The Healthcare Policy Podcast ® Produced by David Introcaso

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How Can We Improve Primary Care: A Conversation with Ann O'Malley (June 10th) Jun 11, 2014

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Primary care is considered the bedrock of healthcare delivery. Primary care services promotes wellness, prevents disease onset, progression, exacerbation and premature death and moderates the need for higher-cost specialty services. However, as the recent news about wait times at VA health care facilities demonstrated, the US suffers a shortage of primary care providers. The current shortage, estimated at approximately 8,000 primary care physicians, is anticipated to grow to 50,000 or more by 2020.

During this 21 minute discussion Dr. O'Malley explains why primary care is becoming more team based and why that is important, the adoption and use of electronic medical records in the primary care practice setting and the emergence of retail health clinics over the past 15 years and her assessment thereof.

Dr. Ann O’Malley is a Senior Fellow in the Health Research Division at Mathematica, a social policy research organization. Her research focuses moreover on primary care and quality of care. Dr. O’Malley has also held faculty positions at Georgetown University Medical Center where she worked on research funded by the NIH's National Cancer Institute and foundations examining the use of evidence-based preventive services in primary care settings. She serves as a reviewer and has published in the New England Journal of Medicine, Health Affairs, and the Annals of Internal Medicine. She is a member of AcademyHealth and a fellow of the American College of Preventive Medicine. Ann earned her MD from the University of Rochester School of Medicine and her MPH in Health Policy and Management from Johns Hopkins.

For more on retail health clinics see this 2013 Center for Studying Health System Change publication titled "Despite Rapid Growth, Retail Clinic Use Remains Modest," by Ha T. Tu and Ellyn R. Boukus at: http://www.hschange.org/CONTENT/1392/.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Vermont's Move to Single Payer, Universal Health Care: A Conversation with Joshua Slen (May 29th) May 22, 2014

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In May 2011 Vermont passed legislation signed by Governor Peter Shumlin creating a single-payer, publicly financed, universal health care system termed Green Mountain Care. The law recognized health care as a public good much like electricity. The program, not expected to go into effect until at least 2017, will be defined by an independent board, the Green Mountain Care Board, created to oversee all aspects of the program including rate setting, hospital budget authorization and the regulation of insurance carriers. The single payer system is expected to increase insurance claims costs but the savings derived from lower administrative costs are expected to result in net savings.

During this 19 minute discussion Joshua discusses how politically Green Mountain Care came about, where presently the state is in rolling out the plan, how the state's insurance marketplace will enable the program, what role private insurance plans will play, how will the program be financed, what skeptics are saying and how Vermont's effors may inform the on-going natonal health care policy debate.

Joshua Slen served as Vermont's Mediciad Director from 2004-2008. Presently, or since 2011, Joshua has been an Executive Account Director with Molina Healthcare. He was a Senior Consultant to Bailit Health Purchasing from 2009-2011 and prior to serving as Medicaid Director he was a Deputy (Budget) Commissioner and a Budget and Management Analyst for the State of Vermont. Joshua began his public service career working in several Ohio state budget offices from 1991-1999. He earned his MPA at Ohio State University and his BA in political science at Wittenberg University.

To learn more about Green Mountain Care go to: http://gmcboard.vermont.gov/.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Enrollment Results Under the Affordable Care Act: A Conversation with Brian Webb (May 15th) May 12, 2014

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The ACA's open enrollment period ended this past March 31st. Over eight million Americans signed up for health care insurance. Of these 2.2 million, or 28 percent, were young adults or between the ages of 18 and 34. In 26 states and the District of Columbia approximately 15 million adults with income below 138 percent of the poverty level became eligible for Medicaid coverage. (19 states are not participating in the ACA's Medicaid expansion program and five states remain undecided).

During this 21 minute discussion Brian explains the National Association of Insurance Commissioner's (NAIC) work, what we know about the 8 million individuals that signed up for health care insurance under the ACA marketplaces, the most popular plan, what "effectuated enrollment" means, how many individuals already had insurance and prospects for 2015 enrollment.

