Thursday, December 29, 2011

Guest Commentary: Vaccine Hesitancy Leading to Lower Immunization Rates

Ruth S. Gubernick, MPH

I am the proud grandmother of a 5-month-old granddaughter whose parents are having her immunized by her pediatrician, according to the Recommended Immunization Schedule, approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).

Recent articles and a national survey are reporting, however, that at least one out of every 10 parents in this country are not following this recommended schedule and are opting out of immunizing their children either on time or at all. Most of these parents are college-educated professionals. Some of these children will be the playmates of my granddaughter.

Vaccine hesitancy is resulting in lower immunization rates in the U.S. today. This year alone, we've had outbreaks of whooping cough and measles in several U.S. communities. Those diseases are only a plane ride away. Several people incubating measles flew into Newark, NJ earlier this year coming in contact with young families in several communities. The un/under-protected infants and children in those communities without high immunization rates or community/herd immunity were especially at risk of disease.

Parents don't want the government or anyone else to make those decisions for their children. I get that. But the problem is where they are choosing to get their information about vaccine safety. It's often the talking heads on TV and Internet bloggers with misinformation, rather than science-based research. I'm in favor of individual rights but their decisions for their own children can adversely impact my granddaughter, who is not yet old enough to be protected against diseases such as measles or chickenpox.

As a public health professional, I see immunizations as a societal responsibility, to protect those who are too young or otherwise unable to receive these recommended childhood immunizations against 14 potentially life-threatening vaccine preventable diseases. Parents who hold "pox parties" or share "lolly-pox" with their infected child's saliva or swabs dabbed with fluid from their child's pox with other families, rather than have their children immunized, make me crazy. Natural disease is not less risky than a vaccine!

I recently piloted an online course that I designed and built for the JSPH Teaching/Learning Seminar required for my doctoral program. It is about immunizations and targets college-educated professionals who are new parents. My students reported that video clips of parents telling their own stories had the most impact on them. I introduced the course with How safe are we? The Role of Vaccines in Protecting your Community ( http://www.youtube.com/watch?v=hsDU35G477E&feature=youtu.be ). It opens with a mom sharing how she felt about unknowingly infecting her newborn with Pertussis. Share these stories with the families that you care for and care about who may be vaccine hesitant. As a grandparent and population health advocate and student, I thank you.

Ruth Gubernick is a JSPH doctoral student.

Saturday, December 17, 2011

What a year!!!

As I reflect on 2011, from a health policy perspective, it has been quite a year indeed. Berwick is out, ACOs are in, and costs continue to rise. Employers are trying everything and corporate wellness and prevention is the "new green". The lines separating payers, providers and purchasers are blurring every single day as insurance companies buy doctor practices and hospitals too!! The New England Journal says Disease Management doesn't work and everyone believes one study based on the sickest Medicare patients only. It is increasingly difficult to separate out the "truth" from the background noise, especially as the noise gets louder and louder.

Personally, I am really looking forward to 2012 and the ongoing struggle to make health care more accountable, transparent, safer and more cost effective. I am confident that the Jefferson School of Population Health will continue to provide leadership in its research, teaching and dissemination agenda. Our journals, this BLOG, our Medpages column, our national conferences, continue to resonate with the key opinion leaders in healthcare across the nation.

I hope that you will continue to turn to us for informed opinions and solid evidence too about what is working and what is not. One thing surely still remains the same regarding the reform efforts and that is of course " No Outcome--No Income". I am convinced that the future belongs to groups that can make this pithy statement a reality for everyday practice. We are always interested in your views too. DAVID NASH

Thursday, December 15, 2011

Guest Commentary: CMS Continues to Raise Stakes on Quality Measurement


This is the third in a series of blog postings summarizing issues, methods and results from current research in the Center for Value in Healthcare. We will be presenting a JSPH Forum entitled “Translating Research into Policy and Practice” on January 11th, 2012 with more details of the Center’s work.

Valerie P. Pracilio, MPH, Project Manager for Quality Improvement
and Bettina Berman, RN, Project Director for Quality Improvement

Measuring quality of care in the inpatient setting has been a staple of the healthcare environment for several years. Hospitals are penalized financially if they do not report data to the Centers for Medicare and Medicaid Services (CMS) on certain conditions, so solid measurement criteria is a necessity.

CMS’s desire to increase accountability at the provider-level created a need to assess quality in outpatient settings. In 2006, a governmental mandate led to the establishment of the Physician Quality Reporting System (PQRS) to incent eligible professionals who satisfactorily report data on quality measures for services provided to Medicare beneficiaries. Since then, JSPH has been collaborating with Quality Insights of Pennsylvania (QIP) on the development and maintenance of the measures included in the PQRS program.

Measurement development is a rigorous process that must be supported by solid evidence and must also consider feasibility of application in practice. Through our engagement with the QIP, our team has supported this process through evidence gathering and grading. A Technical Expert Panel (TEP) established for each measure also works with QIP to discuss feasibility of measure application. JSPH plays a part in engaging relevant experts to serve on the panel and presents the evidence to support their decisions. Once the measure development process has concluded, the measures are submitted to the National Quality Forum (NQF) for endorsement and broadly disseminated.

