The Disruptive Women in Health Care blog continually aims to encourage discussion and debate among readers about emerging issues and topics in the health care world. Historically, one of the ways that we have done that is through our weekly round-ups – that is, posts containing summaries and links to some of the big stories in health care news for the given week, with some original commentary and content sprinkled in as well. The way we see it, there is just too much happening in this burgeoning industry; it’s hard to keep up, especially when you’re busy disrupting and making headlines in the health care world yourselves. We know the weekly round-ups have been on hiatus for a while, but are happy to report that they’re finally making a comeback. Each week, we’ll be gathering some of the biggest health care news you can use from at home and abroad for posting on Wednesdays. Feel free to comment on what’s included and send us some links to articles to be considered for next week!

Has your week been too disruptive for you to keep up with the news?  Disruptive Women are on the case!  Here is this week’s round up of some of the most pressing issues here in America and around the world.

Here at Home:

Thanks to a provision of the Affordable Care Act (ACA), women are now able to receive free birth control, but only if it’s prescribed.  The New York Times explains how Catholic Colleges are using this loophole to combat contraception.

And, speaking of the Catholic Church and the ACA, USA Today says that Obama’s decision on Friday not to expand the conscience exemption to include religious institutions has been met with outrage from Church leaders and parishioners.

Remember that moment of panic you had when the swine flu epidemic came to the United States?  CBS News reports that swine flu numbers are rising again in Mexico. Will the US be next?

Susan G. Komen for the Cure, the nation’s leading breast cancer charity, announced Tuesday that it is halting its partnership with Planned Parenthood (per NPR) – a controversial decision that ignited a backlash from some of its supporters.

Here’s one perspective on Komen’s decision. What do you think? Will this impact your decision in giving donating to Komen, or another breast cancer non-profit in the future?

Sick? Took a sick day?  Is that enough of a reason for you to wind up unemployed?  HuffPo explains how an issue as simple as recovery from the flu has reached the Supreme Court.

With nearly two million women lacking health insurance and a quarter of a million unplanned pregnancies per year, Florida has a lot of challenges in terms of women’s healthcare.  Here’s what the state is doing to try and move ahead.

Around the World:

Brazil is calling for a registration of all pregnant women.  What does this mean for a woman’s right to choose within Brazil?

Japan’s population is shrinking. As more women choose a career over family, Japan faces declining birth rates. Could the United States be next?  ABC News takes a look.

Check back each week for the latest health care news!

CMS Administrator Marilyn Tavenner addressing Care Innovations Summit attendees. Image courtesy of Kaiser Health News.

“I think we would all agree that these are not ordinary times, that this is not an ordinary conference, nor is it an ordinary time in health care,” commented Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner, in her address at the first ever Care Innovations Summit Thursday. In saying so, Tavenner captured not only the essence of the problems facing our nation’s health care system and the reason that over a thousand national thought leaders, senior government officials and industry experts had gathered, but also inspiring attendees with the idea that, by being there, they had the opportunity to be a part of the solution.

Driving the day at the Care Innovations Summit, which was hosted by the Center for Medicare and Medicaid Innovation (CMMI), Health Affairs and the West Wireless Health Institute, was the notion that American innovation could solve any problem, and the thousand-plus attendees were the innovators to solve this one. Emphasizing CMMI’s founding mission of better health, better care and lower costs, speakers across sectors, industries and areas of expertise continued to echo each other’s cries that it was all possible, if people began collaborating and innovating across fields.

Even before HHS Chief Technology Officer Todd Park compared data to rocket fuel, the Summit was beginning to sound like President Kennedy’s speech to Congress announcing the Space Race. In fact, the addresses and panels were broken up by “Ignite Talks” — wherein private-sector stakeholders presented problems and issued challenges to attendees and to entrepreneurs across the country, offering not only prizes, but implementation funding for the best solutions (you can see a list with links to descriptions of the various challenges issued here).

Park best captured the sentiment of the Summit, saying, “There is no problem that Americans can’t invent themselves out of…Transformation driven by a tide of grassroots innovation mojo has already begun.”

While this sentiment and attitude towards repairing and revitalizing our nation’s health care system certainly drove the day, it is not new, nor is it exclusive to CMMI. In fact, it echoes many of the themes that motivated us to launch the Health in Place™ (HIP) initiative last month. The concept of HIP is built around the idea that, thanks to wireless communications and emerging technologies, our homes are more than ju

st houses, our offices are more than just workplaces, our schools are more than just places of learning and our cars are more than just modes of transportation — and that, for this facet of 21st century health care to achieve its full potential, a number of public policy issues are involved, cutting across multiple disciplines from health care regulations and benefit structures to tax policy and technology incentives. HIP aims to connect the dots between industries, inspire innovation and drive policy changes that accomplish CMMI’s goals of better health, better care and lower costs while simplifying things in the process.

With all of this collaboration and innovative thinking, there is no doubt that this is an exciting time in health care, but as Don Casey expressed in his closing remarks at the Summit, there are some significant obstacles to overcome to get the rockets to the moon. “I think a lot of people are skeptical about two things,” Casey said, “the American economy and do we have the ingenuity to get this stuff done, and can we actually engineer a jailbreak for health care.”

Are you planning to take part in any of the innovation challenges issued? Do you think cross-industry collaboration is really possible? And, what do you think we need to do in order to break down the barriers Casey and others at the Summit alluded to?

If you chose to partake in what HuffPo referred to yesterday as “ your country’s empty displays of patriotic kitsch” — aka a State of the Union Drinking Game — last night, I certainly hope health care wasn’t one of your buzzwords.

President Obama delivered his 4^th State of the Union (SOTU) address to Congress last night, outlining his goals and his priorities for the nation in the coming year, and – as Sarah Kliff from the Washington Post’s WonkBlog put it  – “For health policy wonks, Tuesday night’s State of the Union speech wasn’t a thriller.”

In fact, in his nearly 70-minute, 7,000 word address, “President Obama mentioned Medicare and Medicaid… once. ‘Health care’ got two shout-outs. The Affordable Care Act? Not even a name-check,” (per Kliff).

To think of it another way, consider how Daily Briefing editor Dan Diamond broke it down — the president spent 44 words on health reform, accounting for 0.6% of the total speech.

As Politico pointed out, “Obama spent so little time on the [health reform] law that he didn’t even acknowledge an audience member the White House had brought to the speech — a cancer survivor who could have been an example of someone with a pre-existing condition who was helped by the law.”

The White House had announced earlier Tuesday that this young man, Adam Rapp, would be sitting in the first lady’s box. Rapp was diagnosed with testicular cancer on his 23^rd birthday, the same day that he would have lost health insurance coverage were it not for the Affordable Care Act (per CBS) – a potentially powerful testament touting the impact of ACA, and yet one that went unmentioned.

All of this is more staggering when you consider what a departure it represents from years past.

Medscape Medical News reports that, “Obama mentioned either “healthcare” or “health insurance” only 3 times, compared to 6 references in 2011 and 10 in 2010.”