Brian Webb is the Manager of Health Policy and Legislation for NAIC. The NAIC represents the insurance regulators in all 50 states, DC and the five U.S. territories. Previously, Brian worked on Medicare and Medicaid policy for the BlueCross BlueShield Association and prior still was the Assistant VP for Legislation for the then-Federation of American Health Systems (FAHS). Brian began working in DC in 1988 as a legislative aide for Congressman Bill Thomas. After six years with Mr. Thomas, Brian worked for five years in California Governor Pete Wilson’s Washington office as health and welfare aide and Deputy Director. Brian was graduated with a MPA from The George Washington University and his Bachelor's degree is from Biola University in California.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

The FDA's Proposal to Regulate E-Cigarettes: A Conversation with David Abrams (May 5th) May 06, 2014

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This past April 24th the FDA announced a proposed rule to regulate e-cigarettes. The FDA is, in part, proposing to ban the sale of e-cigarettes to minors, require manufacturers to disclose e-cigarette ingredients and prohibit manufacturers to claim e-cigarettes are less harmful than tobacco cigarettes without submitting scientific proof. The proposed rule did not forbid TV advertising and does not ban flavorings such as cotton candy and Gummi Bear. Are these regulations adequate, or alternatively, even necessary since some claim e-cigarettes are a lifesaver since they can prevent smokers from consuming harmful tobacco.

During this 23 minute discussion Dr. Abrams, in part, provides a brief overview of the Schroeder Institute's work, evaluates the efficacy of e-cigarettes as an aid to smoking cessation (are they a lifesaver), assesses the FDA's proposed regulations and how they might be improved.

David B. Abrams is the Executive Director of the Schroeder Institute for Tobacco Reseach and Policy Studies at the Legacy Foundation. He is also a Professor in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health and an Adjunct Professor at Georgetown Univeristy Medical Center, Lombardi Comprehensive Cancer Center. Previously, Dr. Abrams directed the Office of Behavioral and Social Science Research at NIH. He has published over 250 scholary articles and monographs, served as President of the Society for Behavioral Medicine and is the recipient of numerous awards including the Joseph W. Cullen Memorial Award from the American Society for Preventive Oncology. He was graduated from the University of Witwatersrand, South Africa with a BS in Computer Science and from Rutgers University with a Ph.D. in Clinical Psychology.

For more on the FDA's proposed rule, see: www.fda.gov/TobaccoProducts/default.htm

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

ACA and Innovation: Mary's Center's Efforts to Improve Population Health: A Conversation with Gina Pistulka (April 28th) Apr 28, 2014

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The 2010 Affordable Care Act created the Center for Medicare and Medicaid Innovation at CMS with $10 billion in funding to test innovation and service delivery models to improve health care delivery and outcomes and reduce costs. To date the CMS Innovation Center has funded one round of innovation awards throughout the US (a second round of awards are expected to be announced this summer). In DC, Mary's Center was awarded in 2012 a three-year $15 million grant to create the "Capital Clinical Integration Network" (CCIN). The CCIN promises to save $17 million over three years by implementing and testing an integrated clinical network to improve care for chronically ill DC residents whom typically rely on emergency room visits for health care. To do this Mary's Center will, in part, train and hire 44 health care workers to serve as care managers and community-based care coordinators.

During this 18 minute discussion Dr. Pistulka discusses Mary's Center's work generally, how the CCIN is organized, the clinical care and social service support work CCIN is doing via care coordinators and others and results they've been able to achieve now two years into the three year CMMI award.

Gina Pistulka joined Mary’s Center in 2006. During her 17 years in nursing, she has also worked as a rural public health nurse and as an urban health nurse educator in Minnesota. She has also done nursing work overseas in Central America. Her research background includes having done cross-cultural intervention research. She has also served on boards to further nurse training through Catholic University of America and via the nonprofit organization Truth About Nursing. Gina was graduaged from Johns Hopkins with a duel Master’s in Public Health and Community Health Nursing and in 2007 received her Ph.D. in Nursing also from Johns Hopkins.

To learn more regarding CMMI's innivation awards see: http://innovation.cms.gov/initiatives/map/index.html.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

The Work Community Health Centers Have Been Doing With ACA Funding: A Conversation with Michelle Proser (April 10th) Apr 09, 2014

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Since the 1960s Community Health Centers (CHCs) have been providing health care services to moreover minority populations, the poor and the uninsured. Today there are approximately 1,200 health centers providing health care to over 20 million Americans in all fifty states. They our the nation's true safety net. The Affordable Care Act created the CHC Fund that provided $11 billion over five years for the expansion of health centers and services throughout the country.