At Thomas Jefferson University, the faculty practice plan, Jefferson University Physicians (JUP), has participated in the PQRS program since its inception. Under the leadership of Dr. David B. Nash, the committee that oversees JUP’s performance improvement activities, the JUP Clinical Care Subcommittee (CCS), decided that participation in this program would be valuable to advance quality of care. A strong collaboration between the JUP Performance Improvement Team and JUP administration led to successful implementation of the PQRS program in all practices. The team works closely with practice representatives to select measures for submission and provides ongoing education and support for the practices. As a result, JUP has successfully increased physician participation and incentive payments over the past four years since the start of the program.

More accountability is on the way. CMS plans to move from pay for reporting to pay for performance. Beginning in 2013, CMS will publish PQRS data on the Physician Compare website for providers who report on quality measures through the Group Practice Method (GPRO). In 2015, the stakes will be raised even higher when providers’ Medicare payments are adjusted downward if they do not participate in the PQRS program. The question remains – will demand for provider accountability benefit Medicare beneficiaries?

As always, we are interested in your comments.

Wednesday, December 7, 2011

Guest Commentary: Physician Profiling in Emilia-Romagna Italy: A Tool for Quality Improvement



Vittorio Maio, PharmD, MS, MSPH,
Associate Professor
and Valerie Pracilio, MPH, Project Manager
for Quality Improvemement
Jefferson School of Population Health

This is the second in a series of blog postings summarizing issues, methods and results from current research in the Center for Value in Healthcare. We will be presenting a JSPH Forum entitled “Translating Research into Policy and Practice” on January 11th, 2012 with more details of the Center’s work.

Assessment is part of our daily lives. In school, we apply for admittance; in employment, we are screened before being hired, and once we’re “in,” we are regularly evaluated to ensure that we are performing at a level deemed appropriate. In the Italian Healthcare System a similar approach is being used to engage primary care physicians in quality. Performance data presented to physician teams is the first step in a profiling process. Not only does this help raise their awareness about the level of care they are providing, but it also engages them in discussions with their peers about what they can do to improve.

By definition, physician profiling is an analytic tool used to compare physician practice patterns across quality of care dimensions (American Academy of Family Physicians). The benefit is that it raises provider awareness of quality through feedback to stimulate improvement.

In Italy, primary care, provided by general practitioners (GPs), is the foundation of the Italian National Health Service, which maintains universal coverage to all citizens either free or at minimal charge at the point of service. Traditionally, GPs have worked in solo practices. However, in the last ten years, in an effort to increase coordination of care, the Italian National Health Service has introduced substantial reforms seeking to encourage collaborative arrangements among GPs. In order to build on earlier national reform, the Emilia-Romagna region (a large region located in northern Italy with a population of about 4.6 million inhabitants) passed a law in 2004 that required GPs to join a Primary Care Team (PCT).

In a PCT, GPs, many of whom are in solo practice, act in full autonomy, but are part of clinical networks designed to provide patients with integrated delivery of healthcare. Specifically, in a PCT, GPs are mandated to collaborate and share information, and by means of clinical governance, to engage in improving the quality of healthcare services provided to patients.

To this end, using the regional healthcare administrative database, the Emilia-Romagna region and Thomas Jefferson University began a collaboration to provide PCTs with information about the quality of services delivered to their patients via PCT profiles. GPs discuss the PCT profile data they are presented with their colleagues in their PCT and initiate PDSA cycles of improvement to make changes to their practice accordingly. Through a collective agreement with the region, GPs receive incentives to participate in the activity.

In the U.S., where the mission is not unified as it is in Italy, the focus has been on paying for performance rather than participation. There is something to be said for the focus on participation that has been demonstrated in Italy to invite physicians into the conversation about quality and actively engage in improvement. In the current U.S. healthcare environment, the stakes are being raised and soon the incentives for improving will turn into disincentives for not meeting standards.

Should we be focused on engaging physicians in quality through a non-punitive approach such as the one our colleagues in Italy are using, or continue to expect physicians will meet quality goals if incentivized? We’re interested in your thoughts.

Monday, November 28, 2011

Guest Commentary: Translational Research for Actuaries





This is the first of a series of four blog postings summarizing issues, methods and results from current research in the Center for Value in Healthcare. We will be presenting a JSPH Forum entitled “Translating Research into Policy and Practice” on January 11, 2012 with more details of the Center’s work.

Rob Lieberthal, PhD
Faculty, Jefferson School of Population Health

I will be talking about my research project funded by the Society of Actuaries (SOA) at the JSPH Center for Value in Healthcare Forum on January 11, 2012. The project is “Validating the PRIDIT method for determining hospital quality with outcomes data.” The goal of our project is to determine hospital quality using publicly available Hospital Compare data.

After funding the project, the SOA organized a project oversight group, comprised of practicing actuaries volunteering to serve the profession by supervising our research project. Actuaries are the professionals who are responsible for calculating and managing the cost of health insurance. They have always played a crucial role in benefit design. In the era of managed care, that has meant more and more involvement in creating and managing provider networks.

Given their professional interest, the oversight group was intrigued by my prior findings and was interested in using these findings to reduce cost and increase quality. I explained that, from my perspective, one of the barriers to putting my results into practice was that healthcare professionals did not seem interested in using my results. Their feedback was that my method might be inaccessible, even to a group as mathematically inclined as actuaries.

As a result of our discussions, our work has become literally translational: they are helping me translate my work from my language into theirs. If we can pair actionable results on hospital quality with an instruction book for how to use the PRIDIT method, we can increase the chance that actuaries put our findings and our methodology into practice.

I have previously noted that actuaries could be the ideal group to bridge healthcare quality and safety data with financial and nonfinancial incentives. This could drive patient behavior and improve population health. This is very much a work in progress, so stay tuned for an update from me on January 11, 2012!

