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Blah Blah Health Care Reform Blah Blah

August 26th 2010		 0 comments

Wednesday, August 25, 2010

Blah Blah Health Care Reform Blah Blah
By Dean L. Johnson, Vice President, Community Relations, Seven Counties Services, Inc., Louisville, KY

Seems to me there's plenty of nonsense reporting and self-interested revelations surrounding the health insurance reform act passed earlier this year. If the mass media is your only source of information about what the act does and how it might affect you, your family, your business or your employer, then you've been shortchanged. 2 column articles and 30 second sound bites can't do it justice. Mostly, they do an injustice. Your most likely to find out somebody's beef with the bill. You're leastly likely to find out how it will affect you.
 
There is another way. An industry selling manuals, articles and slideshows centered on "what's in the bill" instantly materialized and continues to grow. I've had no less than four documents explaining the reform package in my briefcase at any one time for the past two months. I've read health insurance reform papers on planes, on trains, on buses and in automobiles.Most of them are large. Many of them are barely comprehensible. Nearly all are focused on how the bill affects a particular segment of the health care industry.
 
There's not a lot out there that delivers comprehensive, easy to understand and unbiased information to Joe and Jane Public, who need to understand what this bill does for and to them.
 
Fortunately, in Kentucky, we have a resource that fits the need. It's a ten page, easy-to-follow piece created by a coalition of organizations called Kentucky Voices for Health. It's simply titled: "The New Health Reform Law: What it Means to Kentuckians." Want to know if you'll be eligible for a subsidy to pay your insurance? It's in there. Wondering if your employer will have to provide you with insurance coverage? It's in there. Looking for small business assistance? It's in there. Worried about how the law affects Medicare recipients? The answers are in there.

Getting Your Kid Covered and in the Game

August 13th 2010		 0 comments

 

Making Prevention a Priority

January 9th 2010		 0 comments
Posted by Amy Barkley, Director
Tobacco States and Mid-Atlantic
Campaign for Tobacco Free Kids
 

As you’ve read in this space before, public health and medical authorities agree that disease prevention is an absolutely critical component of health care reform. As Congress negotiates a final health care reform bill, our elected leaders should seize this unprecedented opportunity to invest in proven measures that prevent costly diseases from occurring in the first place to both improve health AND reduce health care costs.  These include measures to prevent and reduce tobacco use, which remains the leading cause of preventable death in the United States, killing more than 400,000 people and costing the nation $96 billion in health care expenditures annually.  In Kentucky alone, where smoking rates remain among the highest in the nation, tobacco use kills more than 7,000 people and costs $1.5 billion each year.

 

The legislation now being crafted by House and Senate negotiators contains essential disease prevention programs that will improve health and reduce costs. These include: A requirement that Medicaid cover preventive services with demonstrated effectiveness, including treatment to help smokers quit, and creation of a prevention trust fund to finance proven, community-based prevention programs aimed at problems such as tobacco use and obesity.

 

Medicaid coverage of smoking cessation treatment: The final health care reform legislation should require comprehensive coverage of smoking cessation treatment, including medication and counseling with no cost-sharing requirements, for all Medicaid recipients, as the House-passed legislation would.  The Senate bill would require such coverage only for pregnant women receiving Medicaid. 

 

Medicaid coverage of smoking cessation treatment is critical as lower-income Americans have higher rates of smoking than the general population, and health care reform is expected to expand Medicaid coverage to millions of new beneficiaries.  In 2007, 33 percent of adult enrollees in Medicaid smoked, according to the Centers for Disease Control and Prevention. The overall rate of smoking among U.S. adults in 2008 was 20.6 percent. Medicaid expenditures attributable to smoking total $22 billion annually, representing 11 percent of all Medicaid expenditures, according to the CDC.  Here in Kentucky, where we have a staggering 285,000 adult smokers on Medicaid, the program spends nearly $500 million every year to treat those who get sick due to their tobacco addiction.

