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!

There is, however, one area we don’t touch (in fact, we avoid it at all costs): partisan support for a candidate. While certainly all of our individual bloggers have opinions and perspectives, points of view and inherent biases, we will never run posts that are blatantly promoting one candidate for elected office over another.

I say this as a caveat to this post, the purpose of which is to announce a new series we’ll be running this year on the Disruptive Women in Health Care blog in which we explore the presidential candidates’ positions on health care and health policy, where they stand on particular aspect or aspects, what they envision to be an ideal health care system for this country and what role they envision the federal government playing in it.

This series is about more than just the Sustainable Growth Rate (SGR), the Affordable Care Act (ACA) or Medicare and Medicaid; it is about delving into each candidate’s philosophies, beliefs and stances towards health care and health policy, and trying to determine what specific policies and reforms each might undertake.

Image courtesy of the Mobile Press-Register.

The editorial team and I are very excited to be launching this series, as we feel it will provide us the opportunity to address important issues during a significant year from a much different perspective and in much greater detail than the mainstream media is likely to discuss.

You can expect to see a lot of substantive political and policy analysis being put forth via the series in the coming weeks and months, but like I said earlier — one thing you definitely won’t see is bias towards one particular candidate (though our posts will certainly contain links to articles from other outlets that may or may not be biased, because we feel it is important to provide a survey of what others are saying on the topic). Help us make the series even better by letting us know what topics or specific policy areas you would like to see explored – we’ll do our best to incorporate your feedback into upcoming installments.

We’ll be back with our first full installment of the series in the next few weeks, but in the meantime, we’ve rounded up some related articles we think are worth reading:

• CNN takes a look at claims of Medicare fraud being made against Mitt Romney by a pro-Newt Gingrich super PAC
• NPR explores “Romney’s unlikely and persuasive defense of the ‘Individual Mandate’”
• WaPo discusses Rick Santorum’s position on abortion in the context of his personal experiences

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!

Millions of Americans disapprove of the Affordable Care Act without understanding what the act aims to accomplish or how it works.  Dr. Jonathan Gruber’s book “Health Care Reform:  What It Is, Why It’s Necessary, How It Works” breaks down the individual components of the act in order to give Americans a greater understanding of what all it includes and how its provisions will affect their daily lives.  Gruber discussed the book, ACA and the future of health care reform in the United States with an audience at Disruptive Women in Washington, DC last night.

Continue reading here…

By Randi Kahn.

I have been unable to get these strong, Disruptive Women out of my mind, and could not help thinking about both Evelyn and Cynthia while listening to the National Journal’s “Living Well at the End of Life” event on Tuesday, wondering what their conversations about end of life care were like with their clinicians, and if there was a difference between them as a result of their insurance and financial statuses. Did Cynthia choose to live her final days in the hospital?  Did her medical situation necessitate it? Was she given proper information about her hospice and palliative options?

Although we’ll never know the answers to those questions, it is interesting to take a look at barriers that exist for clinicians in end of life care that are likely impacting potential disparities.

First, there are Medicare and Medicaid reimbursement issues. Although both programs currently provide some coverage for hospice and palliative care, there is not reimbursement for the tough conversations doctors should have with their patients about their care options at the end of life. Former Obama advisor on health reform and now chair of the National Institute for Health’s Department on Bioethics, Ezekiel Emanuel, MD, PhD, said at the National Journal event, that those consultations can take anywhere from a few minutes to several hours and that without reimbursement for them, some clinicians don’t take the time to conduct them. His statements align with a survey of 500 board certified physicians conducted by the National Journal and the Regence Foundation where 82 percent of respondents identified inadequate reimbursement from Medicare, Medicaid and private insurers for end of life consultations as a significant barrier for palliative care.

There is also the issue that some clinicians put off the conversations because they do not know enough about end of life care options, or about how to talk to a patient about the decisions that need to be made as they near death’s door. The poll data found 73 percent of physicians 39 or younger reported “a great deal or some exposure to palliative care during medical school” compared to 36 percent of those 40-49, 23 percent of those 50-59, and only 6 percent of those age 60 or older, highlighting the need for continuing medical education courses on palliative care, hospice care, and the development of an advanced care directive. The poll didn’t inquire about communications training that, according to Dr. Emanuel, would help clinicians overcome their own psychological barriers to having these discussions and enable them to better address the patient’s psychological needs to make the conversations more effective.

With entitlement reform almost inevitable, and much of continued medical education focused more on health care reform related topics like coordinating care and utilizing health IT, what will the end of life look like for women like Cynthia and Evelyn in the future?