Sunday, November 20, 2011

The American Israel Commerce Committee Meeting

This past week I had the privilege of playing co host for the American Israel Commerce Committee meeting on "Healthcare Information Technology". Nearly a dozen amazing young Israeli companies came to Philadelphia to make their "pitches" to raise money AND awareness about their work in the IT sphere of healthcare. Each firm did an incredible job discussing their software and related new tools for building a better infrastructure in our crazy business. The meeting was "bookended" by two panel discussions that I moderated. The first panel of experts tackled the question of "Funding Opportunities" and the second panel discussed "Power Collaborations". The keynote luncheon talk was delivered by David Jones Jr., my colleague and friend. David is the managing director of Chrysalis Ventures in Louisville KY and for many years, has been a driving force behind HUMANA as an active Board Member.

The conference drew more than 100 persons from around the Delaware Valley and the sprited conversations were peppered with Israeli wit and wisdom too. For such a small country Israel produces a disproportionate share of leading IT firms and being able to bring them to our home town was a real treat. The mission of our School of Population Health, and the mission of the AICC, were totally aligned for this important event. To learn more go to www.americaisraelchamber.com. We would welcome your feedback about any of the firms, or the content of the two panels as well. DAVID NASH

Friday, November 18, 2011

Guest Commentary: Reflections on the 2011 APHA Conference



From left, Kevin Scott, MD, Manisha Verna, MD,
MPH, and Rob Simmons, DrPH, MPH, MCHES,
CPH, director of JSPH's Master of Public Health
Program.


Kevin Scott, MD
Instructor & Primary Care Research Fellow
Department of Family & Community Medicine
Thomas Jefferson University

I was fortunate enough to attend the annual American Public Health Association (APHA) conference for the third time and, with each visit, I am more impressed (and less overwhelmed!) by the diversity and quality of programs that are offered.

As a family medicine physician and primary care research fellow interested in improving access to care for marginalized populations, I came to the meeting with a few goals.

First, to take part in the activities of the Refugee and Immigrant Health Caucus and to (hopefully) earn a spot within the Caucus' leadership.

Second, to attend sessions addressing the capacity of Community Health Workers and experiences with their deployment in different environments.

Finally, I also was looking forward to the sessions detailing Canada's truly enormous Housing First project, which evaluated different programs in 5 cities in Canada.

I developed these goals prior to the meeting because the breadth of interesting content can paralyze you unless you are ready for it (and have a plan!).

I was also happy to have the opportunity to meet many luminaries in the public health world (former APHA president, high-level mental health researchers, many CA researchers) while working the Jefferson School of Population Health booth with Rob Simmons, director of Jefferson’s Master of Public Health program. Additionally, I had the opportunity to meet a graduate of the program and her mentor who had piloted some very exciting work with same-site legal services (a program that I hope to adapt for use with the refugees we see in family medicine).

I was elected secretary of the Refugee and Immigrant Caucus and am excited for what promises to be an exciting year of developing high-quality programming, improving intra- and inter-caucus coordination, and planning additional activities before the next annual meeting.

Fortunately, I was also able to network with a number of service providers and fellow researchers in the areas of homelessness, refugee/immigrant care, and community health worker deployment. Hopefully, this momentum will help springboard our efforts to develop a national refugee research network as well as local efforts to evaluate the efficacy of a hybrid community health worker-patient navigator.

Just like the meeting itself, it's hard to contain the entire experience in one short piece, but to summarize, it's a great way to share your research, meet others in your field, learn about cutting-edge techniques, and re-charge your inspiration battery!

Manisha Verna, MD, MPH

Attending the 2011 Annual APHA meeting – my first – was an exciting opportunity.

My capstone project was accepted as an oral presentation in the vision care section (Knowledge and perceived barriers about diabetic retinopathy among patients with diabetes in an urban academic environment). There was a discussion about the availability of onsite optometry in primary care practice- benefits and costs associated with it. This is a take home message to improve the practice.

Volunteering at the Jefferson School of Population Health booth was quite fascinating, as it allowed a chance to meet and greet like-minded people. Discussing our school’s educational programs, the faculty and courses with students and public health leaders provided a venue to feel proud of the Jefferson community.

I met with one of our new faculty members – Dr. John Oswald – who teaches a course on International Health, a subject of great interest to me. I volunteered to give a guest lecture on the health care system of India, and now will also give presentations on some other developing and developed countries (China, Russia, Cuba, and Congo).

I highly recommend attending the APHA meeting; it provides a doorway to meet the public health workforce and learn from their experiences.

Friday, November 11, 2011

Guest Commentary: Translating Public Health Systems Research into Practice



Tamar Klaiman, PhD, MPH
Assistant Professor
Jefferson School of Population Health

As part of the On Saturday, October 29, I attended a Public Health Systems and Services Research (PHSSR) lunch n’ learn in Washington, DC, an affiliate meeting of the American Public Health Association’s Annual meeting. The lunch n’ learn focused on translating research into practice.

The field of PHSSR seeks “to explore the impact of specific public health strategies on the quality and performance of the United States public health system.” PHSSR is distinct from -- but related to -- the established field of Health Services Research (HSR), which has traditionally focused on the delivery of medical services.