 

Remarkable results recently reported by Massachusetts underscore the benefits of providing Medicaid coverage of smoking cessation treatment.  The state found that smoking rates among beneficiaries in its MassHealth program dropped by 26 percent in the first two and a half years after it began providing coverage and promoting use of smoking cessation services in 2006.  Costly medical procedures also were reduced substantially.  Among the group that enrolled in the smoking cessation program, there were 38 percent fewer hospitalizations for heart attacks and 17 percent fewer emergency-room visits for asthma symptoms in the first year.  There were 17 percent fewer claims for maternal birth complications since the benefit was implemented. 

A federal requirement for coverage of smoking cessation makes our current effort to fund the state’s share of those benefits even more critical. Fortunately, Governor Beshear just announced that he would make funding for Medicaid smoking cessation benefits a budget priority so that our state can offer all Medicaid beneficiaries the tools they need to quit smoking – saving lives and taxpayer dollars.  

 

Prevention funds:  Both the House and Senate bills also would establish a fund to finance proven community-based prevention programs targeting public health problems such as tobacco use and obesity. Americans spend more than $2 trillion a year to treat disease and manage illnesses, and almost three quarters of that money is spent on caring for people whose illnesses we know how to prevent.  For example, smoking causes one in five deaths from heart disease, nearly one-third of all cancer deaths and nine in 10 deaths from lung cancer.  The lifetime health care costs for individuals who smoke are $17,500 higher than they are for non-smokers.

 

The Trust for America’s Health reviewed prevention programs that already have been tried and found that an investment of $10 per person, per year in proven initiatives to prevent smoking, promote physical activity and improve nutrition could save more than $16 billion a year within five years. That’s a return of $5.60 for every dollar invested. While the Congressional Budget Office has not estimated short-term savings from prevention in the health reform bills, it has said that “certain types of preventive services have been found to yield substantial net savings, largely because the initial costs are low and the long-term benefits are large.”

 

The final legislation should adopt the higher 5-year public health and prevention funding level in the House bill and the ongoing funding stream found in the Senate bill.  These funds would help finance community-based prevention activities and media campaigns that promote disease prevention.  Effective prevention will mean fewer premature deaths, less disease and more cost-effective health care spending.

 

Definition and Disscussion of "Health System"

January 9th 2010		 0 comments
Posted by Gil Friedell, M.D.
Friedell Committee for Health Transformation
 

We began a discussion in an earlier blog of the roles of responsibility, accountability and authority in the health system.  At this point, however, before proceeding further, it would be well to pause and define “health system” as we will use the term in these blogs..  This is particularly apropos now when ‘health system reform” is the major topic of concern in Washington and elsewhere in the country, In those discussions the word “system” seems to relate primarily to the provision of health services.  Occasionally “prevention” is included, but in those cases it seems to be considered as one of the services offered by health professionals, eg., immunization.

                        

Our view is broader than that.  For us “health system” is a macrosystem including both “upstream” health promotion and disease prevention as well as “downstream” screening, diagnosis, treatment, disease management and palliative care, ie., the provision of health services. The latter, the provision of health services, is the subject of most of today’s sometimes heated discussions, especially in Congress. However, we believe it is essential to identify and deal as effectively with the factors contributing to disease development as we do with disease diagnosis and treatment if we are going to reduce the burden of disease in this country.  That is the rationale for our more inclusive definition of “health system”. 

 

In reality, as Berwick has pointed out, our “system of health care” is a macrosystem composed of a variable number of often independent “small units of care delivery” or microsystems.  These include individual, or groups of, physicians and their professional associates, other health professionals, and a variety of ambulatory care sites.  Beyond that, the macrosystem includes hospitals and organizations providing a range of supporting services.  Still others deal with payment for services, and additional ones are concerned with policy, accreditation, etc.  And each of these elements in the macrosystem   has some degrees of autonomy.  Therefore as things now stand, it is only by taking an extremely tolerant view that we can call what is being discussed in Washington a “health system”.   