The California Healthline blog lays it out a bit differently, explaining that, “Two years ago, the president spoke for several minutes — a total of 570 words — in urging Congress to pass the Affordable Care Act. Last night, Obama devoted just 44 words to his health reforms — never once touting the law’s actual impact, like 2.5 million young Americans gaining coverage through the ACA. In comparison, the president spent more than 130 words on his renewed cause of streamlining the government.”

And for you visual learners and/or infographics enthusiasts like myself out there, Dan Diamond tweeted this graphic a few hours ago, which I think best serves to drive the point home.

Wondering what Obama spent 70 commercial-free minutes talking about, then? According to the Washington Post, the economy mostly. Check out WaPo’s interactive infographic breaking down the speech by time spent/mentions per subject, and how this year’s spread compares to his previous SOTUs, here.

Meanwhile, the GOP rebuttal, delivered by Indiana Gov. Mitch Daniels, was only marginally better to us health wonks – at least for our interest’s sake. While it steered clear of “repeal and replace,” it did echo Rep. Paul Ryan’s pitch for an overhaul of entitlement programs.

“Medicare and Social Security have served us well, and that must continue. But after half and three-quarters of a century respectively, it’s not surprising that they need some repairs,” Daniels said. “We can preserve them unchanged and untouched for those now in or near retirement, but we must fashion a new, affordable safety net so future Americans are protected, too.”

No one would deny that the SOTU, above all, is an act of political theater. But were there even more theatrics occurring last night than usual? Many Beltway insiders have seemed to indicate this, saying that the SOTU was not only a list of goals for the year, but also, as Kliff put it, “an opening campaign gambit.”

If that is the case, it raises some interesting questions about what we can expect to hear in the fall. After all, as The Hill’s Healthwatch blog pointed out, “Although Democrats insist that Obama will be able to campaign on the healthcare law, it was almost entirely absent from a speech that helped establish the themes and frames of his reelection campaign.”

Just because the president seems to be steering the narrative away from health care so far doesn’t mean it won’t be issue in the upcoming presidential election. Odds are that the Republican nominee – whoever it turns out he (or she… hey, you never know!) may be – will want to discuss health reform, as it has certainly been a hot topic on the campaign trail.

How important of an issue do you think health reform will be in the upcoming election? Will a candidate’s position on health reform and the Affordable Care Act impact your decision to support him or her? Tell us your thoughts in the Comments section below!

A man who contracted polio walks on crutches in the village of Kosi, 113 miles from Patna, India. Photo by Altaf Qadri / AP.

By Lois Privor-Dumm. This is a moment we have been cautiously optimistic about. Would Friday the 13^th finally be the day? Rather than being an unlucky day this year, it is the day that India has gone one year without a single new case of poliovirus!  Every time I look out the window as I’m driving around India, I witness the all-too-common sight of someone suffering the debilitating effects of the disease.  That image is a reminder about how horrible this disease is and that polio’s impact is not just on the individual, but a whole nation.

The efforts to stop this disease in India have been dramatic and it has been a roller coaster with significant ups and downs.  After 741 new cases in 2009, there were only 42 in 2010 – the country was almost there. And then in 2011, there was just a single new case in 18-month old named Rukhsar from West Bengal. It was a heartbreaking occurrence, but efforts persevered.

I am struck by the level of effort committed to this goal: government, civil society and international organizations including WHO, the National Polio Surveillance Project (NPSP) based in Delhi, UNICEF, CDC and Rotary are all laser-focused on making sure that kids even in the hardest to reach places were immunized. The Bill & Melinda Gates Foundation is also instrumental in these efforts. It was no easy feat, as we’ve seen in other polio-endemic countries including Nigeria, Pakistan and Afghanistan. India was considered one of the toughest countries to tackle, making this effort all the more impressive.

The infrastructure requires an enormous amount of coordination with stakeholders who were not part of the government or its partners. Civil society, including community and religious leaders, NGOs and others all needed to be engaged. The outcome of polio eradication efforts is not just the achievement of interrupting transmission, but the commitment that is gained by those involved in disease prevention efforts. I don’t work directly on polio, but I recognize the benefits of building an understanding of the value of vaccines, creating a system that can handle the supply chain, monitoring and evaluation and constant communication. On a recent GAVI consultation visit to India, I was very happy to hear that the discussion was about how we can leverage the infrastructure created by the polio efforts.

It is important that we learn the lessons from polio and leverage the best practices, not only in India, but in other large countries like Nigeria, where stopping Polio is also within reach. One of the biggest lessons is that there are a lot of stakeholders that contribute to a successful vaccine program – it takes a village. The government plays a big role, but it is the community, that will directly determine success. 

Building an understanding of what can be achieved, and helping to implement the strategies that can lead to that success, are ways that I am privileged make contributions as a part of my work at IVAC. We are all working towards the goal of improved health for people in countries like India and Nigeria. Today’s milestone inspires others to act in ways that can help not only polio eradication efforts, but disease prevention and control efforts more broadly. One year without a new case of polio in India is an important milestone, but as we continue to make great strides around the world, our best years are ahead of us.

“If we are going to prevent the projected escalation in chronic illness, which threatens to overwhelm our health care system, we need to develop new and better ways to elevate the health of our fellow citizens. The good news is that the next frontier in consumer health and well-being is right on our doorstep – literally,” said Robin Strongin, Creator of the Disruptive Women in Health Care blog and HIP. “We crafted this new initiative to advance the next wave in consumer health and well-being, bringing the best of health care to the places where we spend virtually every hour of every day.”

This project will be unique, not only in its vision of 21st century health and wellness, but also in its scope and composition of experts supporting this new direction. It will involve leaders from health care, technology, telecommunications, housing, travel and other sectors that will have a stake in the success of this exciting endeavor.

The concept of Health In Place™ is built around the idea that our homes are more than just houses, our offices are more than just workplaces, our schools are more than just places of learning, and even our cars are more than just modes of transportation. Thanks to wireless communications and emerging technologies, each of these venues has become potential health and wellness centers. No matter where we are or what we’re doing, we can protect and enhance our well-being.

For this facet of 21st century health care to achieve its full potential – for more Americans to have the tools to link to their caregivers, to protect against illness and monitor their well-being – a number of public policy issues are involved, cutting across multiple disciplines from health care regulations and benefit structures to tax policy to technology incentives.

HIP aims to connect the dots between industries, inspire innovation and drive policy changes that improve health outside of the Affordable Care Act.

Large, industry leaders like Philips Healthcare and UnitedHealthcare have gotten behind the idea of HIP.

“Philips is on the forefront of health care delivery—that’s why participating in a concept like Health in Place is a natural fit,” states Deb Citrin, Senior Director of Strategy and Business Development, Home Monitoring, for Philips Healthcare. “With experience in both the hospital and home settings, Philips understands that health care is evolving and we need to evolve with it by expanding care whenever, and wherever, people need it.”

For more on Health In Place™, read mHimss’ Editor Eric Wicklund’s piece, ‘Health in Place’ initiative seeks mHealth ideas from…everyone.

