Access

The Robert Wood Johnson Foundation (RWJF) recently released findings from a study of American physicians about the links between health and unmet social needs. These needs included basic necessities like adequate nutrition, access to public transportation, and safe housing. Physicians overwhelmingly identified unmet needs as fundamentally related to their patients' health conditions, particularly among lower-income patient populations. Unfortunately, four out of five doctors surveyed (a sample of 1000 primary care physicians and pediatricians) said they did not feel confident in their capacity to meet these needs, which limited the effectiveness of the care they provided. Over half of surveyed doctors said their patients did not have access to the resources they needed to stay healthy. As Jane Lowe of RWJF noted in a press release, "America’s physicians understand that our health is largely determined by forces outside of the doctor’s office. Housing, employment, income and education are key factors that shape our health, especially for the most vulnerable among us.”

This is the fourth and final installment in a series of interviews with policy experts who participated in an event we hosted on November 22nd, "Poverty, Inequality, Mobility, Oh My," where we explored different ways of assessing how families are doing post-Great Recession and how applying these different approaches to the design of public policies might improve the conditions and opportunities of low-income families.

Editor’s Note: This is part of a series of posts contributed by Andrew Wickerham, who attended the 139^th Annual Meeting of the American Public Health Association this week in Washington, DC.

Think back to high school or college when a teacher would offer comments on a test or essay, along the lines of,  “B-, could have included more background on FDR’s reason for passing Social Security.”  That's not far off from the exercise the Department of Health and Human Services (HHS) undergoes periodically as part of its HealthyPeople Leading Health Indicators (LHIs) program, only the note to the country is more alongs the lines of,  “C-, work on diet, exercise, and making sure people with high blood pressure take their medication.” 

Unfortunately, most Americans, like bored, uninterested students in history class, don't seem to care. We have yet to make improvements to our health—and by many measures are worse off than we were a decade ago. So why does the federal government bother with the regular (read: expensive) process of revising the HealthyPeople guidelines?

HealthyPeople (HP)  started with a 1979 Surgeon General’s report intended to focus America’s public health agenda, prevent disease, and promote overall wellness. Three reports—HP1990, HP2000, and HP2010—followed, offering a decennial update to the national health improvement framework. Each report listed a series of LHIs, with the intent of focusing efforts for the coming decade. HP2020 launched in December 2010, and on Monday, HHS Assistant Secretary for Health Howard Koh, MD, MPH announced the newly updated list of 26 LHIs during a press conference at the American Public Health Association annual meeting.

Now, goals and objectives are certainly good things—they can serve to guide policy and reinvigorate practice. “The Leading Health Indicators imply priorities,” former Texas Commissioner of Health Eduardo J. Sanchez, MD, MPH, said at Monday’s event. Yet, the process of setting new goals for HealthyPeople seems rather conflicted.

Early reports on the relative successes and failures of HP2010 suggest that only a few hundred out of almost 1,000 HP2010 goals were achieved, and that ground was lost in the critical area of chronic disease management, with Americans suffering higher rates of obesity and hypertension. Nevertheless, HP2020 rolls out hundreds of new goals and objectives, in addition to the new LHIs.

There was one bright spot at the meeting. For the first time HP2020 includes consideration of the social determinants of health—the non-clinical factors that affect human health—as part of the LHIs. Socioeconomic disparities are widely recognized health indicators because disparity affects ability to access health care, self advocate, and make healthier behavior choices.  High-school graduation rates will be tracked as an LHI under HP2020 as a way to study the socioeconomic factors that influence health, and to encourage policymakers and providers to take a more holistic approach to improving population health.

Health Wonk Review, Muppet Edition!

Hello all, and welcome to another exciting episode of Health Wonk Review! (Regular readers will note that yes, I used line last time. I have half a mind to make Alistair Cookie the official HWR mascot, here at New Health Dialogue.) In honor of what would have been Jim Henson’s 75^th birthday last week, I bring you the Muppet Edition of Health Wonk Review!