 

However, if there were effective means of information transfer existing among these various units, making possible coordinated, comprehensive and continuity care of patients and their families, and if there was an agreed upon understanding among the service units about the provision of a coherent set of services focused on effectively meeting a recognized patient health problem or problems, then we could justifiably refer to a “health system”.  The Kaiser Permanente organization is just such a system, as are the Mayo Clinic, the Geisinger Clinic, and the Veterans Administration Health System. 

 

We will have more “system talk” on subsequent occasions, with this clarification about terminology we can return to further discussion of responsibility, accountability and authority in upcoming blogs.   

Health Reform and Tobacco Prevention

November 4th 2009		 0 comments
Posted by Amy Barkley, Director
Tobacco States and Mid-Atlantic
Campaign for Tobacco Free Kids
 
The House could debate health care reform legislation on the floor as early as this week, with a final vote on a bill likely before Veterans’ Day next week. Meanwhile, the U.S. Senate is still finalizing a bill that should go to the floor for debate later in the month or early December.

 

A critical component of health care reform is disease prevention.  It's often said that the American health care system is more like "sick care" with too much emphasis on treating disease and little effort toward preventing it in the first place. With a greater emphasis on wellness and prevention, a reformed health care system would be a more effective use of health care dollars by addressing the underlying causes of poor health. Nowhere is a focus on prevention more important than in Kentucky, where we have the embarrassing distinction of being number #1 in a host of diseases and health problems, many of which can be avoided with changes in lifestyle and various health behaviors. Chief among them is tobacco use.

 

Keeping kids from ever using tobacco and providing treatment for tobacco addiction will save lives and reduce disease and will lower health care costs over the long run. Each year, tobacco use is responsible for more than 400,000 deaths nationwide and 7,800 in Kentucky. Nearly $100 billion is spent nationwide treating tobacco related illness, and $1.5 billion of that is spent in Kentucky alone. About one in five deaths from coronary heart disease, nearly one in three deaths from cancer, and almost 9 in 10 deaths from lung cancer are attributable to smoking.

To reduce the devastating toll that tobacco takes on our nation, our state and our families, we and other health organizations recommended to the Obama Administration and Congressional leaders that health reform should include the following components:

Require private and public health insurance coverage of tobacco cessation services. Tobacco users should have access to the tools that will improve their chances of quitting. The U.S. Preventive Services Task Force (USPSTF) and the Public Health Service recommend coverage of FDA-approved medications (both prescription and over-the-counter) and counseling sessions. Use of these services has been shown to increase the proportion of smokers who attempt to quit and quit successfully. Private health insurance and state Medicaid programs should be required to cover USPSTF-recommended tobacco cessation services and impose no cost-sharing requirements for using them.

Invest in community-based prevention. State-based, community-based, and school-based tobacco prevention programs and national mass media campaigns have successfully reduced tobacco use. According to best practice guidelines developed by the CDC, state tobacco control programs should include: public education efforts to prevent kids from starting to smoke and encourage people to quit; community-based programs that target populations most impacted by tobacco use where they live, work, play and worship; and cessation programs to help tobacco users quit such as providing access to counseling (e.g., quitlines) and FDA-approved medications. While state tobacco prevention programs and well done national mass media campaigns work, they have been chronically underfunded. In fiscal year 2009, no state committed the level of resources that the CDC recommended for tobacco prevention. Health reform legislation should include a new source of mandatory funding for evidence-based prevention programs with a proven track record of impact, such as tobacco control.

The health reform bills that have been approved at the committee level would make great progress in preventing disease by enhancing coverage of cessation services and investing in prevention.  As these bills move to the House and Senate floor, we and other health organizations will be advocating for preserving these provisions in the final bill.  There's a danger that, in an effort to find a compromise and keep the cost down, investments in prevention could be reduced.  Lawmakers should be reminded that health reform presents an important opportunity to create a health care system that values prevention of disease as much as treatment of disease. There are enormous health gains to be had from reducing tobacco use. Clinical- and community-based efforts have proven to be effective at reducing tobacco use and should be included in health reform legislation.

 

 

 

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