Today, you can receive text messages, voice mail, or email reminders for just about anything from medications, to testing, to health tips, or appointments.  Information and help where you want it, when you want it, and how you want it are transforming the relationship between you and your providers.  Teens get help with diet and smoking cessation as well as disease management.  Elders and their care givers get live follow up and real time transmission of important vital signs through remote patient monitoring that can alert providers to developing problems at home.  Ambient assisted living systems that track movement at home, and personal emergency response systems help elders stay at home but alert others when a condition changes over time or in an emergency.

Mobile personal monitoring is getting a boost from other companies who recognize people want to be on the go, and are not held back by the need to monitor or address health needs in traditional ways.  In the next several years, Ford Motor company plans to provide “First Assist” emergency health care instruction through its OnStar system. They will provide allergy alerts based on day-to-day location indices of allergens, and glucose level monitoring alerts via dashboard applications.  Future plans also include voice requests for health information and updates, seat sensors to detect electrical heart rhythms/problems, and stress reduction responses.  Leveraging existing technologies such as GPS, telecommunications, and internet access is catapulting us into an age of ubiquitous computing where our environment is instantaneously and unobtrusively enabled by computer assisted functions.

Electronic medication reminder boxes and vials already offer services to remind people what to take, and when to take it with flashing lights and compartments that release.  Failure to respond on schedule triggers follow up to the consumer and family members. Simple transmission of daily weight and other vital signs is easily performed through a variety of economical products including one scale that will post your weight on Twitter.  Edible computer chips are being tested to report proper drug ingestion. 

Thousands of cell phone applications provide tools to receive and send health information as data points, documents, and static as well as moving images.  With 24/7 expectations, we now have 24/7 access to information and data interactivity.  Technology is delivering on the promise to help improve care.  It is always on, and fits in our pockets. 

*Mark D. Smith. Disruptive Innovation: Can Health Care Learn From Other Industries? A Conversation With Clayton M. Christensen.  Health Affairs, 26, no.3 (2007):w288-w295. (published online March 13, 2007; 10.1377/hlthaff.26.3.w288)

By Saundra Pelletier. Big numbers always make people stop and think. Big birthdays, anniversaries or milestone are moments to reflect on what once was, and what could be.

Over the last few months, media coverage of the population reaching seven billion people has been especially ponderous, causing wonder about what the pressure of so many people will do to our planet. Questions abound. What will the carbon footprint of seven billion plus people be? Will there be enough food to feed everyone?  What can we do about population growth? How many people can the planet manage?

One of the ways we can help our planet is by investing in family planning. Family planning is one of the most cost-effective, high-yield interventions that exists today. Countries that invest in family planning can reap immediate health benefits, investment savings in health and education sectors, and social and environmental benefits that extend well beyond a single generation.

As I wrote in an earlier post, the ability for women here in the U.S. to use birth control to prevent or delay pregnancy gave every woman  the power to decide if and when she wanted to have children, and how many to have. And with the ability to keep families smaller, came the ability to provide for their present and future well-being.

This argument – small-family-equal-prosperous-communities– is not lost in the broader discussion about the seven billionth baby, but while pundits stress the urgent need to reduce the size of the world’s population, nowhere near enough is being done to ensure that the 215 million women who want to use modern contraception have access to do so.

The fact that this amazing milestone has made people stop and think about the people on our planet is a good thing. A good place to start on a road to a healthy, more prosperous planet is to ensure  that the women and girls, who make up just over half of the planet, can make informed choices about if and when to have children, and that they have access to the supplies to allow them to do so. Providing this access will slow the pace to reaching 8 billion.

About WomanCare Global: It is a nonprofit organization working with partners around the world to improve the lives of women by providing access to affordable, quality reproductive health products. The organization believes that every woman, no matter where she lives, should have control over her reproductive health and family planning needs, ultimately improving her ability to care for herself and her family. WomanCare Global closes the access gap by bringing the same quality products available in the developed world to developing countries. WomanCare Global serves both public and private sectors via an established global supply chain reaching countries around the world, with particular focus on under-served markets in Africa, Asia and Latin America.

Over the years, solutions to this problem were placed in the hands of law enforcement, which, among other measures, monitored physicians to assure they were not enabling existing addicts or creating new ones. Later, pharmacists were monitored as well and soon became engaged in measures of their own to prevent abuse. Recently, under the guise of patient safety, FDA joined in.

Intrusions led physicians to fear prescribing pain medicines for legitimate medical purposes and warned pharmacists away from essential community-based pain management. Law enforcement and regulatory barriers made it more difficult—even personally threatening and certainly more costly—for them to do so.

Isn’t it ironic that the law and the healing arts should clash? Early civilizations considered both to have been gifts from God. Both were intended to serve man, not to victimize the most vulnerable. Yet, today’s clashes have done precisely that, and jeopardize those in pain.

Those near death for whom society should have the most compassionate response have been harmed as a result. They have immediate needs that, in some cases, only powerful medicines can help.

Unrelieved pain takes a terrible toll on patients and their loved ones. Unable to get help from physicians and incapable of negotiating the maze of intrusive legal restrictions on their care, at one time families turned to politicians for intervention. They asked Congress to legalize heroin as a pain treatment. Thankfully, that era’s street drug-of-choice was not needed – we had better drugs than heroin. Congress did not grant their wish. But the families were right about one thing: those medicines were not being used. I know their frustration and anger. I was witness to the devastation they felt when loved ones had died, in pain unnecessarily.

Families took matters into their own hands in other ways. Some sued physicians for their failure to provide adequate pain relief. Imagine the physician’s dilemma: law enforcement sanctions for prescribing vs. malpractice suits for not.

Some aspects of pain management have improved since then and quality care standards monitor pain relief in institutions. Whatever improvements we achieve, however, are at risk if hysteria about abuse of legitimate medicines resurges. Relatively recent news reports about the illicit use of important medicines are only the latest—and certainly not the last—example. Press coverage about OxyContin abuse vilified—and victimized—the medicine, those who make it, and those who need it.

When law enforcement and medicine are at odds, dying people suffer all the more and my primary concern is for them. When some of us abuse medicines, those of us who use those same therapies for legitimate medical reasons become suspect.

Can’t we find a better way? Can’t we reduce suspicions about the valid use of pain medicines and correct the tragedy of under-prescribing and under-administering these critical solutions?

We can and we must. There are ways we can start:

• End the witch hunts against clinicians and protect them from harassment as they provide patients with medicines while we sort out our differences about legitimate prescribing and drug-abuse prosecution. Doing this will help patients now.
• Provide clinicians with immunity from malpractice litigation for failure to provide pain medications while we sort out the law enforcement issues. Doing this will help patients now.
• Radically accelerate improved clinical practices of pain management. Some efforts are underway nationally, but they’re insufficient and patients with only weeks or months to live cannot wait the average 17 years for even simple changes in clinical practice to change. 
• Require any individual who legislates, regulates, enforces or reports in the media on matters related to the abuse of pain medications work in hospice care with patients experiencing pain for a least one week. Doing this will help patients in the future, bringing better balance to future policy making, enforcement and reporting activity.
• All of us should resist the temptation to allow those of us who abuse pain-relieving medicines to numb our compassion for those who need them.

We must balance healing and the law better. Let’s not forget the compassion we should have for those in pain, as they live and especially as they die.

Can it be done? I believe so, and draw optimism for the future from my brother, Jim, and his wife Nancy, who for more than three decades volunteered their time to hospice. Jim wants to write a book. He’d call it, “You Live, Until You Die.” It comes from his experience of seeing the old and the sick die well, living—and often laughing—right up to the last moments. It would be a book of warm, tender, and funny stories. His stories echo the words of one cancer patient who helped us understand the importance of pain management back in my government days. She said, “I found that when I didn’t have the pain, I could forget I had cancer.”

How can we not embark on these changes?

To do less is to diminish the living of everyone, the dying as they leave us and the ones they leave behind. 

Cook Medical’s Zilver PTX is likely to become the first peripheral drug-eluting stent (DES) to be approved in the U.S., after an FDA advisory panel voted unanimously in favor of the device on Oct. 13. Approval would give the sponsor, Cook Medical (Bloomington, Indiana) access to a peripheral arterial disease (PAD) market valued at $1 billion, depending on whose figures one relies.

I attended the Oct. 13 advisory committee hearing for the device and observed the panel members comment that this was among the best submissions they had seen in some time. Cook presented a clear study that met all primary endpoints and showed improvement over percutaneous transluminal angioplasty, the current standard of care. To non-FDA experts like myself, it seemed as though Cook was recognized for setting a new bar for conducting clinical trials and collaborating with the FDA.

I imagine that Cook Medical’s leadership was able to make all the right clinical trial investments necessary for the long-term viability of the product’s market value, not just the ones that were on display at the advisory panel meeting.

Simply put, such a prudent investment for the long term is equally, if not more, essential when planning for the reimbursement success of any new medical device. Medicare already pays for peripheral endovascular interventions, both in the out-patient and the hospital in-patient settings. So as any “new” interventions receive FDA approval, such as a Zilver PTX, Medicare likely would pay for these within the existing payment levels. After all, these are existing technologies, using existing drugs, being utilized in a new application, so Medicare payment would default to those existing payment classifications.

How then can makers of novel devices – with clinical improvements over standard-of-care – seek premium pricing? Device developers must calculate the impact of a higher product price on customers’ (hospitals) before commercializing at a premium price. With the same Medicare reimbursement for the procedure regardless of stent cost, hospitals will think carefully about paying a premium to use a new device, such as the Zilver PTX. This makes premium pricing very difficult without some justifiable improvement elsewhere in the disease treatment continuum.

The Medicare reimbursement bar has been raised. To seek any additional product reimbursement for the hospitals, the device must prove it delivers “significant clinical improvement” over the standard of care currently reimbursed by Medicare. “Significant clinical improvement,” is a loosely defined standard, however, and is applied subjectively for each new technology. For example, does a new neurovascular implant have to show evidence of superiority over “standard of care” in a pivotal trial to justify a higher price? Is proof of non-inferiority of a new continuous glucose monitor sufficient? Is a separate study necessary? Should we invest scarce funding to support studies when non-inferiority is the goal?

I think the key to demonstrating substantial clinical improvement lies in demonstrating patients’ functional improvement – this could be walking, resuming activities of daily living, returning to work or reducing days away from work, and other patient-reported outcomes measures – in combination to show that the new treatment has improved a patient’s life. Medicare wants to see the measurable “So what?” quantified and compared to the “So what?” of existing treatment options. I am certain that Medicare will no longer be satisfied by clinical results that are considered equal to existing care. The mandated Medicare evidence bar – “significant clinical improvement” – is the key to product success. After all, “significant clinical improvement” is necessary to trigger a new technology add-on payment, reimbursable to hospitals in addition to existing payment.

Preparing to demonstrate significant clinical improvement for reimbursement purposes is an essential part of clinical trials strategy and execution – it must be built into planning and costs of clinical trials management. Doing so as part of clinical trials will accelerate time to market. Conversely, not having these data for Medicare may delay sales and revenues indefinitely.

Adi Renbaum, senior VP of health policy and reimbursement for the Neocure Group (Washington DC), joined the Neocure Group shortly after it was founded in 2006, and today heads its Washington DC office, where she leads the health policy and reimbursement practice. She has more than 17 years’ experience in the field of regulatory and clinical development strategies, and has negotiated directly with CMS and commercial payers to expand coverage and secure reimbursement for clients’ technologies. She also works closely with medical and specialty societies to build consensus about innovative products and for support with payers.

To kick the tires on the survey a bit, I spent time on the phone with the “3 M’s” of Manhattan Research — Meredith Ressi, President; Monique Levy, VP of Research; and, Maureen Malloy, Senior Healthcare Analyst who can recite the survey data backwards and forwards. Together, they guided me through the topline on digital health information use among U.S. adults in 2011.

The 56 million US adults who access data via electronic health records (EHRs) was a surprise to me, and to this trio, as well — so much so that they revisited the study methodology and samples to ensure that this was not a statistical anomaly. It’s not. But as with all numbers, it’s insightful to know what lies beneath the raw stat.

The big number to consider here is 24% of U.S. adults who are accessing their personal health information (PHI) from their physicians’ EHRs. In this case, the 56 million tend to be younger, better educated (more with college education), higher internet adoption, and more likely to own smartphones and tablet computers. They are also more likely to observe a physician doing digital activities during the consult – such as seeing the doctor entering information into the EHR.

What’s common among those consumers interacting with their EHR-borne health information is that they are more frequent online health information seekers than people who are non-users of their EHR data: three times more likely.

Monique Levy pointed out that EHR information users are “more acutely aware of the pain points they have in the health system: they are more likely to identify certain problems and barriers in managing care. They are a more self-aware group about what’s working, what’s not working, and what they need” out of the health system.

What’s beyond the 56 million (24%) U.S. adults who Manhattan Research calls “users” of EHR information? Another 41 million who are interested in doing so but haven’t yet.

This leaves millions more people in America who don’t appear interested in accessing their health information via a doctor’s EHR. Cybercitizen Health identified the least-engaged group within this cohort: 15% of people who have seen a doctor in the past twelve months whose doctors provided access to medical information on an EHR, but neither accessed their EHR data nor are interested in doing so.

Thus, the consumer side is only one-half of this equation: physicians, of course, play yang to the patient’s yin. In Taking the Pulse, Manhattan Research’s annual physician poll, the company found that doctors’ adoption of tablets (especially the iPad) continues to quickly grow. Their use will turbocharge physician adoption of mobile EHR capabilities, and physicians’ ability to share data, up-close-and-personal, and in seamless ways without disrupting workflow in the exam room which can happen when sitting behind a computer monitor.

For Cybercitizen Health, Manhattan Research surveyed 8,745 U.S. adults age 18 and over via online and phone in the third quarter of 2011.

Health Populi’s Hot Points: In The Two-Way Street of Patient Engagement in Health IT, I wrote in California HealthCare Foundation‘s iHealthBeat on September 27, 2001, “In the two-way street that is patient engagement, it is health care providers  who will play a key role in getting the mass-middle of people more involved in  their health data. That may be a lot to ask of health care providers given their  already-cramped workflow, but doctors and hospitals will be motivated by at  least two market drivers: payment and consumer pressure.”

