Category Archives: Health Policy

Report Sheds Light on Difficulties of Family Members Caring for People with ‘Challenging Behaviors’

Caregivers_Report_Cover_300pI bet every reader of Health AGEnda knows someone who is a family caregiver (many see one every day in the mirror). And I bet every family member or friend providing care to an older adult who needs assistance because of chronic disease or frailty has their stories of good and bad days—of feeling incredibly fulfilled and completely overwhelmed.

Caregivers have much in common with each other, and our policies and systems need several overarching improvements to address caregiver needs. That is why the John A. Hartford Foundation is supporting an Institute of Medicine study to lay out the top level policy and practice recommendations (For more information, read New Grants Target Policy and Practice Change.)

However, it is worth noting that not all caregiving is the same. A recent analysis funded by the John A. Hartford Foundation from the AARP Public Policy Institute and the United Hospital Fund points to the especially difficult circumstances of those who care for people with cognitive impairment (such asAlzheimer’s or other dementias) and/or behavioral health conditions (such as depression, anxiety or serious mental illness), referred to in the study together as “challenging behaviors.”

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Poll Briefing Makes Voices of Older Americans Heard in DC

From left, featured experts Peggy O'Kane, Robert Berenson, and Caroline Blaum listen intently.

From left, featured experts Peggy O’Kane, Robert Berenson, and Caroline Blaum listen intently.

Like so many stakeholders in health care, we at the John A. Hartford Foundation  have many of our hopes pinned on enhanced primary care as a way of improving health outcomes, particularly for older Americans who face multiple chronic conditions.

Primary care providers will need more skills, more teammates, community partners, and, of course, more money, to live up to these hopes. But we believe that better primary care can prevent some of the acute and expensive events such as hospitalizations that they experience, and thereby also lower total costs of health care.

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Equality Does Not Equal Lowering Health Care Standards for the Poor

FrenchRevolution_177737175July is an important month in history, with Bastille Day, on July 14, coming just 10 days after our own 4th of July. So what better time to consider issues of justice and equality?

There are lots of different ways to interpret equality: equality of outcomes, equality of opportunity, or perhaps—as an even more complex relative equality—matching of resources to individuals’ needs.

In the context of improving health care delivery to older adults, there are several important examples of these principles of equality in what is called “risk adjustment.” And I find myself with very different reactions to the different kinds.

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Grappling With the Big Questions About Big Data

BigData_466582229_400We swim in an ever expanding ocean of electronic data.

Every Google search or credit card transaction can be aggregated and analyzed by companies that often seem to know what we want before we do. With new and cheaper analytic tools and more sophisticated modeling, the result is the ability to individualize and target, as well as spot broad trends among populations.

In health care, the explosion of electronic health records is adding to the sea of data that already exists from billing and claims. This raises a number of questions, including: Continue reading

Change AGEnts Push Health Care Policies In the Right Direction

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2014 Hartford Change AGEnts Policy Institute Participants

Improving the transitional care of frail older adults through better skilled nursing facility reimbursement.

Reducing regulatory barriers to evidence-based care coordination for older adults with multiple chronic conditions.

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New Grants Target Policy and Practice Change

One of the Hartford Foundation's new grants will support an additional 44 Health and Policy Fellows over the next three years who will bring geriatric expertise to policymakers and in turn receive intensive training in policymaking through placements at key agencies and offices in the federal government.

One of the Hartford Foundation’s new grants will support an additional 44 Health and Policy Fellows over the next three years.

While the two new grants approved by the John A. Hartford Foundation Board of Trustees last week continue to move us forward in our new strategic direction, which includes a focus on health policy and practice change, they also build on partnerships and successful work we have engaged in for years.

The grants totaling $2.13 million will support an additional 44 Health and Aging Policy Fellows (HAPF) over the next three years and help co-support a new Institute of Medicine (IOM) study on family caregiving of older adults. Both projects also offer great opportunities for our new Hartford Change AGEnts to bring their talents, expertise, and skills to bear on important issues related to creating policy and practice change that improves the health of older Americans.

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Toward a More Effective CMMI

CMIinnovationlogofinal1Last week on Health AGEnda, I stuck up for  the Center for Medicare and Medicaid Innovation (CMMI) in the face of what seemed to me fairly unrealistic criticism from a Wall Street Journal op-ed.

I approached the issue from my perspective as a funder and as a very, very, much smaller player in the reform of the health care delivery system than CMMI. It got me thinking that, while I have offered advice directly to the Centers for Medicare and Medicaid Services (CMS) and CMMI staff and mentioned various concerns here on the blog in passing, I haven’t really tried to think through what our experience at Hartford suggests might help CMMI be as effective as possible.

CMMI is the big player in health care delivery reform—the changes to culture, training, regulation, payment, and organization in health care that we all hope will lead to higher quality care, a healthier public, and lower costs of care per capita.

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Health Affairs Tackles Tough Question: How Do We Live With Alzheimer’s Disease?

Dr. Julie Bynum moderates the Health Affairs briefing on the special issue on Alzheimer's disease.

Dr. Julie Bynum moderates the Health Affairs briefing on the special issue on Alzheimer’s disease.

We all have Alzheimer’s disease.

This is a key message I took away from the April special Alzheimer’s issue of Health Affairs, the country’s leading health policy journal. One of the contributing authors, Jason Karlawish, makes this point writing about the ethical challenges inherent in caring for patients losing their cognitive abilities and autonomy. Inevitably, the disease belongs to caregivers and other people in that patient’s life.

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Debate Role of CMMI? Absolutely. Abolish it? No

WSJCapture400When I first saw the Wall Street Journal op-ed attacking the Center for Medicare and Medicaid Innovation (CMMI) for many purported sins, my first thought was that I should just congratulate CMMI for having arrived. After all, in our hyper-partisan environment, you aren’t anybody unless you are considered worth bashing by someone.

CMMI was set up and funded as part of the Affordable Care Act under section 3021of Title III, the hitherto relatively noncontroversial part of the law aimed at “IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE.” The agency’s goal is one that the John A. Hartford Foundation  has pursued on behalf of older Americans for 30 years and one that we feel passionate about:

The purpose of the CMI is to test innovative payment and service delivery models to reduce program expenditures under the applicable titles while preserving or enhancing the quality of care furnished to individuals under such titles. In selecting such models, the Secretary shall give preference to models that also improve the coordination, quality, and efficiency of health care services furnished to applicable individuals defined in paragraph (4)(A).

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Leadership Opportunities Available Now for Hartford Change AGEnts!

TS_150878885ChangeAGEntsMany of our grantees have heard about two new and exciting opportunities now available to Hartford Change AGEnts. In case you missed prior announcements, here are the details about the Hartford Change AGEnts Policy Institute and the Hartford Interdisciplinary Communications Conference, both taking place this summer.

Anyone who has ever been connected in any way to a Hartford-funded project (as a scholar, grantee, mentor, advisor, etc.) can be a Change AGEnt and is eligible to apply. And please help us spread the word by sharing these opportunities with anyone connected to Hartford who you think could benefit from them.

Hartford Change AGEnts Policy Institute
June 22-24, Washington, DC
Application due: April 25, 2014

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