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Live Blog of Opening Plenary Session: Sarah Kliff

Posted By Benjamin Miller and AJ Jayabarathan, Thursday, October 4, 2012
 Tonight's Live Blog is hosted by AJ Jayabarathan and Benjamin Miller. 
Check back often to read their posts and to add your comments. 
You may also email your comments for posting to
Ben and AJ


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 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 do they all fit together?

Sarah: 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.

Audience member (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 contrary.

Sarah: Wait 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 performance???? 


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.

"Unlike 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.”

The 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?

Nay, 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.

ACOs 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).

A.J. 5:50pm. 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 it?

The rate of insurance has actually gone down because of the affordable health care act policies...for those younger than 26.
The kindergarten approach expecting all health care providers to cooperate is an important element that needs to happen in order for silos of care to change.
Doctor's 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.  


Sarah Kliff at #CFHA2012

A.J. 5:35pm. 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.

Ben 5:00pm. Healthcare policy is always moving. It is a complex adaptive system constantly interacting with all kinds of other components. Tonight’s plenary speaker, Sarah Kliff, begins her talk telling her story. It is a story about becoming involved in politics and the complexity of politics and healthcare policy. It is a story that often highlights the differences between public perception, our politicians, and law. It is a story that highlights how disconnected we can be in healthcare policy from that which actually happens on the ground with our patients.

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