Manhattan Research found that people who have begun to embrace their PHI via EHR tend to have physicians who bring them into the process in the exam room: physician engagement with meaningful use is drawing patients into conversations about their personal health information and, therefore, their health.

Further fanning the flame of physician involvement is Meredith Ressi’s observation that, “once you get an iPhone or Droid in physicians’ hands, it changes their behavior.” She noted that access to the web is the first changed behavior: doctors are doing medical information searches via smartphones wherever they are — and with iPhones, the use of simple-to-access apps further bolsters their mobile health behavior.

Originally posted on Health Populi on October 14th.

In the study, J.D. Power segments brick-and-mortar pharmacies from mail-order. Brick-and-mortar pharmacies cover chain drug stores, supermarkets and mass merchandisers/Big Box stores.

What drives top performance for consumers shopping brick-and-mortar pharmacies are the ordering and pick-up process, the store itself, cost, the non-pharmacist staff, and the pharmacist.

In mail-order, quality translates into cost competitiveness, prescription delivery, ordering, and customer service. Consumer satisfaction with the mail-order Rx channel declined between 2010 and 2011, primarily due to ordering and delivery problems. But due to price and challenges in switching back to the brick/mortar option, mail-order customers are largely expectedly to remain in the channel and not switch to a store. One-third of consumers are required by their insurance provider to use mail-order for maintenance and repeat scripts – these customers are even less satisfied with their pharmacy than those who freely choose to go the mail-order route for prescriptions.

J.D. Power, analysts on consumer satisfaction, notes that Amazon has set a high bar for speed and convenience in the online shopping world. Mail-order pharmacy has a ways to go to catch up to those standards.

High customer satisfaction ties to those consumers who have an ability to have a private conversation with the pharmacist or staff in a private area of the pharmacy. Furthermore, added services such as immunizations and wellness services are driving higher consumer satisfaction with those pharmacies who offer them.

The highest rankings by segment were:

Chain drug stores: Good Neighbor Pharmacy, Health Mart, The Medicine Shoppe (all well above competitors in the segment)

Mass merchandisers: Target, Sam’s Club, Costco (with Walmart at the bottom)

Supermarkets: Publix, Wegmans, Winn-Dixie, Jewel-Osco, Vons (all above the segment average)

Mail-order: Kaiser Permanente Pharmacy, Humana RightSourceRx (both well above competitors).

This is the fifth year J.D. Power has conducted the national pharmacy survey. The poll, fielded in May and June 2011, was conducted among 12,300 consumers who filled a new prescription or a refill in early 2011.

Health Populi’s Hot Points: The pharmacy has always been a touchpoint in consumers’ health, but its importance is growing as a primary care site for wellness, prevention, immunization and a growing menu of consumer-driven primary health care services. The supermarket channel, in particular, has begun to marry messages about nutrition and healthy food with chronic health condition messaging. For example, Wegmans (ranked #2 after Publix stores, features a food/health related display adjacent to the pharmacy: this month, my local Wegmans has been promoting quinoa’s nutritional contributions to healthy eating at a “pharmacy teaching table.’ In the winter, the pharmacy promoted the purchase of frozen blueberries to enhance shoppers’ intake of the fruit’s health benefits in the cold season.

This is another example of health being where our Surgeon General says it is – not in isolation in the doctor’s office, but where we live, work, play and pray. Let’s add the word “shop” to that mantra.

On a personal note, I have a comment to make on J.D. Power’s mail-order pharmacy results. In the past six months, we have been forced to switch to the mail-order channel to acquire a repeat prescription for a member of our family. The company, whom I will not name, is one of the poorer performers on the table – and no surprise to me. The company has a cumbersome, un-helpful, poorly designed website which it claims streamlines the process. For the first three months of the fulfillment process, I’ve had to dial into the company’s call center – which has no hours on the weekend, when I, and most working people, usually run household errands. Suffice it to say, after speaking with the doctor-prescriber’s insurance associate, our experience with this mail-order company was not atypical.

Would that this company, whose services I am compelled to use, could demonstrate the efficiency, accessibility, and friendly quality of my favorite shoe purveyor – Zappos. This is a case where I cannot, if you’ll excuse the pun, vote with my feet.

Non-communicable diseases (NCDs), which include cancer, cardiovascular disease, diabetes, lung disease, and mental health are one of the greatest health and development challenges of the century, responsible collectively for 2/3 of all deaths worldwide. Though all people the world over are susceptible to the threat of these chronic diseases, this is a women’s health rights and empowerment issue because these diseases impact girls and women differently. At the same time, women are a crucial part of the solution to this crisis.

Arogya World, World YWCA and other organizations have joined forces to form the Women for a Healthy Future movement. We are mobilizing women and men from around the world to sign a petition demanding that world leaders reduce the vulnerability of women and children to NCDs.

As advocates for women’s right to health and empowerment, we call on the world leaders during the forthcoming United Nations High Level Meeting on NCDs to consider the following critical factors related to women and NCDs:

1. NCDs have a direct impact on women’s health
NCDs are the #1 killer of women. A staggering 50,000 women lose their lives to NCDs every single day. More than 1,000 women die from cardiovascular disease, one of the four main NCDs, every hour.

Women are uniquely affected by NCDs. New research published in The Lancet (Aug 2011) shows that for women, especially pregnant women, the harmful effects of smoking are even higher than for men. When it comes to coronary heart disease, smoking is 25% more dangerous for women.

In the developing world, the effect of NCDs on women is even more pronounced. Women comprise 60% of the world’s poor, and poverty worsens chances of survival from NCDs. Women in developing countries also cook daily over open flames, and as a result acquire NCDs like Chronic Obstructive Pulmonary Disease. How can we allow 1.9 million people a year — mostly women and children in developing countries — to die because of everyday cooking?

2. NCDs impact women as caregivers
Women and girls play a critical role in caregiving. At YWCAs around the world, we have seen that when someone at home falls sick and needs extensive care (as is usually the case with chronic NCDs), it is the girls and young women who stay home to provide care. These women fall behind in school, miss work, or are forced to accept lower paying jobs because they need the flexibility to provide home care for a sick family member. Even if a woman doesn’t suffer personally from an NCD, she is often drastically affected.

3. Women are disadvantaged with regard to prevention
While 80% of cardiovascular disease and diabetes and 40% of cancer are preventable through stopping tobacco use, increasing physical activity and improving diet, often these prevention efforts are not accessible to women. When women make up 2/3 of illiterate adults, they are at a great disadvantage to even learn about prevention. Moreover, social and cultural taboos sometimes restrict a woman’s engagement in physical activity, because sport is considered ‘unfeminine.’ We believe that access to sports and physical exercise is not only a right in itself, but also a catalyst for development, leading to the empowerment of women and girls.

4. NCDs are an integral part of maternal and child health
Since low birth weight predisposes a baby to get diabetes and cardiovascular disease later in life, it is imperative that we educate pregnant women about good nutrition during pregnancy. In fact, some scholars believe the key to the entire NCD crisis lies in ensuring good health for adolescent girls, before they become pregnant, so that they can have safe and healthy pregnancies and give birth to healthy babies of normal birth weight.