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.

In Cleveland, Clinic CEO Delos Cosgrove has essentially declared war against preventable chronic disease.  Smoking is completely banned anywhere on the campus (and, in fact, physicians have been fired for violating this prohibition), deep fryers and sugared sodas have been removed from the Clinic premises, and Clinic employees pay higher health insurance premiums if they don’t take part in some form of fitness or stress management classes.  Employees’ health conditions – blood pressure, blood sugar, weight and other measurable – are monitored to make sure they are being proactive in improving their health.

The results, as Klein writes, are indisputable.  The Clinic has reduced its employee healthcare costs.  Smoking rates and blood pressure are way down.  Employees have lost a collective 125 tons of weight since 2005.

There will undoubtedly be disagreements over whether the Clinic’s tough love approach is an appropriate policy.  And if the same policies were brought to a large non-healthcare workforce like a General Motors or a Xerox, one could even project that there would be charges of discrimation against smokers, the obese and people who just happen to love a Wendy’s Baconator.

But this is a conversation that America needs to have.  At the same time in which policymakers are debating whether to cut reimbursement levels in the Medicare program, affecting access to quality care and medical innovation, there are billions of dollars being spent to treat cases of diabetes, heart disease, pulmonary illness and other conditions that are caused or exacerbated by lifestyle choices.

Employees and healthcare providers throughout the country are developing innovative ways to strengthen wellness and prevent chronic disease.  We’ve chronicled many of the very effective ones in the HLC Wellness Compendium.

If the Cleveland Clinic’s aggressive methods on employee wellness stir a widespread debate, that’s a very good thing.  The Center for Disease Control and Prevention projects that one of every three Americans will have diabetes by the year 2050.  If that occurs, today’s healthcare cost concerns will seem like child’s play compared to what we’ll be facing later this century.  Wellness has to become a national priority.

This post originally ran on the Prognosis Blog on October 18th.

Most people are dissatisfied with the U.S. health system overall, with 27% of U.S. adults rating the system as “poor” and 29% giving a rating of “fair.”

High costs may be at the root of peoples’ dissatisfaction with the U.S. health system. Only 18% of people are satisfied with the cost of health insurance; only 15% satisfied with the cost of health services not covered by insurance.

EBRI looked into peoples’ health-consumer behaviors, detailed in the chart. Most people who have visited doctors ask them to explain why a test is needed, as well as inquire about risks of treatments and medications and their success rates. Nearly one-half of people ask about less costly treatment options often or always.

Consumers also adjust their health care utilization when facing higher health care costs:

• 74% of U.S. adults try to take better care of themselves
• 69% choose generic drugs when available
• 64% talk to the doctor more carefully about treatment options and costs
• 59% go to the doctor only for more serious conditions or symptoms
• 44% delay going to the doctor
• 36% switch to over-the-counter (OTC) drugs
• 34% look for cheaper health insurance
• 31% look for cheaper health providers
• 25% skip medication doses or don’t fill prescriptions.

Health care costs are eating into peoples’ savings contributions: 56% of people say they have decreased contributions to other savings due to health cost increases, and 33% have difficulty paying for other bills beyond health care.

The Health Confidence Survey interviewed 1,001 U.S. adults over age 21 in May and June 2011 via telephone.

Health Populi’s Hot Points: The future of health care in the U.S. feels very uncertain to the nation’s health citizens: “confidence about the health care system decreases as Americans look to the future,” EBRI found. 57% of Americans say they’re confident about their ability to get treatment they need today. However, only 30% of people are confident they’ll be able to get needed treatment over the next 10 years. Only 20% are confident they’ll get necessary treatment when they’re eligible for Medicare.

In the immediate term, with health consumers concerned about costs, they’re responding by seeking information about their providers, treatments and costs, shown in the second chart. While “all” of the information people seek about health care isn’t available for any of the types of information sought, most people are finding “some” of the information they seek. The most popular kind of information sought is comparing treatments’ disadvantages and advantages, sought by 54% of U.S. adult. However, only 1 in 4 people found all of the information they sought on comparisons. 31% of people look for the full costs of different treatments: only 23% of people found all of this information.

Consumer empowerment requires information transparency. As health citizens in the U.S. continue to take on more financial responsibility for health, they appear to be trying to take that role of health “consumer” seriously. To do that requires information that’s available in accessible, understandable forms via media channels and platforms people want to use. While there’s a proliferation of these services emerging – Castlight Health, Change:healthcare, and QuickenHealth, among them — most health consumers aren’t aware of or accessing these services yet.

