Health AGEnda

No Single, Simple Explanation for High Health Care Costs

As we enter 2014, the topic of health care costs continues to be a major topic of conversation in the media and among policy makers. The topic is complex and can be spun in different ways.

You may have seen the recent news about how growth in health care spending in the United States has remained low for four consecutive years, for which the White House would like to take some credit. Or you may have seen news reports about how Medicaid expansion in Oregon led to higher emergency department use (and therefore higher costs), which is used by some to argue against the Affordable Care Act. The bottom line is that understanding health care costs is a complex task.

Clearly, the issue of out-of-control U.S. health care costs is of crucial importance and has been a serious challenge to increasing funding for other needs, such as improving infrastructure and education. It is also one in which the general public, pundits, and politicians look for simple, single reasons and matching solutions, e.g., obesity/calorie designations on menus; malpractice insurance/tort reform, too much government involvement/more private sector competition, etc.

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The Question of Long-Term Care: How Do You Eat An Elephant?

Dr. Tracy Lustig testified in August before the Commission on Long-Term Care.

One of my biggest surprises in the passage of the Patient Protection and Affordable Care Act (PPACA) was the inclusion of title VIII, the CLASS ACT, which created the possibility of a national, voluntary, premium-financed, and federally administered long-term care insurance program.

While the benefits might have been small and delivered through our only marginally adequate long-term care system, at least it was a start and a step toward recognizing the serious long-term care needs of our aging population.

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Medicare readmissions reduction reform is complex, scary—and absolutely necessary

NHPFlogo250Last Friday I was at a session of the National Health Policy Forum (NHPF) in Washington D.C. focused on Medicare’s readmission reduction program  The program, authorized under section 3025 of the Patient Protection and Affordable Care Act (PPACA), is the “stick” to section 3026′s “carrot.”

Section 3026 authorizes the $500 million Community-based Care Transitions Program that will pay partnerships of community-based organizations and hospitals to offer evidence-based, post-discharge services to reduce readmissions. Section 3025, in effect since October 2012, dropped the other shoe and requires the Centers for Medicare and Medicaid Services (CMS) to reduce payment for Medicare services to hospitals whose patients have higher than expected rates of rehospitalization within 30 days of discharge. (For more background, watch this Modern Health interview  with longtime John A. Hartford Foundation grantee Eric Coleman, MD, read this recent Reuters article featuring Coleman, and this post I wrote on Health AGEna in December 2010.

Clearly the audience at the session was very concerned about the program and seemed sure that it should changed, if not abandoned (See my response to a Wall Street Journal op-ed last month.). I see the matter very differently and I’d like to explain why. NHPF Sessions are off the record, so I won’t use any quotes or attribution.

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The National Health Policy Forum: A Wealth of Information

WashingtonCapitol300To outsiders, Washington D.C. is a mysterious place filled with smart and hardworking people. But it is very hard to know who has influence, whose opinion is respected, and where to start. It’s also a place where young staffers have incredible responsibilities to carry out the ideas and intentions of their elected bosses, but not a lot of background or time to master issues.

Who would have guessed six or seven years ago that the young staffers of the junior senator from Illinois would have been elevated to positions of enormous influence by their boss’s election to President? For us at the John A. Hartford Foundation, one way to help navigate these mysteries and to be sure that the issues and work of the grantees we support are communicated to policymakers is our relationship with the National Health Policy Forum.

Over the years—31, to be exact—the Hartford Foundation has funded 10 grants totaling more than $6.4 million to the National Health Policy Forum (NHPF or “the Forum”), located at George Washington University in Washington, D.C., and headed by its founding director, Judith Miller Jones. In the early days, the Hartford Foundation funded Judy and the NHPF to further the foundation’s work under its short-lived Health Care Cost & Quality initiative. A few years after that initiative ended, Hartford again commissioned Judy and the NHPF to further the Foundation’s current mission and work in aging and health care issues, which it has been doing since 1997 with six grants worth more than $5.7 million.

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Volk Lecture: Nurses Play Essential Role in Health Care Innovation

Jennie Chin Hansen, chief executive officer of AGS, delivers the Norman and Alicia Volk Lecture in Geriatric Nursing.

Jennie Chin Hansen, chief executive officer of AGS, delivers the Norman and Alicia Volk Lecture in Geriatric Nursing.

Delivering the 5th Annual Norman and Alicia Volk Lecture in Geriatric Nursing, Jennie Chin Hansen, RN, MS, the chief executive officer of the American Geriatrics Society (AGS), eloquently challenged her audience to renew their efforts to ensure that older adults receive better care in hospitals, in their communities, and at home.

A crowd of more than 300 nursing students, faculty, and guests attended the recent lecture at New York University’s College of Nursing. The topic was “Health Care Today and Tomorrow: How Can We Make a Difference?”