Those of us who are trained researchers talk a lot about translating our research into practice; however, for most scientists it takes over 15 years for our work to be used practically. This session gave specific examples of how PHSSR is impacting the work public health agencies conduct across the country. One example was the use of social networking analysis, which can help us better understand how organizations work and pinpoint areas for improvement. The results of social network analysis include depictions of how different departments communicate and cooperate. This work allows managers to see where problems lie in their departments and address them. Data collected before and after a social network analysis show that the analysis leads to measurable improvements in health department activities.

It is helpful for me to attend similar sessions periodically to remind me not only how important research is to practice, but to find inspiration in what others are doing. I am hopeful for the future of PHSSR and its impact on public health practice!

Friday, November 4, 2011

Guest Commentary: Reflections from the SOPHE 62nd Annual Meeting “Leveraging the Power of Health Education: Changing Systems”



Rob Simmons, DrPH, MPH, MCHES, CPH
Clinical Associate Professor
Program Director, Master of Public Health
Jefferson School of Population Health

I had the privilege to participate in the 62nd Society for Public Health Education (SOPHE) Annual Meeting in Washington, DC last week. Over 400 professional health promotion professionals and students attended the meeting. The theme was “Leveraging the Power of Health Education: Changing Systems”. Some of the highlights included:

• An opening presentation on the National Prevention Strategy by the US Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, who presented the first-ever HHS 2011 Healthy Living Innovation Awards. National and local organizations and agencies were honored for their efforts in preventive health programming in such categories as healthy workplace for large and small employers, non-profits, local and state government, schools, health care, and community health initiatives.

• Transforming Systems for Health presentations by Karen Lee, Director of New York City’s Healthy Eating and Living Initiative, and Larry Cohen, Executive Director of the Prevention Institute in Oakland, California.

• Seeking Synergy to Enhance Health, Well-Being, and Performance presentation by James Prochaska, developer of the Transtheoretical Model of Change (Stages of Change).

• The Perspectives of a Grassroots Advocate presentation by Michael O’Donnell, noted national leader on workforce health promotion and editor of the American Journal of Health Promotion

• Panel presentation on Building Capacity of Health Professionals and Workers for the 21st Century featuring Dr. Jim Plumb of the Jefferson Medical College, Department of Family and Community Medicine on Jefferson’s innovative Population Health College within the College program for Jefferson medical students.

In addition to all the excellent sessions and networking, I was able to participate in a pre-conference workshop on evaluation of health promotion programs and policies by Richard Windsor, noted national and international behavioral science researcher and author of Evaluation of Health Promotion and Disease Prevention and Management Programs: Improving Population Health Through Evidenced-Based Practice. We look forward to working with Richard here in Philadelphia as Jefferson will be part of a national research study on the use of smoking cessation for pregnant women in our clinical practices over the next few years.

A wonderful, entertaining closing session was led by Todd Park, Chief Technology Officer for the “Open Government Initiative” for the US Dept. of Health and Human Services. Todd, a founder of the innovative data company, AthenaHealth, described the plethora of health initiatives using data technology and innovation linking data developers and health information users in the creation of open data sources for health. Todd led us through the maze of rapidly changing health data innovations, including “Blue Button” technology, health quality indicators, health data “Paloozas”, Health 2.0 developer challenges, and health education initiatives and games such as “Asthmapolis” and “Farmville.” The national link is www.healthdata.gov.

Having been a member of SOPHE since 1974 and having served as its national president and treasurer, I could not have been prouder to experience the tremendous growth of this national organization representing the field and profession of health promotion and health education. I look forward to SOPHE’s Annual Meeting next year in San Francisco and The Silicon Valley with its expected theme of advancing technologies to promote health.

Wednesday, October 26, 2011

Guest Commentary: Grappling with Health Care Workforce Needs in the 21st Century



Patrick Monaghan
Director of Communications
Jefferson School of Population Health

In their opening remarks to “Creating the Health Care Workforce for the 21st Century,” Thomas Jefferson University President Robert L. Barchi, MD, and University of Delaware President Patrick T. Harker, PhD, fittingly set the table for the day’s discussions.

Dr. Barchi spoke of the millions of newly insured that have been entering the country’s healthcare system with the passage of the Affordable Care Act, and the need to develop creative approaches to extend the health care workforce in the face of the ongoing shortage of primary care doctors.

Dr. Harker spoke of the relationship between Thomas Jefferson University (TJU) and the University of Delaware, and how the two institutions can “show the country how coordinated care can be provided.”

With that, the one-day conference, focused on addressing the challenges of workforce development under health reform, was off and running. In a day filled with poignant talks and thought-provoking panel discussions, a highlight was former Pennsylvania Governor Edward G. Rendell’s keynote speech.

In his typically honest, disarmingly straight-ahead style, the former Governor expressed his concern over the competitive edge America has lost in science and technology; the need for the education of America’s youth to once again take center stage, and a call to return to the “can do” attitude that once made America the world leader in innovation, discovery, and scientific breakthrough. He spoke of the importance of the healthcare industry to the Greater Philadelphia region, and how conferences such as this one underlie how Philadelphia can serve as the point for an era of drastically improved healthcare in terms of quality, safety, innovation, and job creation.

Susan Dentzer, editor-in-chief of Health Affairs, spoke on the benefits of cultivating collaborative and coordinated care and the great responsibility vested in academic medical centers, such as TJU, to train tomorrow’s medical professionals to work collaboratively as a team, and the importance of reducing waste and medical error to cut costs and improve medical outcomes.

Joanne Conroy, MD, chief health care officer of the Association of American Medical Colleges, addressed the need for transformational change in the education of health care professionals, calling for “the right mix of physicians and essential health care providers with the right skills and training, in the right places.”

In one of two exceptional panel discussions, George W. Bo-Linn, MD, chief program officer for the Gordon and Betty Moore Foundation’s San Francisco Bay Area Program, underlined the importance of teamwork in healthcare, and how critical it is for health care professionals to engage their patients – or “persons,” as Dr. Bo-Linn prefers – in their own health care. “The current most widely unrecognized and largest workforce is patients and their families,” Dr. Bo-Linn declared.

The health care workforce for the 21st century will need to adapt to a health care system currently in reform, but the most basic tenet remains the same, surmised David B. Nash, MD, MBA, Dean of the Jefferson School of Population Health - “Patients, or persons, will remain at the center of all we do.”

Sunday, October 16, 2011

October 21 Special Conference



The Jefferson School of Population Health is all fired up this week as we head toward our long planned special joint conference with our colleagues at the University of Delaware entitled "Creating the Healthcare Workforce of the 21st Century". This conference will be held on our campus in center city Philadelphia in the Hamilton Building between 10th and 11th streets in the Connelly auditorium.

The day is devoted to addressing the key policy question---what kind of healthcare workforce will our nation need to help fulfill the promise of health reform?. Among the luminaries who will be presenting are Susan Dentzer, the Editor in Chief of HEALTH AFFAIRS, Dr Joanne Conroy, a key leader from the AAMC in Washington DC, former Governor of PA Ed Rendell, and Dr George Bo-Lin, the CMO of the Intel foundation in California. It is an amazing line up for sure.

There will also be two panel discussions with many other regional leaders as we tackle some tough questions about, for example, the role of nurse practitioners in the future, the appropriate supply of primary care doctors, the need for interprofessional education in the health professions and related subjects.

I hope you will join us for this amazing event. You can register directly at the following address...http://www.delawarehsa.org/conferences/kbpc.php We look forward to seeing you there!! DAVID NASH

Friday, October 14, 2011

Guest Commentary: JSPH's Academic Programs are Thriving



Caroline Golab, PhD
Associate Dean for Academic and Student Affairs
Jefferson School of Population Health

This September, the Jefferson School of Population Health (JSPH) welcomed 185 new and returning students to a combination of on-site, off-site, and online courses – an 80%increase in enrollment over September 2010. And this is only our third year of operation!

In addition to our PhD program in Population Health Sciences and our Master’s degree and certificate programs in public health, health policy, healthcare quality & safety, and chronic care management, we introduced two new degree programs – a Master of Science in Healthcare Quality and Safety Management (MS-HQSM) and a Master of Science in Applied Health Economics and Outcomes Research (MS-AHEOR). We have also developed programs in healthcare risk management, scheduled for debut in fall 2012.

The MS-HQSM, offered in cooperation with the American College of Physician Executives (ACPE), is designed specifically for physician leaders and addresses the national need for executive leadership in healthcare quality and patient safety. It equips physician leaders with tools, methods, knowledge, and strategies necessary for this task. The MS-AHEOR builds on Jefferson’s more than twenty years of experience and expertise in health outcomes research. It meets the growing need for professionals to evaluate and measure health outcomes (both physical and humanistic) and to ascertain economic consequences of health care interventions by determining optimal clinical effectiveness, comparative effectiveness, and economic value.

The 2011-2012 academic season also represents our second year of asynchronous online course delivery to a national audience. The introduction of online programs followed an extensive period of preparation that included adoption of a nationally recognized rubric (Quality Matters) and development of a mandatory comprehensive faculty training program (CATS) to assure excellence in online course design and instruction. Often to their surprise, both students and faculty have discovered that online learning provides exceptional opportunities for increased collaboration, community building, and enhanced learning outcomes – all items near and dear to our educational mission.

Through curriculum development and consultation, JSPH will continue to support the College within a College (CwiC) program for 50+ first- and second-year medical students enrolled in Jefferson Medical College. A co-curricular activity partially funded through a HRSA grant, CwiC enables these JMC students to complete six credits toward a Master of Public Health (MPH) degree in conjunction with their medical education. The goal of this initiative is to encourage medical students to complete coursework for the MPH degree prior to their graduation from Jefferson Medical College.

For the fifth year, we have successfully recruited and obtained funding to support fourteen Fellows as part of the Greater Philadelphia Albert Schweitzer Fellowship Program. The mission of the Schweitzer Fellowships is to encourage students in various health-related professions to become “leaders in service” and, by their example, to inspire others in addressing the health needs of underserved communities.

Finally, as the new School year starts, we are already planning next summer’s Global Health Academy, a four-week summer didactic and hands-on experience for high school students. Successfully launched this past summer under the guidance of Jefferson faculty and outside experts, students from local high schools studied major challenges to global health – everything from infectious diseases, natural disasters, water shortages, and healthcare delivery systems to the international resources, agencies and technologies that respond to these challenges. We believe it’s never too early to find and nourish future leaders in population health.

Monday, October 10, 2011

Guest Commentary: International Collaboration with Universidad CES, Medellín, Colombia



Rob Simmons, DrPH, MPH, MCHES, CPH
Director, MPH Program
Jefferson School of Population Health

This past August, I had the opportunity to spend three weeks in Medellín, Colombia at Universidad CES representing the Jefferson School of Population Health (JSPH). CES is an acronym for the “City of Eternal Spring” in English and is an indication of the temperate climate of Medellín, Colombia’s second largest city with a population of over 4 million. Universidad CES was founded 34 years ago by a group of Colombian physicians who wanted to establish a private, health science university with an emphasis on medical, dental, mental and veterinary medicine, and allied health education. Universidad CES has three large clinical entities in the region, including a major hospital in downtown Medellín, and has expanded its undergraduate and graduate education programs in the biosciences, physical therapy, public health, and most recently, health law. Enrollment currently stands at approximately 2700 students.

Universidad CES is considered the top university in the health sciences in Colombia and served as host to representatives of the US CDC Center for Global Health during my visit. Similar to the JSPH, one of its areas of focus is health care quality and safety, and CES holds an annual conference for health care professionals in South and Central America each fall.

In 2008, I had the opportunity to visit Universidad CES for a day and shared information about Thomas Jefferson University and our plans for a new school of population health. Over the past two years, the Jefferson School of Population Health has returned the favor and has hosted Dr. Julián Osorio, the Dean of the CES Medical School, Dr. Oscar Saldarriaga, its Director of International Relations, and one of its medical students. In the interest of collaboration, I was asked to come to Medellín to provide training and technical assistance for program directors and faculty.

During my stay at Universidad CES, I provided training on the infusion of public and community health education and practice in their medical education, presented an overview of the US public health and healthcare systems, provided a framework and resources for expansion of their global health prevention initiatives, and met with researchers on preventive health research opportunities in Colombia and the Americas.

At the conclusion of my visit, we discussed future collaborative opportunities between Universidad CES and Thomas Jefferson University and, particularly, the Jefferson School of Population Health. These could include student and faculty exchanges, collaborative research opportunities, and joint professional education symposia in-person and via satellite in both Philadelphia and Medellín. David Nash, JSPH Dean, has been invited to be the keynote speaker at one of CES’s annual international conferences on Quality and Safety in the future. I look forward to working with Universidad CES and helping build future collaborative health initiatives between our two universities.

Monday, September 26, 2011

Guest Commentary: Spending More Resources on Preventive Services is our Common Strategy



Akira Babazono, MS, MD, PhD**
Chair and Professor
Department of Health Care Administration and Management
Graduate School of Medical Sciences, Kyushu University, Japan


Dr. Saito and I visited JSPH to meet most faculty members, with the help of. Dr. Nash, this past August. We thanked them to have given precious information concerning healthcare problems. We are very happy to agree that we need more resources on primary care, including prevention, rather than for specialized care in developed countries where chronic diseases are prevalent.

Lifestyle-related diseases account for about 60% of deaths and we spend majority of health care expenditure on treatment for those diseases in Japan. The Japanese government has mandated insurers to provide health examinations and guidance related to metabolic syndrome since 2010. Insurers have to determine the risk for metabolic syndrome, including level of obesity (abdominal circumference and BMI), blood glucose and lipid levels, blood pressure, and the presence or absence of a smoking habit for every insured person aged 40 and over. Then, insurers are obliged to offer health guidance interventions according to the degree of risk of each insured person.

There are several studies that have reported favorable outcomes. The health examinations and guidance program would be productive because it is the efficient way to motivate patients to continue to maintain a healthy lifestyle in order to prevent chronic diseases.

I hear that the Patient Protection and Affordable Care Act mandates insurers to make co-payments on cancer screening free and to give subsidies to the insured to participate in fitness programs. I believe that we are on the right track because chronic diseases, which cannot always be cured by procedures, are preventable.


** Dr. Babazono and his colleague, Dr. Takao Saito, MD, PhD, attended the Tenth Quality Colloquium at Harvard in August, 2011 and spent the following week at JSPH. This is Dr. Babazono’s 3rd visit with JSPH.

Friday, September 23, 2011

Guest Commentary: Population Health on the World Stage: The UN High Level Conference on Non-Communicable Diseases (NCDs)


Rob Simmons, DrPH, MPH, MCHES, CPH

Director, MPH Program

Jefferson School of Population Health

For only the second time in its 66-year history, the first being in 2001 on HIV/AIDS, the United Nations held a high level (Heads of State and Ministries of Health) meeting of the General Assembly on a population health topic.

Jefferson School of Population Health (JSPH) was one of only eight US university schools to be invited to participate in this historic meeting representing the Civil Society and the NCD Alliance on the health and economic impact of non-communicable diseases (chronic diseases). Along with our colleague, Global Health Specialist Dr. Lucille Pilling, , I was honored to represent JSPH at this event in New York earlier this week.

The five major NCDs are those we are all familiar with in the U.S.: cardiovascular diseases (CVDs), cancers, chronic respiratory diseases (CRDs), diabetes, and mental illness. The major NCD risk factors include poor diet and physical inactivity, tobacco use, and excessive alcohol use.

Currently, more than 60% of all deaths worldwide stem from NCDs. It is estimated that 80% of all NCD deaths occur in low and middle-income nations, up sharply from just under, 40% just twenty years ago.

NCDs have been established as a clear threat not only to human health, but also to development and economic growth. Once considered “diseases of affluence”, NCD’s have now encroached on developing countries, most of whom have limited health, education, and economic infrastructure to address the changing demographics in their countries.

A global analysis of the economic impact of NCDs recently released by the World Economic Forum and the Harvard School of Public Health reported that cumulative economic losses to low and middle-income countries are estimated to surpass US $7 trillion over the fifteen year period of 2011-2025 (an average of $500 billion per year). This yearly loss is equivalent to approximately 4% of these countries’ current annual output. The negative health and economic impact will put a major strain on the budgets of every country around the globe, especially low and middle-income nations.