It’s a long, winding and bumpy ride on the road to consumers’ empowerment in health. It will get bumpier without health plan sponsors’ linking their enrollees to services that will truly empower them to make sound decisions on how to use the health system.

Originally posted on Health Populi on October 10th.

The newspaper listed five ways to “squeeze” Medicare spending and then discussed the political arguments for and against each.  Some, such as gradually raising the Medicare eligibility age from 65 to 67 and requiring higher-income beneficiaries to pay full premiums for their Medicare Part B (physician services) and Part D (prescription drug) coverage are recommendations that the Healthcare Leadership Council has made to the congressional deficit reduction “super committee.”

But, in a number of ways, the USA Today article missed the mark:

In discussing cutbacks to Medicare providers, including physicians, hospitals and pharmaceutical companies, the newspaper expanded on the likelihood that those health sectors would strenuously argue against any cuts, but there was no reporting on the impact those reductions would have upon beneficiaries.

This is a pet peeve of mine, as I’ve noted previously.  Too often, both politicians and commentators speak of the value of cutting providers instead of patients, obscuring the fact that reduced payments to providers has an impact on both the accessibility and quality of healthcare.  If, as the Obama Administration has proposed, pharmaceutical companies are required to send over $100 billion in rebates back to the government, can there be any other outcome besides higher prices for consumers and less money available for research and development of new innovative medicines?

Relating to another sector, there was an interesting discussion on the KevinMD blog yesterday that raised legitimate questions over whether cutting physicians’ incomes will make a dent in overall healthcare spending.

• Aside from a quick reference to the controversy over Congressman Paul Ryan’s (R-WI), USA Today quickly dismissed the idea of giving Medicare beneficiaries greater consumer choice among competing health plans, citing one study that showed it would increase out-of-pocket costs.

The concept deserves more consideration than that.  If, as the Healthcare Leadership Council and experts like former Clinton budget director Alice Rivlin has proposed, you give beneficiaries the choice of staying in conventional fee-for-service Medicare or moving into a new competitive Medicare Exchange, both health plans and providers would be compelled to find innovative ways to reduce costs while maintaining high quality and value.  This is a pro-consumer direction that deserved more than a couple of sentences in a major story on Medicare costs.

• Where was any reference in the USA Today story to medical liability reform?  Fixing our nation’s broken medical malpractice system won’t, by itself, fix Medicare’s long-term fiscal problems, but reducing the practice of defensive medicine to protect against exposure to litigation will certainly generate meaningful savings.Or

Originally posted on Prognosis Blog on October 4th.

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.

In Is the Foreclosure Crisis Making Us Sick? published by the National Bureau of Economic Research in August 2011, Janet Currie and Erdal Tekin find that the number of foreclosures in a community is associated with increases in medical visits for mental health (anxiety and suicide attempts), preventable conditions such as hypertension, and a long list of stress-related diseases.

Furthermore, more foreclosures in an area are most harmful on people age 20 to 64, and disproportionately impact African-Americans and Hispanics compared to whites.

The map shows the “heat index” for areas with the most home foreclosures: the redder, the higher the foreclosure rates in the state. Currie and Tekin focused on four of the hardest-hit foreclosure states: Arizona, California, Florida and New Jersey. They combined foreclosure data from 2005 to 2009 with data on ER visits and hospital discharges at the zip code level.

Health Populi’s Hot Points: Previous research has looked at the link between health and the house mortgage crisis, finding that unhealthful behaviors are often used to cope with stressful life events. Such negative coping behaviors include tobacco use, alcohol consumption, sleep dysregulation, and weight gain perhaps via decreased physical activity. For more on these impacts, see the 2009 essay in PLOS Medicine by Gary Bennett et. al. called, Will the Public’s Health Fall Victim to the Home Foreclosure Epidemic?

The health of a nation’s macroeconomy clearly impacts the health of the household’s microeconomy – not just of a parent but on children’s health, as well, according to Currie and Tekin.

This study connects the dots between personal finances and health, which is a connection that people make for themselves. The first Edelman Health Engagement Barometer identified that people define their health and wellness across several dimensions: physical health, mental health, appearance, and financial health.

This study raises many points for both health and economic policy which are inextricably linked. First is the rationale for universal health insurance coverage provides a health safety net for all health citizens, can help stem the negative impacts of unemployment in a community and the longer term downstream health costs that increase when conditions aren’t prevented and managed. Second is the importance of COBRA and unemployment insurance payments, the latter of which often can’t cover the former (see this post describing that financial disequilibrium).

Finally, the relationship between economic development and population health has been long documented. As the U.S. economy continues to lag — and the “recovery-less recovery” continues to continue — the public’s health will be in jeopardy, particularly in minority communities.

This scenario also reminds us of the connections between people that Christakis talks about…Health is Contagious, and vice versa.

Originally posted on Health Populi.

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.

Health care spending will be a target of efforts to cut the federal deficit. The best way to reduce unnecessary spending, Dr. Davis says, is to make sure everyone gets the right care, using new provider payment mechanisms such as bundled payment and value-based purchasing. In this video, Dr. Davis describes some of these payment reforms and lays out the case for greater use of comparative effectiveness research to learn “what really works.”

This video is part of a series produced by the Alliance and supported by the Robert Wood Johnson Foundation.

A bit of Hollywood silly escapism?  No doubt.  But, you can say this for President Dave and his fictional cabinet.  At least they approached the budget process with a constructive purpose and vision.

We can only hope that the same holds true for the supercommittee, the panel of 12 Senators and Representatives created as part of the cobbled-together solution to the debt ceiling debacle.  By Thanksgiving, the supercommittee must come up with $1.5 trillion in deficit reduction that must then be ratified by the full Congress no later than December 23.

There’s no question that health care will play a key role in those calculations.  When it comes to finding ways to reduce federal deficits, health spending is the rapidly growing elephant in the room. 

And that leads to genuine concerns about this process.  Already, policymakers are bouncing around ideas to extract more money from the healthcare system and tighten belts further.  Medicare provider payment cuts.  New home health care co-pays and budget reductions.  Mandated Medicare Part D prescription drug rebates.  The upshot of each of these steps will be a health care system that’s more expensive, less accessible, but not necessarily better.

It’s important to note, though, that the supercommittee isn’t limited to only using the subtract key on the calculator.  The panel has essentially been given carte blanche to recommend any steps it deems necessary to reach that $1.5 trillion target.  That means that, in addition to budget cuts, the committee can venture into areas like entitlement reform, tax reform and a host of wide-ranging policy changes.

Thus, a supercommittee born out of political necessity and the fear of financial default could also present a rare opportunity.  In the weeks between now and Thanksgiving, these 12 lawmakers have a window of time in which to gather input and develop concepts to improve health care quality and cost-effectiveness.  The Affordable Care Act started a process to implement health system delivery and payment reforms.  It could be said that this supercommittee has an opportunity and even a mandate to accelerate that evolution.

There are important choices to be made this fall.  This new legislative entity could very easily take steps that will prompt more doctors to turn away Medicare patients, make prescription drugs more expensive for consumers and make home health care less accessible for seniors and the disabled.  Or, they can go a step beyond and generate savings through better, more innovative care.

Perhaps the supercommittee should begin its work with a screening of Dave.

This weekend, I was among those following the cable news shows to see if Congress would finally reach agreement on a debt ceiling package.  It appears now that, even though it may be a “sugar-coated Satan sandwich” to some, a legislative approach has been crafted that will raise the debt ceiling and establish a process for achieving approximately $2.5 trillion in budget cuts over 10 years. 

In this process, a congressional super-committee will be charged with identifying $1.5 trillion in deficit reductions by Thanksgiving.  If they fail to do so, automatic cuts will occur and fall most heavily on the defense budget and Medicare.

As I was watching the news analysis, though, I saw a continued misunderstanding of what it means to cut Medicare provider payments.  One commentator praised the deal for protecting the most vulnerable in society, pointing out that Social Security and Medicaid were exempt from cuts, and Medicare cuts “would only affect providers.’  We’ve seen the same type of analysis several times today in print reports.

This kind of verbage creates the impression that an acceptable way to reduce Medicare spending, in a way that doesn’t do harm to patients, is to ratchet down payments for physicians, hospitals, medical devices, pharmaceuticals and medical supplies.

What is seldom acknowledged is that, for every percentage point shaved off of Medicare provider payments, seniors lose a little more access to quality healthcare.  We’ve already learned, thanks to a survey by the American Medical Association, that approximately one in every three primary care physicians is limiting the number of Medicare patients in their practice.  That’s the consequence of payment levels that are significantly below private insurance levels.  Given the rising number of baby boomers entering the Medicare program, the last policy change we need is one that will reduce the number of physicians available for this population.