During this 20 minute discussion Michelle Proser discusses the work of the National Association of Community Health Centers, how CHCs work to reduce health care disparities, what work CHCs have been doing with ACA's $11 billion in funding and the potential effect should CHC Fund moneys not be renewed when they expire later next year.

Michelle Proser is the Director of Research at the National Association of Community Health Centers where she conducts research and policy analysis on a variety of topics used to empower health centers and educate policymakers and the public. Michelle also directs NACHCs’ efforts to build health center capacity for community-directed translational research. Previously, Michelle served as a research analyst at the Center for Health Services Research and Policy at The George Washington University. Michelle received her MPP from George Washington and is presently a Ph.D. candidate at GWU.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

All "RUC'ed" Up or The Problems With How Physician Reimbursement is Determined: A Conversation with Kavita Patel (April 7th) Apr 04, 2014

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Since 1992 use of the RBRVS (Resource Based Relative Value Scale) has been the prevailing method by which physician procedure prices are determined. The method or formula for determining prices is managed by the AMA's RUC (or the Relative Value Update Committee). In recent years the RUC has come under increasing criticism largely because their work perversely incents the use or overuse of higher priced medical procedures. The RUC has been a topic of Congressional hearings over the past few years and just this past week the Congress included a provision in the so called "doc fix" bill to have the DHHS Secretary begin to collect information on physician services to better determine relative values in setting physician fees.

During this 23 minute conversation Kavita discusses how the RUC determines prices, the AMA's defense of the RUC process, what effect price skewing has on the practice of primary care and how the RBRVS might be reformed.

Dr. Kavita Patelis a Fellow in the Economic Studies program and Managing Director for clinical transformation and delivery at the Engelberg Center for Health Care Reform at the Brookings Institution. She is also a practicing primary care internist at Johns Hopkins Medicine. She served previously in the Obama Administration as Director of Policy for the Office of Intergovernmental Affairs and Public Engagement in the White House. Dr. Patel also served as Deputy Staff Director for the late Senator Edward Kennedy. She too has an extensive research and clinical background having worked as a researcher at the RAND Corporation and as a practicing physician in both California and Oregon. She earned her medical degree from the University of Texas and her masters in public health from the UCLA.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

What Is "Dead Peasant's" Insurance: A Conversation with Peter Kochenberger (March 20th) Mar 10, 2014

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Corporate Owned Life Insurance are life insurance policies corporations buy on their employees whereby the corporation is the named beneficiary. This practice, at least initially, was adopted as a way of insuring a company against the loss of a limited number of key executives. These policies also became attractive because both premium returns and benefits paid were not taxed. Over time large companies, like Walmart, purchased these policies on millions of employees increasingly for the tax advantages and, industry executives argued, to provide or afford employee and retiree medical benefits. Beyond the moral objection of profiting from an employee's death, even in instances where the person dies years after they left their employer, these polices perversely incent companies to compromise on insuring employee health and workplace safety. While regulatory limitations have been placed on these policies, in 2007 dead peasant's insurance was estimated to account for 30% of the life insurance market.

During this 22 minute podcast Peter explains what is an "insurable interest," whether we know how corporations use the income derived from these policies, whether employee consent is required, the outcome of law suits filed by surviving family members against corporations for this practice, reforms made in 2006 to better regulate this practice and whether these policies do indeed on balance undermine insuring worker safety and health status.

Professor Peter Kochenburger is the Executive Director of the University of Connecticut's Law School’s Insurance Law Center. He also serves as Director of the Law School’s graduate program, is a Consumer Representative for the National Association of Insurance Commissioners and is an Associate Editor for the ABA Tort Trial & Insurance Practice Law Journal. Before joining UConn. in 2004 Professor Kochenburger spent eleven years as Counsel at Travelers Property Casualty, where he managed coverage and bad faith litigation, as well as legislative and regulatory affairs across such subjects as workers compensation, OSHA, guaranty funds, tort reform, antitrust, and environmental issues. His professional experience also includes serving as an Assistant Attorney General in the Consumer Protection Division of Iowa’s Department of Justice and from 1986-1988 he served as Special Assistant to the dean of the Harvard Law School. He is a graduate of Yale University and Harvard Law School.

'Dead Peasant Insurance' Still Alive in Corporate America

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Concierge Medicine Helps Physicians But at What Costs to the Patient: A Conversation with Casey Schwarz (March 5th) Mar 06, 2014

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Concierge medicine (also termed membership medicine, direct pay or cash only practice) has become a rapidly-growing care model moreover among primary care physicians. In concept, physicians charge patients a monthly or annual fee that can vary widely from approximately $50 per month to $25,000 per year (or accept cash only per visit). In exchange patients are promised greater access, longer appointment times and possibly services not typically reimbursed by payers. The current number of physicians practicing concierge medicine is today small, approximately 5,500 nationwide, however, concierge practices are expected to continue to grow at a healthy rate, currently estimated at 25% per year. While these fees enable physicians to reduce patient panel size and presumably improve physician satisfaction, the model by definition posses access problems for the sickest patients, typically those least able to afford a concierge fee. For example, among Medicare beneficiaries, in 2012 half of all had annual incomes less than $22,500 and for African American and Hispanic Medicare beneficiaries annual income was less than $15,000.

During this 21 minute discussion Ms. Schwarz explains the intersection between concierge medicine and the Medicare program, related investigative efforts by CMS and the DHHS Office of the Inspector General, whether there is any data showing improved care quality and/or reduced health care system costs, whether the practice of concierge medicine constitutes patient abandonment and what would the Medicare Rights Center tell a beneficiary if they called the Center inquiring about the appropriateness and merits of concierge medicine.

Ms. Casey Schwarz is currently the Policy and Client Services Counsel at the Medicare Rights Center in Washington, DC. Among other duties Ms. Schwarz represents individuals in appeals and directly counsels individuals with complicated Medicare questions. She works closely with the Medicare statute, regulations, and guidance on a daily basis, including drafting responses to proposed regulatory changes. She also provides trainings for legal and other professionals working with Medicare clients. Prior to her Rights Center work Ms. Schwarz served as a Court Attorney in the New York County Supreme Court. Ms. Schwarz is a graduate of Brown University and the New York University School of Law. She is a member of the New York and Maine State Bars.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Primary Care Medical Homes, What Are They and Are They Working: A Conversation with Marci Nielsen (February 19th) Feb 20, 2014

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The term "medical home" was first introduced in the 1960s by the pediatric profession. Still to date this model of care emphasizes team-based comprehensive, continuous and coordinated care. The care model is intended to improve primary care generally via improved patient communication, care quality, safety and outcomes. In several ways the ACA encouraged the adoption of the, now termed, Primary Care Medical Home/PCMH for both the Medicaid and Medicare programs and among private health insurers. (In some ways the PCMH is seen as a precursor for providers interested in becoming an Affordable Care Organization (ACO), i.e., taking on reimbursement risk.) Over the past few years PCMHs have become widely adopted. Over forty state Medicaid programs are experimenting with the model along with 90 commercial health plans and three federal initiatives.

During this 23 minute discussion Dr. Nielsen discusses the PCPCC's purpose and goals, more specifically what is the PCMH model of care, the varying ways PCMH's are reimbursed, what does the research to date show regarding PCMH effectiveness and challenges in adopting this new model of care.

Dr. Marci Nielsen currently serves as CEO of the Patient Centered Primary Care Collaborative (PCPCC), an organization dedicated to advancing an effective and efficient health system built on a foundation of primary care. Prior to the PCPCC, Dr. Nielsen served as Vice Chancellor for Public Affairs and Associate Professor at the University of Kansas School of Medicine’s Department of Health Policy and Management. Dr. Nielsen was appointed by then-Governor Kathleen Sebelius as first Executive Director and Board Chair of the Kansas Health Policy Authority (KHPA). She worked as a Legislative Assistant to Senator Bob Kerrey and later served as the health lobbyist for the AFL-CIO. Dr. Nielsen is a board member of the American Board of Family Medicine and also a committee member for the Institute of Medicine’s Leading Health Indicators for Healthy People 2020 and Living Well with Chronic Illness: A Call for Public Health Action. Early in her career she served as a Peace Corps volunteer in Thailand and served for six years in the US Army Reserves. Dr. Nielsen earned her MPH at The George Washington University and her Ph.D. from the Johns Hopkins School of Public Health.

The PCPCC's 1/14 PCMH impact on cost and quality report can be found at: http://www.pcpcc.org/newsletter/annual-report-pcmhs-impact-cost-quality-2012-2013.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

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