For these reasons, world leaders came together for this two-day meeting to ratify a series of policies and action steps to address the burden of NCDs. Highlights included presentations from UN Secretary General Ban Ki-moon, Dr. Margaret Chan, Director General of the World Health Organization, 19 “Heads of State,” and leaders from a range of public and private foundations. Throughout the conference, collaboration between the public and private sectors of society was emphasized as the only viable, sustainable platform to reduce the growing and potentially devastating burden of NCDs around the world.

The UN High Level Conference on NCDs was only the first step in a multiple decades-long endeavor to avert a global health and economic crisis. Each nation, multi-national and national public and private organizations, and global business leaders were asked to pledge their political and economic support (to the best of their ability) to this global health initiative. Hopefully, over the next decade and beyond, we will be able to look back at this seminal event and recognize the importance of population health being on the world stage at this place in time.

To learn more about the UN High Level Meeting on NCDs and the global health NCD initiatives, here are some websites regarding the event and actions taken:

http://www.un.org/en/ga/ncdmeeting2011/

http://www.un.org/en/ga/president/65/issues/ncdiseases.shtml

http://www.who.int/nmh/events/un_ncd_summit2011/qa_hlm.pdf

http://www.un.org/apps/news/story.asp?NewsID=39642&Cr=non-communicable+diseases&Cr1=

Some just released resources on NCDs include:

“The Global Economic Burden of Non-communicable Diseases”, Harvard School of Public Health, World Economic Council, September, 2011

“Scaling Up Action Against Non-communicable Diseases: How Much Will It Cost”, World Health Organization, 2011

“From Burden to “Best Buys”: Reducing the Economic Impact of Non-communicable Disease in Low- and Middle-Income Countries”, World Health Organization, World Economic Forum, 2011

“NCDs: Time for Change”, Global Health, Issue 12, Fall, 2011, Global Health Council

“A Call to Action on Health Promotion Approaches to Non-Communicable Disease Prevention”, International Union for Health Promotion and Education”, September, 2011

Sunday, September 18, 2011

BACK on the ROAD AGAIN



As the School of Population Health officially starts its second full academic year I want to take a moment to thank our entire team---the faculty and staff who make it possible for us to bring first-rate "in person and online content" to so many students around the nation. Right now we have more than 310 students taking at least one 3-credit course with us, either in person or online, across our 5 degree programs. It is thrilling for me to report these numbers to you!

On another note, I have been "back on the road again" preaching the gospel, if you would, of health reform through improvement, leadership, waste reduction, and care coordination. Everything that our school stands for and teaches. My message has been very well received...

This past week I was in Colorado Springs for the Fall meeting of the Governance Institute--I have served on their faculty for nearly 20 years and now I generally headline the opening day event. I spoke to almost 300 leaders from hospitals across the nation about the role of good governance in promoting quality and safety. The next day, I led the AHA Center for Governance Meeting in Boston, MA. I reiterated my message to this group and then led 2 workshops where we dug into the details about the structure and function of a good Board Committee on Quality.

Later in the week I attended the National Quality Forum Annual Awards Dinner and meeting in Washington, DC, and was in attendance when Norton Healthcare won the 2011 Annual Award. I am especially proud of Norton as they are partners with Humana in a successful Accountable Care Organization model in Louisville, KY. More on that another time.

I capped off the week with the closing plenary for the South Carolina Hospital Association at their meeting in Hilton Head Island. Here, I emphasized the need for care coordination and the creation of a physician leadership class. I also had the wonderful experience of signing scores of copies of my latest book, Demand Better.

Finally, I am especially proud of my ongoing affiliation with the Main Line Health System in suburban Philadelphia where I chair the Board Committee on Quality. In case you missed it, MLH was named by the Joint Commission as one of the very top systems in the entire country. Kudos should go to the leaders of MLH including Jack Lynch, Don Arthur, and Denise Murphy.

What are you doing to be a part of the solution for health care? DAVID NASH

Thursday, September 15, 2011

Guest Commentary: RECs – Help for Ambulatory Care Physicians in Implementing EHRs






Richard Jacoby, MD
Clinical Associate Professor
Jefferson School of Population Health

Over the past year, states across the country have developed Regional Extension Centers (RECs) to support the electronic health record (EHR) initiative passed as part of the American Recovery and Reinvestment Act (ARRA) of 2009. Why is this important? With benefit of a little background information, the answer is pretty clear.

The evidence suggests -- and it is generally believed -- that adoption of EHRs by physicians and other health care providers is a critical first step in enhancing the quality and value of health care delivered in the U. S. However, adoption of electronic health records by physicians has been painfully slow in this country. How many of you still have to fill out a paper form when you visit your doctor?

The Health Information Technology for Economic and Clinical Health (HITECH) Act was included as part of ARRA to provide incentives for physicians and other health care providers to adopt and use EHRs in a meaningful way. By meeting HITECH criteria for “meaningful use”, physicians and other providers can qualify for up to $44,000 from Medicare and/or $63,750 from Medicaid to offset their EHR purchase costs. However, there is a stick to go along with the carrot. Beginning in 2015, CMS will impose financial penalties on providers who do not engage in meaningful use of health information technology.