That’s the consequence, though, of budget reductions that “only affect providers.”

Originally posted on Prognosis Blog on August 1st.

The summary also includes brief descriptions of Medicare proposals in other deficit reduction proposals from American Enterprise Institute; Cato Institute; Center for American Progress, Sen. Tom Coburn; Congressional Progressive Caucus; Dr. Bill Galston and Ms. Maya MacGuineas; Heritage Foundation; Institute for America’s Future; Sen. Joseph Lieberman and Sen. Coburn; Our Fiscal Security; Dr. Alice Rivlin and Chairman Paul Ryan; Republican Study Committee; Roosevelt Institute Campus Network; and Chairman Ryan.

The side-by-side summary is part of the Foundation’s Project on Medicare’s Future, which focuses on producing timely analysis of leading Medicare reforms affecting people on Medicare.  .The Kaiser Family Foundation is a non-profit private operating foundation dedicated to producing and communicating the best possible analysis and information on health issues.

As with April’s narrowly-avoided government shutdown, pundits are all atwitter (figuratively and literally, as many seem to get special joy in posting their doomsday provocations in 140 characters or less) posting increasingly ugly “what if” scenarios and rumors. No doubt one day, a researcher will be reading the tweets of July 2011 (since all tweets are part of the official public record and documented in the Library of Congress) and come to the not-completely-unsubstantiated conclusion that mankind only narrowly averted total annihilation at the hands of some sort of Armageddon-like natural disaster (only to be corrected by a wiser researcher that there was a far greater threat to mankind in 2011 than natural disasters and that was Congress).

All joking aside, all the chatter led me to wonder – how would the various outcomes of the debt ceiling debate (yes, including defaulting) impact health care? Amongst all the speculating and posturing, despite the usual inclination of political reporters to relate everything back to the Affordable Care Act, I could find nary a mention of how a debt ceiling deal or even defaulting might impact health care [and the yet-to-be-implemented ACA provisions]. Until yesterday, that is, when Kaiser Health News first reported a document summarizing areas discussed by House and Senate negotiators at a debt ceiling meeting with Vice President Biden Monday had been leaked. As it turned out, this document was a spreadsheet identifying potential Medicare and Medicaid savings that could be included in a debt ceiling deal. In total, the list adds up to between $334 billion and $353 billion in savings over the next decade – including $100 billion in Medicaid cuts.

Want all the details? A PDF of the leaked spreadsheet can be viewed here: http://capsules.kaiserhealthnews.org/index.php/2011/07/list-of-potential-medicare-and-medicaid-cuts-stirs-washington/

The greatest regional variances by service type are for MRI scans of the brain, varying 747% between a low price of $425 in the Southwest to a high of $3,600 in the Southeast, based on an analysis from change: healthcare‘s Q2 2011 Healthcare Transparency Index.

USA Today reported on this study on June 30, 2011. Christopher Parks, founder of change:healthcare, pointed out that it’s not uncommon to find inter-regional differences of health prices. However, this is happening ”within a 20-mile radius in your own town,” Parks points out based on his firm’s research.

change:healthcare launched the Healthcare Transparency Index (HCTI) in Q4 2010 to analyze health claims data for various health care services and provide health care buyers with data about cost trends. The tool helps people identify savings opportunities for various health care products and services such as prescription drugs, dentistry, physician office visits, physical therapy, and imaging.

The methodology of the Index looked at 12 months of de-personalized demographics and claims information generated by 82,000 employees representing 152,000 lives from over 200 companies that change: healthcare serves.

Heath Populi’s Hot Points: The argument of whether people who get health care in the U.S. are “consumers” or not rages on, from Paul Krugman in the New York Times to a column in Fast Company published this week which talks about the demise of Google health.

change:healthcare’s data demonstrates that there are cost savings to be accrued to health citizens who shop around for digital imaging services. Whether we call these people ‘consumers’ or not, we as patients or caregivers are taking on more financial responsibility for our health care in the forms of premium sharing, co-payments and coinsurance; have more influence on clinical decision making with our physicians when it comes to prescription drug alternatives, therapies and procedures; and must care for aging parents and growing children. Having access to transparent, high-quality, current information on health care costs, quality, and availability — such as that offered by the Healthcare Transparency Index — will inform and aid us in better managing our own health and health care. A just-launched example of this is Robert Wood Johnson’s National Directory for Comparing Health Care Providers, which provides users with details of physician and hospital quality, costs and patient experience survey data.

Originially posted on Health Populi on June 30th.