5. NCDs impact the next generation
While women are rightly concerned about the health of other women, they are fiercely concerned about the health and futures of their children. Children have a right to health. They deserve a dynamic future full of hope and happiness, a future where they can live their dreams and become productive world citizens. Aggressive marketing of tobacco products, junk foods and sugary drinks, and alcohol to children and young people is threatening that future. When the future of our children is at stake, women must take action.

The Promise of Women
It is sad that we still have to fight for the basic human right of women and children to good health, despite all the commitments to the world’s women contained in the Beijing Platform for Action, CEDAW, and many other regional and national commitments. But, the truth is that on our watch, in our lifetimes, NCDs have exploded. We must do something about it. This is our responsibility.

Today, we have a chance to to take positive steps in securing women’s health rights. Join us at Women for a Healthy Future. We are calling on all the people of the world, women and men to sign our petition and forward it to other personal and professional networks. On September 19 and 20, world leaders will convene at the United Nations for a summit on NCDs, the second ever UN summit on global health in history. We seek to gather 10,000 signatures to our petition, and we promise to bring your voices to those gathered at the United Nations to ensure that women’s rights are included in the key decisions.

When the world takes care of women, women take care of the whole world.

But there was another line in the blockbuster movie that moved me even more. I heard it and the heavens seemed to open. The light bulb came on.

Hilly Holbrook’s new maid is $75 short on one of the college tuitions for her twin sons and asks Hilly and her husband for a loan so she doesn’t have to choose which son should go to college. Doing the ‘Christian thing,’ Hilly refuses, “God does not give charity to those who are well and able.”

Twelve simple words from a fictional 1960’s character summed up our nation’s current political will regarding the poor. And allow me to condense this into just one word: selfishness.

We movie-goers were quick to see the bigotry in Hilly’s statement. The maid and her husband had been saving money from their meager wages for a long time and she wasn’t seeking a hand-out, but a loan she would pay off with her thankless labor. But I was also quick to see the hipocracy in those of us who identify ourselves as Christians regarding the poor–many like this maid are in temporarily tight spots by no fault of their own. I was convicted by the thought that a selfish Christian is just as much of an oxymoron as a Christian murderer.

We use the word Christian so loosely nowadays, especially in politics. Calling ourselves Christians is not just the politically sexy thing to do. It is bearing the responsibility to personify the totality of God’s word and value every stage of every life, even the poor. Perhaps our selfishness is rooted in fear, more specifically, fear of shortage. We are so afraid that assistance to the poor robs us, but the Bible is clear that it is better to give than to receive (Acts 20:35) and we will never lack giving to the poor (Proverbs 28:27). Now I’m not suggesting that Christians are obligated to give to any and everybody. We must be good stewards over what we’ve been blessed with and use wisdom, but we must never forget we have been blessed with what we are stewards over. None of it truly belongs to us.

What makes giving complicated is when the poor is undeserving for reasons we determine in our own minds. With the issue of Medicaid, for example, we are quick to point to the rare cases of system defrauders. But for every story of fraud, there are at least nine stories of genuine need.

The Institute of Medicine, the trusted, non-political council advising the nation on ways to improve health, recently released “The Healthcare Imperative Report” on how to lower health care costs and improve outcomes. The Institute thoroughly studied excess costs in our health care system and identified six domains of excess spending: unnecessary services, inefficiently delivered services, excess administrative costs, prices that are too high, missed prevention opportunities and fraud. Want to guess how much waste is due to fraud? Less than you think. Only 10 percent. And that figure includes fraud at the hands of payers, clinicians and patients, so patient fraud represents only a fraction of health care waste.

I got ticked off… Oh, pardon me… I was greatly disturbed this week while speaking with a cousin who attends one of Columbia, SC’s most prominent churches. After the August 5-6, SC Mission 2011: Midlands event that served more than 2,000 uninsured from around and outside the state, a water cooler conversation at the church included appalling accounts of some people in line for services using iPhones. The nerve of those beggars!

Thankfully, my cousin was quick and correct to point out that many of those in line were among the working poor. SC Mission 2010 in Greenville, SC, for example, drew 1,200 of the state’s underserved to the Carolina First Center. Forty-four percent were employed, tax-paying citizens. My co-worker even received a call from an area city councilman inquiring if his uninsured family of four (wife, two teenagers and himself) could come for services at the Midlands event at the Carolina Coliseum.

These are realities, but we citizens have made it too easy for our elected officials to turn a blind eye and deaf ear. In an attempt to heighten awareness of these realities to policy-makers, the South Carolina Hospital Association sent personal invitations to Mission 2011 to more than 400 elected officials in federal, state and local government. Guess how many showed up? Two. Republican SC House Representative Todd Atwater who also serves as President of the South Carolina Medical Association and volunteered at Mission, and Democratic SC House Representative Leon Howard. Two, I said! One Republican. One Democrat. Zero from the Tea Party. Zero Independents. Zero from local government. Zero from the federal government. Raise your index finger, then your middle finger. Two. They could have at least followed the lead of Columbia, SC Mayor Steve Benjamin who knew he’d be out of town. Mayor Benjamin marketed the event through e-mail and social media.

Maybe if more of our officials had seen the lines of men, women and children forming as early as 10 am the day before the Midlands event began, those camping on the concrete outside the Carolina Coliseum, and the countless people who were turned away due to maxed capacity, these and other social ills would not plague our community as much because policy-makers would be more prone to do the true ‘Christian thing’ and care.

According to the study published in the journal Health Services Research, 21 percent of American adults said they had delayed care for non-financial reasons compared to 19 percent that cited cost as the primary reason for not seeking healthcare.

Those non-financial reasons included not being able to get to a doctor’s office during working hours, long commutes to the medical office, or not being able to get an appointment soon enough.  As the study’s lead author said, “In reality, there are all kinds of reasons why people can’t get the care they need when they need it.”

There are at least a couple of important points to take from this report.  One is that healthcare providers have to continue exploring creative ways, from telemedicine to non-traditional office hours, to meet the needs of today’s patient population.

More importantly, though, as we’ve said often over the past several months, coverage and access are not synonymous with each other.  The Affordable Care Act makes health coverage available to all Americans, but that doesn’t mean that all of these newly-insured patients will have easy access to quality care.  If some patients today, as the study indicates, have difficulty getting an immediate appointment with a physician, that problem may only worsen when an influx of new patients, the aging of the baby boom generation and a future shortage of healthcare professionals converge.

By Saundra Pelletier. In 1965, Griswold v. Connecticut gave a married woman the right to use birth control to prevent or delay pregnancy as she saw fit. This guarantee of a basic human right led to other reforms that allowed millions more American women to decide the direction of their own reproductive lives.  This summer, we are proud to see another key reform go through: starting next year, the Affordable Care Act will allow even more women in the United States to be in charge of their own health by requiring new health plans to provide free birth control without a co-payment. These are hard-fought wins for women’s health and for women’s rights of which we can all be proud, but sadly the ability of a woman to choose when and whether to become pregnant is far from assured in other parts of the world.