Now, without further silliness, the articles!

Quality Care

Here at New Health Dialogue, we’re exulting in doctors’ acceptance that yes, they do overtreat patients! Now, getting them to accept that money is part of the reason why…

Jonena Relth of Healthcare Talent Transformation draws attention to the cool new physician payment system being tried at Fairview clinics in Minnesota: payments are based on patient satisfaction and health, rather than by the number services provided.

David Williams draws a parallel between diagnosis and management consulting: experienced clinicians need to be wary of “early closure,” and avoid becoming like the “more experienced managers [who] are satisfied with two data points – after all, that’s enough to make a line, [or the partners who] just need one data point – they can assume the slope.”

Jessie Gruman, at the Prepared Patient Forum, wonders if the collaboration between HHS, the Robert Wood Johnson Foundation, Dr. Oz, and others will help Americans learn to pay attention to their medical care and improve communication with their providers.

Chris Langston points out that there are fewer people entering training for geriatric specialties—a workforce that may be critical in addressing the communications issue Jessie discussed.

Tarnish on the Golden State, a new report issued by the New America Foundation, exposes how medical debt can lead to ill health and financial insecurity for individuals and families. Tens of millions of American families struggle to pay health insurance premiums and medical bills. In 2010, 44 million working aged American adults had medical debt or medical bills they were paying off over time. In California, over two million people had medical debt prior to the recession and the problem has likely become worse since then.

What’s the most effective way to predict which patients will be hospitalized in the coming year? The Heritage Provider Network, a managed care group in California, hopes to answer this question through its sponsorship of the Heritage Health Prize, a $3 million X Prize-like competition for health care. The contest invites participants to develop a prediction algorithm to identify patients who will spend time in the hospital in the following year and check their methods against three years of Heritage’s own claims data. S/he who most accurately predicts hospitalizations takes the prize.

Just 18 months after the health reform debate killed the potential for a national “public option” in health care, one of the 50 U.S. states is poised to breathe new life into government-run insurance systems. Despite its fiercely independent reputation, the State of Vermont is forging a path towards single-payer health care, and its newly elected governor is determined to succeed.

“Everyone else in the developed world has done this, and we haven’t,” Governor Peter Shumlin (D-VT) told an audience at a recent health care forum sponsored by The Atlantic. The event brought together health care leaders, policymakers, and representatives from dozens of DC policy shops for a daylong discussion of the “next steps” during implementation of the Affordable Care Act (ACA).

Are more physicians the answer to our health care woes? That’s the current thinking in many quarters, including a blog last month posted by The Washington Post’s Ezra Klein. He argues that the U.S. is on the cusp of a looming physician shortage, one that keeps medical costs high and access low.

Klein is hardly the first person to make this argument, and common sense would seem to support it. By following the basic logic of supply and demand, upping the ‘supply’ of docs will decrease the market price of their services, right? But this assumption misses the fact that our current, fee-for-service mechanism of health care financing doesn't allow the market to work that way. For one thing, doctors' fees are set, well, by doctors themselves. What's more, doctors get paid more to deliver more services, and doctors are the ones who decide, for the most part, which services their patients need. Increasing the number of doctors, especially the number of specialists, will drive costs even higher, because the more doctors there are, the more services they will deliver. Most importantly, many of these extra services won’t offer better health or longevity for patients.

During the legislative battle over health reform, we told you over and over again about the Cost of Doing Nothing (read the paper here). Now, we can tell you about the Benefits of Doing Something.

We already know community health centers, strengthened by both last year's stimulus package and the health reform law, are good for keeping people healthy. A new report from the Center for American Progress (CAP) by Ellen-Marie Whelan says it can also help heal the economy.

In case you missed the news coverage of this week's D.C. C.A.R.E. free clinic (our story here), we wanted to draw your attention to this excellent segment from ABC 7's Washington affiliate WJLA: