Harvard and MIT use clinical trials to study health policy #ACA #HCR

A New York Times story on the feds’ failure to use randomized clinical trials for health delivery research led us to J-Pal, a joint Harvard MIT program. Here’s a link to the group’s health page. 

J-PAL’s Health Program seeks to promote the important contributions that randomized evaluations can make in understanding how improvements in health services and delivery can reduce poverty. J-PAL’s Health Program seeks to promote the important contributions that randomized evaluations can make in understanding how improvements in health services and delivery can reduce poverty. Each year, significant resources are allocated to global health and development initiatives. However, despite substantial investment, improvements in global health indicators have been uneven. For example, according to the World Health Organization’s (WHO) latest data, encouraging declines in child mortality rates have occurred globally, while improvements in maternal mortality, TB, and HIV/AIDS have been slower (World Health Statistics Report 2010). Moreover, the WHO reports worsening of certain key indicators such as prevalence of undernutrition in a number of countries.

The Times story quotes researchers saying that the federal government needs “to to do more randomized trials and fewer demonstration projects. “

The situation is different in the developing world. There, randomized trials have become common in health care and other areas, sponsored by a variety of groups like J-PAL, a global network of researchers that was organized by M.I.T. and Harvard economists.

So far, J-PAL has conducted over 440 randomized trials in 55 countries, according to Amy Finkelstein, an M.I.T. economist.

Dr. Finkelstein and Lawrence Katz, a Harvard economist, have now started J-PAL North America to spur randomized trials in, among other areas, health care.

Dr. Finkelstein was encouraged by the Medicaid study she and Katherine Baicker of Harvard did in Oregon. The state wanted to expand Medicaid coverage but could not afford to insure all, so it used a lottery.

The lottery was essentially randomizing people to have Medicaid or not, so Dr. Finkelstein and Dr. Baicker designed a study to see the effects.

Over 18 months, those who got Medicaid saw doctors and went to emergency rooms more often and got more health care. They were less depressed. But so far, their health is not better and they cost the system more.

“It is getting so much attention not just because it is important and credible,” said Dr. Finkelstein, “but because it is rare.”

 

Globe, Times on some of the the 3 million newly insured

globe-ssWith the uproar about computer glitches with the new health insurance exchanges, you would never know that millions of people were about the get coverage at a reasonable cost.

Today, The Boston Globe’s  Chelsea Conaboy offers stories on five of them. The story is  behind the pay wall. You can look at the pictures, go out and buy the Sunday paper or get a digital subscription. 

Much has gone wrong since state and federal health insurance websites created under the Affordable Care Act launched on Oct. 1. Technological glitches have frustrated customers, flustered politicians, and fueled debate about President Obama’s landmark legislation.

Lost amid all the fury, however, have been the success stories.

Many who struggled without insurance are getting it. Others with poor coverage have found better plans. Some whose policies cost a lot, yet covered little, have obtained more comprehensive coverage that — with government subsidies — often costs less.

About 3 million people have signed up for a private health plan through the online insurance exchanges, a senior US health official said Friday. More people are newly enrolled in Medicaid in states expanding that program, which provides coverage to people with low incomes.

Or, check out this story from last week’s New York Times about how the law is having an immediate impact on people who suddenly qualify for Medicaid.

WELCH, W.Va. — Sharon Mills, a disabled nurse, long depended on other people’s kindness to manage her diabetes. She scrounged free samples from doctors’ offices, signed up for drug company discounts and asked for money from her parents and friends. Her church often helped, but last month used its charitable funds to help repair other members’ furnaces.

Ms. Mills, 54, who suffered renal failure last year after having irregular access to medication, said her dependence on others left her feeling helpless and depressed. “I got to the point when I decided I just didn’t want to be here anymore,” she said.

So when a blue slip of paper arrived in the mail this month with a new Medicaid number on it — part of the expanded coverage offered under the Affordable Care Act — Ms. Mills said she felt as if she could breathe again for the first time in years. “The heavy thing that was pressing on me is gone,” she said.

 

Data, health, news contest draws applications from Bostonians

How to get most of the city’s health writers in the same room as a bunch of app developers? A health-themed meet-up of the local Hacks and Hackers group might do it. But last week, a good number of us gathered a WBUR for a presentation on the Knight News Challenge. (WBUR has won in the past for a court-related project.)  The media innovation project has drawn 650 entries,  including one based on  BHN’s ongoing HealthDecider project.  The handful of winners gets money and support for a project designed to answer the following question: How can we harness data and information for the health of communities?

May the best projects win.  Here’s mine.

Here are some others from Boston or with a big local footprint.  Great ideas and stiff competition. (WBUR has its own list with lots of overlap.)

Unlocking the Potential of Patient Blogs To create the first searchable repository of health blogs, giving patients a chance to connect to others with similar medical problems and better understand what it’s like to live with their health issues.

Big Data to Big Story leverages academic medicine’s foremost health-record data-mining tool to allow the public to gain critical, previously unavailable answers about medical treatments and their outcomes.

Gimme My DAM Data This crowdsourced web site will assign a letter grade to each hospital or app privacy policy, thereby encouraging data holders to participate in the health data commons. (This on links to one of Ross Martin’s health policy music videos from The American College of Medical Informatimusicology

Increasing Patient Buy-In to a Statewide Health Data Sharing Effort We will educate consumers about the benefits of sharing their personal medical information in the statewide data-sharing network while also informing them of their rights and gathering input about their concerns, which we will share with decisionmakers at the Massachusetts Executive Office of Health and Human Services to lead to an improved data-sharing system.

Data to Table: A Healthy Recipe for Urban Agriculture The Data to Table website will visualize the details of Boston’s new rezoning ordinance for urban farming, making the information transparent and accessible for those interested in fostering healthy communities through local agriculture.

 Nothing to Hide: Tracking patient harm and hospital efforts to prevent errors We aim to help consumers wisely choose the safest hospitals by building a website that tracks incidents of patient harm at Massachusetts hospitals

 HealthNewsReview.org & Crowdsourcing: We will improve the public dialogue about health care by providing patients and health care consumers a proven platform for telling media messengers what they’re doing well, and where they’re missing the mark with the health care news and information they deliver. 

 

Storify: Gruber on health reform at Boston health writers meeting #hcr

storify shot web

Harvard health policy event: The year in health law and a look to the future #HCR

globe aca from

More Boston health events here.

Health Law in P/Review

When:Fri, February 1, 1pm – 5pm WhereWasserstein Hall 2036,
Milstein East C, Harvard Law School (map)

 1:00-5:00pm (reception to follow)
Wasserstein Hall 2036, Milstein East CHarvard Law School

The past year was an historic one for health law, with the SupremeCourt issuing the final word on the constitutionality of the Affordable Care Act alongside a host of other critical developments. 2013 promises to continue the trend, with a number of other important topics on the horizon, from employer coverage of contraceptives to gene patenting and more.Please join us for the first annual Health Law Year in P/Review event, bringing together leading experts to review some of the most important changes in the health law landscape over the past year, their implications for the future, and a preview of what is to come.Our inaugural session will feature the following topics and presenters:The ACA and Health Care Reform

Personhood Amendments and Contraceptives Coverage

Immigrants’ Access to Health Care

Affirmative Action and Medical School Admissions

Gene Patenting

Tobacco and Obesity Policy and the First Amendment

Summary and Wrap-up
A wine and cheese reception will follow at 5:00pm.

For questions, please contact petrie-flom@law.harvard.edu, 617-496-4662.
Co-sponsored by the Petrie-Flom Center at Harvard Law School and the New England Journal of Medicine.

In Massachusetts, lighter pharma gift ban may = higher costs for consumers #HCR #mapoli

  1. As the Globe story below notes, “A longstanding ban against the coupons in Massachusetts — the last state to prohibit them — was lifted as part of the state budget signed by Governor Deval Patrick on July 8.”This story is behind the pay wall, but here’s the nut: “But some consumer advocates and analysts say the coupons could drive up health care costs at the very time state lawmakers are striving to rein them in. They say discounts will encourage use of brand-name drugs instead of less expensive alternatives, with one estimate showing drug costs for employers, unions, and health plans in Massachusetts could rise by hundreds of millions of dollars over the next decade as a result.”

  2. The industry addressed the issue in general terms here:
  3. The restaurants are not alone in opposing the ban.
  4. More from the opposition

Health Wonk Review: Wearing the Green for the St. Patrick’s Day Edition

Here in Boston, researchers have looked into that most pressing of St. Patrick’s Day health questions: Is Guinness really good for you? Red wine gets all the press, but Tufts researchers found a positive association between beer and bone density.

For this edition of the Health Wonk Review, we take a a look at the Irish Times and find that even with a national health plan, Ireland has to deal with barriers to care. One story details slow progress in the establishment of promised primary care centers, and another story, asks “Is the EU good for your health?”

So, while we refight the battle over birth control, the Irish health ministry – of the largely Catholic country — is releasing a “sexual health” app.

Back here in the new world, the great grandchildren of Irish immigrants celebrate their heritage as Linda Leu at the Health Access Blog writes about a report that “highlights the need for cultural competency and language access, to welcome all ethnicities from California (and America’s) diverse communtiies….The Importance of Equity in the Bridge to Reform: As St. Patrick’s Day celebrates Irish ethnic pride, we need to take note of the full diversity of our states and nation. As we get ready for 2014, remember the communities that will be newly served may not look (or speak) the same as those that the current system serves.” 

For the once-a-year step dancers,Gary Schwitzer at Health News Review answers questions about outcomes data on knee replacement surgeryAlso see posts on the JGIM paper on  data on  shared decision-making in prostate cancer surgery & coronary stents decisions   and an online “Daily Deal” coupon for preventive MRI scan – disease-mongering du jour

Boston’s own David Williams notes: “Profits are up at Massachusetts health plans –should you be upset? On his Health Business Blog, he writes: The Globe reports higher profits and CEO compensation at Massachusetts health plans. But profit margins are low and if anything the CEOs are underpaid.”

More of the best of recent health policy posts

At The Hospitalist Leader, Brad Flansbaum examines physician pay,fairness, and how it relates to the reinvigoration of primary care. Specialty physicians take note.”

Another post on health care providers — and their support teams – notes: “There’s been much discussion of the potential impact of health reform, aka Obamacare, on employment”  Joseph Paduda at ManagedCareMatters.com writes: “Most has referenced employers cutting jobs to avoid the mandate or save dollars for premiums.  What hasn’t received much attention are the new jobs – mostly high-paying ones- that will be created as more Americans are insured and seek coverage and care.”

Julie Ferguson of Workers’ Comp Insider asks “If you had to guess what workplace experienced most assaults by customers/patrons what would you guess? If you guessed healthcare, you would be right.” She informs us that 61% of all workplace assaults are committed by healthcare patients, according to a recent report issued by NCCI.

Two posts came in on shady practices.

Colorado Health Insurance Insider offers: Colorado AG Files Lawsuit Against Discount and Mini-Med Health Plan:  “It’s a pretty typical website for that sort of product, with lots of great-sounding claims and sample cases where members have supposedly saved thousands of dollars.  But they also have a link for people who want to “become a reseller”.  And their process of getting recruits enrolled to sell the product is what has come under the watchful eye of the Colorado AG.”

 Calling it “The latest example of misbehavior by a large health care corporation,”  Roy M. Poses at Health Care Renewal writes : Gentiva’s Odyssey Healthcare Settles Again, Signs Yet Another Corporate Integrity Agreement and gets “little more than a financial wrist slap.  The case was about allegations that a for-profit hospice enrolled patients who did not meet the regulations for federal reimbursement for hospice care.  In particular, they were alleged to be patients who really did not seem to have extremely limited life expectancies.  It is true that enrolling such patients lead the government to pay more for their care than might otherwise be the case.  But the real problem is that patients may have been denied treatments that could have improved, or even lengthened their lives. 

Two on workplace wellness:

Wellness Program Implementation at WCS Looks a Lot Like Dating” says Kat Haselkorn Corporate Wellness Insights. This post details the similarities between customer satisfaction and romantic relationships. Although wellness program implementation and dating do not seem to have much in common, we have found that the process of making a client happy mirrors the act of keeping a romantic prospect satisfied. When it comes to setting up a wellness program, we do whatever it takes!

Henry Stern, LUTCF,  at the CBC InsureBlog writes about “Health vs Common $ense, challenging “the conventional wisdom that workplace health promotion programs work.”

And two on HIT:

“Competition today in healthcare encourages care providers to hoard patient data.”  says Vince Kuraitis of the  e-CareManagement blog in a post called “Stage 2 MU Rules : The proposed Stage 2 Meaningful Use rules support moving competition in healthcare to the right bases — sharing and adding value to patient health record data.

Health Affairs offers a post by Danny McCormick, of Harvard Medical School and the Cambridge Heath Alliance, and coauthors David Bor, Stephanie Woolhandler, and David Himmelstein. The title of the post is  “The Effect Of Physicians’ Electronic Access To Tests: A Response To Farzad Mostashari

The four authors of the post are also the authors of an article in the March issue of Health Affairs. The article reported that electronic access to computerized imaging results (either the report or the actual image) by physicians was associated with a 40% -70% increase in imaging tests, including sharp increases in expensive tests like MRIs and CT scans; the findings for blood tests were similar. The article prompted a critical blog post by national health IT coordinator Farzad Mostashari.

Jason Shafrin writes: “Americans are a litigious culture.  The malpractice claims that make it to court, however, are not many as you may think.The Healthcare Economist explains why.

Finally, how does health care In the U.S. compare to other countries?  On the Disease Management Care Blog  Dr. Jaan Sidorov tests our knowledge of and finds: We’re not so bad after all!

So, our days of drinking black — or green  — beer are over. But, on Saturday I’ll boil up some cabbage and — sorry Walter Willett – and a hunk of  corned beef in honor of my Irish nanny and the Readys and Gradys  and Murphys who left their green shores and made their way across the sea to settle in Boston and New York.  Happy St. Patrick’s Day from BHN.

 

Hounded ex-Medicare chief Berwick back in Boston

Donald Berwick, who was hounded out of Washington for saying something nice about the UK health system, is back in town and on WBUR today.

Also check out today’s NTYimes op/ed by Joe Nocera:

Dr. Donald Berwick was already in Massachusetts when I spoke to him Sunday afternoon. He was back in the Newton home where he’d lived for 30 years, being pleasantly interrupted during our conversation by his 2-year-old grandson. His last day in Washington as the administrator of the Centers for Medicare and Medicaid Services had been Thursday. Friday was packing day. Saturday was moving day. And, by Sunday, he was already talking about his too-short, 17-month tenure as the nation’s top Medicare official in the past tense. Which, alas, it was.       

Dr. Berwick, I’m here to tell you, was the most qualified person in the country to run Medicare at this critical juncture, and the fact that he is no longer in the job is the country’s loss.

Vermonters on how to improve access to primary care

As far as health delivery and payment goes, there’s much innovation to be found north of here. Craig Jones of the Vermont BluePrint for Health was among the speakers at a recent Alliance for Health Reform panel on primary care in DC.

Here’s a summary of his presentation. You can find more and a full transcript on the AllHealth website. 

Dr. Craig Jones, director of Vermont Blueprint for Health, followed with another example of a state health care reform program that is increasing control of quality and cost by advancing a primary care foundation for the health care system.  Like Minnesota, Vermont is instituting payment system reforms to promote quality and outcome reporting to validate the effects of reform.  Dr. Jones also spoke about Community Health Teams, which are unique to Vermont and include social workers, nutrition specialists, and community health workers.  Vermont expects the services provided by Community Health Teams to strengthen the primary care foundation of their health care system and be very cost-effective by preventing hospitalizations and chronic conditions.  Dr. Jones closed by assuring the audience that the ACA was essential for state-led health care reform.  He listed several sections of guidelines, research and evaluation systems, and innovation grants that will facilitate states making the investments necessary to transform into high-performing, primary care-based systems.

From the program’s web site:

Vermonters learning to live healthier.

The Blueprint works to help Vermonters who have chronic conditions stay as healthy as possible – improving their quality and enjoyment of life and avoiding the need for complex care later when illness is harder to treat. Hundreds of Vermonters have attended Healthier Living workshops sponsored by the Blueprint. These self-help workshops teach individuals to manage their chronic conditions and improve their health.

Communities taking action for health.

Communities all over the state are joining the Blueprint to become healthier places to live, work, learn and play. The Blueprint guides and funds hospital service areas and communities to assess local infrastructure, start coalitions, recruit health care providers, host Fit & Healthy Vermonters events and Healthier Living workshops – encouraging everyone to take charge of their health.

A new medical information system.

Having the right information at the right time is essential for providing the best possible care for patients. The Blueprint is developing a web-based chronic care patient information system that is free to health care providers and requires only Internet access.

UMass prof in Huff Po: Blame industry, not government, for high health costs

William Lazonick, director of the UMass-Lowell Center for Industrial Competitiveness writes in yesterday’s Huff Po that the private sector, not the government, is driving the high cost of health. He begins his piece by noting opponents to the health reform law who keep saying they want to keep government out of Medicare — the government-run program that covers just about everyone over 65 in the country.

Where is SNL’s Emily Littela when you need her to say — Nevermind.   

 The United States clearly has a problem of out-of-control health care costs. The problem resides, however, in the business component of costs, not in the government component. What Americans should be worrying about is how to regulate the businesses that get rich when we get sick.

 Also, see the Globe for a story about the possible closure of two Caritas hospitals — St. E’s and the Carney.  Maybe Dr. Lazonick can explain how a company hoping to buy the Caritas chain plans to squeeze profits out of a failing non-profit hospital group.

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