Pause for a moment and imagine you’re not American, but from Sub-Saharan Africa – Ethiopia for example. You are 20 years old and have four children – the first of which you had when you were 15 and newly married. You’re worried about becoming pregnant again. You tried to get birth control once, but arrived at the clinic only to find the shelves bare and no way to access any form of birth control.  The thought of another pregnancy, whether by a husband who won’t take no for an answer, or by a stranger who might force his way upon you while making your way to fetch water for the family is overwhelming. You’re not in great health, and another pregnancy would take its toll on your weakened body. The chances are high that you might not survive pregnancy or labor to be able to take care of your family.

Globally, 215 million women would like to be able to prevent or delay pregnancy, but do not have access to the supplies that would allow them to take control of their lives. As American women, we know from our own experience that the ability to make our own fertility decisions has made an immeasurable impact on our own lives. For women in the developing world, access to reproductive health supplies would save lives and improve health, as well as the economic and social well-being of families and communities.

Consider the staggering number that every single day, 1,000 women die due to pregnancy-related complications. Access to contraceptive supplies would mean that unintended pregnancies would drop by more than 70 percent every year. 150,000 maternal deaths would be avoided every year. And 600,000 children would not lose the love and care of their mothers.

Why is it that a private sector product like a Coca-Cola or a mobile phone can get to ‘customers’ yet much-needed health care information and products are beyond reach? This question has perplexed the global health community for decades.

WomanCare Global was founded in 2009 to address the profound problem of maternal mortality that has challenged the reproductive health field. The path is very clear and one word sums up the problem and the solution – ACCESS.  Our “hybrid” model is trying something new – a way of offering women hope because the emphasis is on access to affordable quality products for the women who need them most.  WomanCare Global recognizes the many challenges facing the distribution of healthcare technologies in underserved markets. All too often, pharmaceutical and device manufacturers decide not to invest in low resource settings, limiting product availability in much of the developing world. Additionally, supply-chain gaps keep products from reaching healthcare facilities, providers, and the women they serve.

By identifying innovative reproductive healthcare technologies and utilizing existing distribution channels, WomanCare Global promotes sustainable access to these critical products.

Family planning is one of the most important, cost-effective interventions available in the world today. Every woman, no matter where she lives, deserves access to the lifeline of information and affordable reproductive health products.

The new apps (FaceDecide & BreastDecide) come in addition to their six existing Orthopedic patient education apps — including an orthopedic app called ShoulderDecide, which was recently reviewed by iMedicalApps.com. While these latest apps are obviously less focused on chronic medical conditions than the original six, they do call attention to just how great the extent of the potential for mHealth seems to be.

In the next few weeks, Orca MD will be rolling out additional features, including an introduction and some infographics dealing with Orthopedic & Cosmetic Surgery. To keep up with these releases, check out their apps, and more, ‘Follow’ @OrcaMD on Twitter, ‘Like’ OrcaMD on Facebook  or check out their YouTube Channel.

Health-related smartphone apps are a relatively recent innovation, and there is no telling what will come. What do you think about the BreastDecide and FaceDecide apps? Would you download them? As the field of mhealth begins to evolve and mature, how do you think apps like this will fare? Do you think these present privacy concerns for users?

The situation is no different in my state of South Carolina. Last week, one of our state senators referred to South Carolina’s Medicaid program as a “Mercedes health plan.”  Our Department of Health and Human Services responded by saying, “It’s a little bit of a stretch to call it a Mercedes.”

This morning, that same senator posted a guest editorial on FITSNews, “A Hand Up, Not a Hand-Out.”  In this piece, the independent pharmacy manager claims that Medicaid’s benefits are better than those of hundreds of insurance plans he works with.

“Hard working South Carolina taxpayers are forced to pay for premium coverage for others. These same hard working taxpayers could never afford these benefits themselves. Where’s the fairness in that? Welfare programs should be a “hand up” instead of a “handout.” Government assistance should be a temporary benefit instead of a lifestyle.”

The Senator says he and his colleagues in the Senate should focus on those unable to help themselves like the low-income elderly and mentally disabled. He then goes on to give two examples about welfare recipients who would rather get a check than work.

It’s disturbing that one of only six legislators in the entire South Carolina General Assembly with any type of health care experience would intermingle Medicaid and welfare as if the programs are the same. Some confuse the typical Medicaid recipient with the infamous Reagan-era “welfare queen.”  What an outrageous comparison.  Medicaid recipients don’t receive checks.  They receive access to health care services like primary care, prescription drugs, screenings, and hospitalizations.  High-paying-job-producing, tax-paying businesses get the checks and pump billions of dollars into the state economy both directly and indirectly. South Carolina hospitals, for example, employ more than 80,000 citizens, and contribute greatly to our state’s well-being and prosperity. Not to mention all the physician practices, nursing homes, health centers and other providers that do the same.

Let’s set the record straight on these Medicaid recipients seeking a hand-out in South Carolina:

• Two-thirds of Medicaid recipients live in working families, but their incomes are too low to afford insurance,
• Eligible families stay on Medicaid an average of only two years,
• A single parent making just more than $7,000 a year is too rich to qualify for Medicaid in South Carolina,
• And adults without children, regardless of their income, cannot qualify for Medicaid because they are categorically ineligible.

The very people the Senator says are unable to help themselves are the very people Medicaid benefits the most. Though women and children make up 75% of Medicaid recipients, they only consume 33% of the costs. The low-income elderly and disabled make up 25% of recipients, but consume 66% of the costs. Simply put: cut Medicaid, cut your Granny.

There’s this ludicrous idea out there that Medicaid recipients are gaming the system. NEWSFLASH: Ain’t nobody getting rich off Medicaid (improper English intended)! The only Medicaid fraud I’ve heard of has been at the hands of a provider. How would a recipient fraud the Medicaid system anyway? By being so desperate for health care access that they don’t disclose their full income? There are standard documentation requirements and yearly reviews in place at our state Medicaid agency to thwart that. By getting one or two unnecessary colonoscopies? I say that if those extra colonoscopies ‘tickle their fancy,’ more power to them! I kid…

Though I understand that overuse of unnecessary services drains our fragile health care system, I’ve been on the other side of health care enough to know that it’s easy to discuss rationing until it’s your loved one who is in medical distress.  

Our state’s budget debate this year has been laced with several misconceptions about the Medicaid program and its beneficiaries.  The three-to-one federal Medicaid match our state receives was even compared to crack-cocaine. Intended or unintended, that characterization also feeds into the erroneous stereotypes for some of our state’s most vulnerable citizens. 

It is incumbent upon us in health care to take the time to share the facts with decision makers and our communities. We cannot allow persons blinded by political ambition to make these important policy decisions that will impact our communities without our expertise and without hearing the perspectives of those without a voice.

Written with reporters in mind, “Covering Health Issues” is useful for anyone looking for concise information on health policy issues, and experts from across the political spectrum. Chapters contain fast facts, background, tips for reporters, story ideas and experts with contact information. The book also includes an extensive glossary, ideas and examples for TV and radio reporters, and links to polls on health issues. Supported by a grant from the Robert Wood Johnson Foundation.

