government is doing to improve
health care!!!!! When informed that it was part of "obamacare", he
appeared to loose interest in the matter.
Ben 5:44pm. Sarah just told us about a story about McDonalds and talking to
people about healthcare policy. She mentioned a gentleman who believed
that something was in PPACA that was in reality not in the law. And it’s true, there is a substantial need for accurate information
in healthcare policy. Finding the most accurate source of information
is hard and made even harder by the fact that we have our own opinions
and political biases.
Austin hosts 1.5 million bats as a colony housed under the bridge over
Lady Bird Lake. 84% (ballpark) of the audience watched the presidential
debate last night. Ben Miller 's interest is in the policy development
of healthcare. Sarah Kliff covers healthcare policy in her writing and
has a remarkable grasp of data as it pertains to healthcare. However,
"The dream of reason did not take power into account" , so, this talk
is perfectly poised between the presidential debate last night and the
elections to come
A.J. 5:30pm. We
heard from Dr. Eduardo Sanchez, Lynda Frost and Katherine Sanchez about
the numerous initiatives in Texas that have further the field of
Collaborative care at a grass roots, horizon and blue sky level. The
Hogg Foundation, Amerigroup Real solutions, VA Health Care, Blue Cross
Blue Shield of Texas, American Psychological Association, Forest
Institute, St. David's Foundation, The Meadows Foundation have provided
sponsorship and support for this conference to be held in Austin, Texas!
A.J. 5:10pm. Journalists
are the story tellers of our time. Instead of campfires of yore, we huddle with
our mobile devices for the warmth of human company and the draw of the "narrative”
element of storytelling. But how
closely does media portray reality? How much reality can we handle? If you
asked someone who has experienced mental illness, domestic violence, bankruptcy
or their family member, the raw emotion of pain and suffering is tangible. And,
our story tellers use these elements to sell their stories. Tonight I
look forward to hearing from a "truth teller”. Sarah’s pieces carry the simplicity
of fact and the review of relevant evidence to help put stories in context.
Tonight I look forward to seeing and hearing her.