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Debate Over Hospital Readmissions Policy Is Essential to Better Care

TS_96071825_Debate300A recent New York Times article noted a “growing chorus of critics” questioning the fairness of new Medicare financial penalties on hospitals with high readmission rates. While it was certainly a well-written piece about a topic more people need to understand, the article paints an incomplete picture about the debate and goes too far in portraying hospitals as victims (although appearing in the Business section, maybe that’s not too surprising).

Since I gave a brief talk a few weeks ago at the American Society on Aging meeting that could be construed as adding to the critical chorus, I thought I’d try to provide additional context. I hope to point out the real story, which is less about fairness—or lack thereof—to hospitals, and really about how the robust debate occurring right now represents a sea change in the way hospitals and our health care systems think about accountability for their patients.

And that’s a good thing.

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Pioneering Paths to Better Care, Better Health, and Lower Costs

Medicare has become a central issue during this heated election season, but the debates are loud, confusing, and often play off fear, intergenerational conflict, and ideological differences about the role of government. Unfortunately, what gets lost in the raucous debate is the opportunity we all have at this particular moment to preserve Medicare, lower its costs, and at the same time improve people’s health.

How can we do this? By working together—no matter our political persuasion—to transform the way care is delivered in Medicare and throughout the U.S. health care system.

I had the opportunity last week to see a federal program that is doing just that. It was the last meeting of this year’s Innovation Advisors, participants in an initiative sponsored by the Center for Medicare and Medicaid Innovation, created under the Affordable Care Act. My colleague, Amy Berman, introduced readers to the Innovation Advisors back in February, and has been involved in their training and development since. The goal of the program is to support individuals who can test and refine new models to drive delivery system reform—models that result in better care, better health, and lower costs.

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Ensuring Quality Care for Older Adults

If we had to pick a theme for 2012, it might be Measuring Quality of Care Year. Our annual report discussed the lack of quality mental health care for older adults, recently illustrated by the callous dismissal of annual report writer Lynne Christensen’s mother’s post-surgical depression as “to be expected.” Our April poll, “How Does It Feel? The Older Adult Health Care Experience,” also concentrated on this theme. The poll showed that although the vast majority of older adults are satisfied with their care, that care lags badly behind recommended care for older adults on numerous measures.

While the poll was a new experience for us, writing about the sorry state of care for older adults isn’t. To help you better understand this important and frustrating issue, we’ve gathered a collection of Health AGEnda posts that address some of the problems—and solutions—we’ve identified.

Supporting the results of our poll was “The Good, the Bad, and the Ugly,” in which I discussed how far we need to go to improve care for older adults. Although there are some good programs improving geriatrics training for physicians, not all of them are producing robust results. For example, raising falls screening from a dismal 11 percent to a still-mediocre 34 percent is nowhere near good enough, and I believe there needs to be a greater sense of urgency in solving the problem.

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A Salute to Berwick as the Guard Changes at CMS

Courtesy of IHI

December 1st was Don Berwick’s last day as the administrator of the world’s largest health insurance entity, the Centers for Medicare and Medicaid Services (CMS). Dr. Berwick was responsible for an $820 billion agency that cares for 47 million Medicare beneficiaries, 39 million over the age of 65. Although trained as a pediatrician, Berwick was keenly aware of the special needs of our nation’s older adults. Much of what he did at CMS will have an enduring impact on the health of older adults. Here at the John A. Hartford Foundation, we believe Don would have made an outstanding geriatrician. Considering our expertise in the area of older adults and health, I think we can confidently say we know one when we see one. As Don rejoins the health care rank and file, we want to recognize his significant achievements.

Dr. Berwick reorganized CMS around innovation and the fundamental desire to achieve the three-part aim: better care, better health, lower costs. The phrase was notably coined by Berwick while at the Institute for Healthcare Improvement. Under his tenure as CMS Administrator, it became the true north for health policy implementation. The three-part aim was central to CMS launching the demonstrations outlined under the Affordable Care Act, aimed at realigning incentives through shared savings. Examples include the Accountable Care Organization, described by Chris Langston in his blog, Everything You Wanted to Know About ACOs but Were Afraid to Ask, and the Community-based Care Transitions Program that Eric Coleman and I wrote about in Health Affairs (see GrantWatch Features Care Transitions).

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Beyond the Boardroom: Interview with John Rother

Each quarterly meeting of the Foundation’s trustees features a prominent speaker in the field of aging and/or health care, giving us an opportunity to increase our collective knowledge. Rather than reserve that knowledge entirely for ourselves, we decided to make it available to everyone through our “Beyond the Boardroom” series, to be posted quarterly on our YouTube channel. We recently posted our inaugural video, in which intrepid reporter and Senior Program Officer Rachael Watman interviews John Rother, Executive Vice President of Policy, Strategy, and International Affairs at AARP. They cover several important topics, including the Affordable Care Act, reimbursement for primary care providers, and the role of foundations in improving health care for older adults.

Check out the video here or at http://www.youtube.com/user/jhartfound.

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