To see a video demonstration of the book by Julie Rovner of NPR, click here. To see individual chapters, click on any of the chapter titles below. To download the entire sourcebook as a PDF, click here.

For all chapters, links are available to local news stories on the chapter topic. For many chapters, there is also a short video featuring one of the nation’s top health policy experts.

Table on contents:

• Introduction and Acknowledgments
• Health Reform
• Cost of Health Care
• Quality of Care
• Employer-Sponsored Health Coverage
• Individual Health Coverage
• Children’s Health Coverage
• Medicare
• Medicaid
• Long-Term Care
• Disparities
• Mental Health and Substance Abuse
• Public Health
• Polls on Health Care Issues
• Covering Health Issues for TV and Radio
• Acronyms and Glossary
• Experts
• Websites

The Alliance for Health Reform is a nonpartisan, not-for-profit health policy education group. We are committed to helping journalists, elected officials and other shapers of public opinion understand the roots of the nation’s health care problems and the trade-offs posed by various proposals for change. Our aim is quality, affordable health coverage for all in the U.S., although we do not lobby or take positions on legislation. Sen. Jay Rockefeller (D-W.Va.) is our founder and honorary chairman; Robert Graham, MD, of the University of Cincinnati is our board chairman.

9 million. That’s how many web hits are returned during a Google search for “Accountable Care Organization,” and reflects the countless articles, white papers and opinions that have been published regarding the potential successes and more likely pitfalls of the proposed ACO mandate. As highlighted in TripleTree’s recent post, our team is continuously evaluating the business development opportunities being fueled by the demands and requirements of these new provider organizations.  Last week, the members of our Healthcare Executive Roundtable recently discussed and debated an element of the ACO equation that is not typically highlighted but is clearly a critical component of ACO success (or failure)…Trust.

In boardrooms around the country, health care executives are focusing on the technical requirements for their future ACO’s clinical and administrative systems. They are pouring over spreadsheets and attempting to understand the data and analytical tools that will be necessary for adequate financial and quality of care reporting. Getting these operational elements “right” is important; however, these business leaders should also focus on designing a culture – and the corresponding behaviors, communication, and incentives that will fuel strong and collaborative relationships between the ACO and its community of providers.

As Ed Brown, CEO of Iowa Clinic puts it, “People are unclear about what the value-based world looks like, and they’re unsettled on what clini­cal integration really means. And nobody has really made it work.”  This lack of clarity around the value-based model will make it challenging for providers to leave the financial security blanket of the traditional fee-for-service payment engine.  Moreover, influencing them to modify their approach to patient care for the benefit of the system and the promise of shared savings is a monumental effort. Success by any measure will largely depend on the trust established between providers and the ACO organization itself. ACO’s should prioritize establishing trust with providers in three key areas:

• ACO Operations and Management:  Providers need to trust that the ACO is well run. Understanding the organizational governance, expertise of the management team and core capabilities (strategic assets) will help generate confidence that the ACO is well-positioned to generate enough shared savings to make participation worthwhile. In addition, it is critical that the ACO measure and report management performance metrics that demonstrate its accountability to the providers.
• Compensation Incentives:  Providers need to trust that they are getting their fair distribution of shared savings. Clinical algorithms defining quality and outcomes must be evidence-based; and the financial tools and risk-adjustment methodologies used to distribute payment must be easy to understand. Above all, the organization’s compensation schemes must be highly transparent and accessible so that providers can validate that they are being treated as an equally valued business partner in the organization.
• Confidence in Provider Team:  Providers need to trust their ACO provider colleagues. If the right incentives are in place to bring members within the organization together, providers will need to trust that their peers will also be active participants working toward fully coordinated care within the ACO. Under an accountabilities and outcomes-based model, it will be important that providers view their care responsibilities as extending beyond the encounter. Active provider participants should be practicing first-class follow-up care, improving patient satisfaction, and reducing re-admission rates which will achieve collective rewards.

The inclusion of ACOs as a provision of the Patient Protection and Affordability Act is a strategy to realign delivery systems in the US so that they provide high quality, coordinated care.  The bottom line for achievement might simply boil down to whether providers can engage in meaningful and integrated relationships with the ACO and with each other. Since relationships are based on trust—predictability, integrity, and reciprocity–it is imperative that ACOs make trust a deliberate priority.

• About half (51%) of Americans who like the law cite expanded access to insurance and health care as the reason. Those who do not like it give a greater variety reasons: 20 percent are concerned about costs; 19 percent have concerns about government’s role; and 18 percent mention opposition to the individual mandate.

• A majority of Americans do agree on something: 53 percent are confused about the law, the major provisions of which won’t take effect until 2014. This is nearly identical to the 55 percent who reported being confused in April 2010. Further, 52 percent this month say they do not have enough information about health reform to understand how it will impact them personally, while 47 percent think they do. Members of the groups most likely to benefit from health reform — the uninsured and those living in low-income households — are the most likely to say they do not know enough about the law’s potential impacts.

• With Republicans quite critical of the law and some state officials chafing at its requirements, the issue of how much flexibility states should be granted, and with what conditions attached, has been a subject of debate in Washington. Two-thirds of Americans agree that states should be able to substitute their own health reform plans provided that they are as comprehensive and affordable as the national one created by the new law. The idea wins majority support across the political spectrum, backed by 75 percent of Republicans, 72 percent of independents and 55 percent of Democrats. But public support for state flexibility drops sharply if people think states would use substitute plans to save money by offering more limited insurance to fewer people than the national plan would. In that case, roughly two in three Americans (65%) would oppose state substitution, while 26 percent would still favor it.

• The requirement that nearly every American obtain health insurance – known as the individual mandate – remains unpopular, with 67 percent of the public supporting the repeal of that provision. That view is not an immovable one, however. For instance, support for repealing the mandate fell to 35 percent when those who initially supported repeal were told that “under the reform law, most Americans would still get coverage through their employers and so would automatically satisfy the requirement without having to buy any new insurance.” There was a similar, if smaller, drop in support for the mandate’s repeal to 48 percent when repeal supporters were told that without such a requirement people might wait until they were sick to buy insurance.

• At the one year mark, seniors continue to be more skeptical about health reform than other Americans, with 52 percent holding an unfavorable view of the law in March and 40 percent holding a favorable one. This month, however, saw a break in the trend of increasing negativity among seniors toward health reform that began in December. Unfavorable views of the law among seniors dropped by 7 percentage points from February to March, while favorable views increased by 8 percentage points. Still, by a two-to-one margin, seniors are more likely to believe that Medicare will be worse off (39%) than better off (19%) because of health reform.

This Kaiser Health Tracking Poll was designed and analyzed by public opinion researchers at the Kaiser Family Foundation. The survey was conducted March 8 – 13, 2011, among a nationally representative random sample of 1,202 adults ages 18 and older. Telephone interviews conducted by landline (801) and cell phone (401, including 171 who had no landline telephone) were carried out in English and Spanish by Princeton Survey Research Associates. The margin of sampling error is plus or minus 3 percentage points. For results based on other subgroups, the margin of sampling error may be higher.

A complete report, chartpack and the full question wording and methodology of the poll can be viewed online.

The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible analysis and information on health issues.