But adopting and utilizing a new technology can be a daunting task – especially when the technology is implemented in the context of health care provider practices. Recognizing this, the HITECH act established and partially funded RECs to act as consultants – i.e. to support priority primary care providers and certain critical access hospitals in making choices, adopting, and “meaningfully using” EHRs.

RECs assist providers in evaluating the available EHR systems offered by different vendors and selecting one that meets the needs and budget of the practice. Next comes the really hard part – providers must re-engineer the way care is delivered in the practice to coincide with the new technology! It requires a detailed analysis of the practice workflow pre-and post-EHR implementation -- i.e., understanding what each employee currently does, and what that employee will do post-implementation, from the moment a patient enters the office until the time he/she leaves.

Once the practice is up and running with the new technology in place, challenges remain. Providers must understand and comply with specific rules in order for the practice to qualify for incentive payments. If all goes as planned, RECs may play an important role in helping with the transition from paper-based to electronic systems.

The Jefferson School of Population Health is providing services to physicians as part of the REC effort in Pennsylvania. For more information, contact Richard Jacoby, M.D. at richard.jacoby@jefferson.edu.

Monday, September 12, 2011

Guest Commentary: Revisiting Managed Care – 10 Years On



David Woods, PhD, FCPP
CEO, Health Care Media International
Adjunct Faculty, Jefferson College of Graduate Studies

More than decade ago I wrote a book for the Economist Intelligence Unit, The Future of the Managed Care Industry and its International Implications.

What's changed about managed care in 10 years? Well, certainly not public perception. In fact, in a poll at that time a solid majority of respondents believed that the quality of medical care would be harmed rather than improved by the trend toward more managed care.

Yet, despite subsequent studies showing that quality of care has not been demonstrably compromised under managed care, it is hard to find many friends of the system. The media cite horror stories about denial of care; and TV series featured doctors trying to do good despite managed care’s strictures.

Today, more than 80% of Americans insured by their employers are in some sort of managed care plan -- as are the overwhelming majority of doctors.

Alain Enthoven, PhD, a professor at Stanford University and a leading authority on healthcare systems and policy, defines managed care as a strategy used by purchasers of healthcare. Four essential principles of managed care are: selective provider contracting; utilization management; negotiated payment; and quality management.

The principal objection of patients to managed care was the prospect of being thrown out of the hospital within hours of major surgery. They also disliked the necessity of having to go through gatekeepers, typically primary care doctors, before being allowed to see a specialist.

One thing I certainly got wrong in the book was my contention that if managed care has achieved anything, it has slowed the breakneck speed at which US healthcare costs were growing. In fact, those costs have now reached a stratospheric $2.3 trillion a year.

So, according to the premise of my book’s title, I asked the question: What is the future for managed care? I answered it by saying that managed care will not only survive but thrive in the US. I also suggested that managed care would need to get away from the perception that its main function is to restrict care, but rather to supply a service to members that should include such care as is needed.

Managed care plans are seeking to rebuild damaged relationships with providers... and they're looking to shift more responsibility for payment on to users. As they move into less restrictive products they lose their ability to control costs, a fact that is likely to contribute to further premium increases, which in turn could put additional pressure on public programs.

In a recent interview, Dr Alain Enthoven told me that despite deficiencies in managed care that tend to favor fee-for-service delivery, Kaiser Permanente has prospered, he says, mainly because it has rolled out an electronic health record that has led to a cultural change both for patients and for physicians. What has impeded managed care’s progress, he says, is that employers continue to offer fee-for-service care and many have still not even tried managed care. And while managed care companies have made steady progress, employers still don't provide employees with incentives to choose economical healthcare.

Despite changes in managed care over the years, some of the original ambitious goals have not been achieved, including cost containment and universality. Some of the challenges of managed care might be obviated by passage of the Affordable Care Act. Unless the Act is significantly diluted it is perhaps the most significant change in healthcare delivery over the past decade. Gone will be denial of care for pre-existing conditions; and, for any type of insurance to work, the requirement that there be 100% enrollment is central.

Wednesday, August 24, 2011

Guest Commentary: A Fellow's Reflections on the 10th Annual Quality Colloquium



Zoe Clancy, PharmD

Fellow, Health Economics & Outcomes Research

Jefferson School of Population Health



In the words of Paul Wallace, MD, co-chair of the Harvard Tenth Quality Colloquium, “The test if you learned something is if you can go back home and talk about it.” This past week I attended the Tenth Quality Colloquium and I would like to think that I learned a lot. This is the first professional conference I have attended as a Health Economics and Outcomes Research Fellow at the School of Population Health and it was a rewarding experience.



Attending this conference has really highlighted a lot of topics and issues that I am learning about through the fellowship. The sessions I attended on health informatics, value-based purchasing, and quality improvement in the patient experience were led by leaders in their fields. Many topics about the culture of safety were discussed, such as accountable care organizations, meaningful use, and electronic health records.



The session devoted to Using Data to Improve Health Care Quality, Safety and Efficacy was interesting to me as a fellow in an outcomes research program. One of the main ideas I learned from the session was that data banks and the amount of information may be growing, but Health Informatics is still only a tool to access that data. Automating healthcare is important, but it is not enough. Training of personnel in informatics is needed in order to use data collection to its full potential.



In the Value-Based Purchasing seminar I became more familiar with Meaningful Use and other quality incentive programs. I was first exposed to these concepts by working with the JUP Quality Improvement team here at Jefferson, and after attending the session I look forward to applying what I learned to future JUP projects.



I noticed that pharmacists were mentioned frequently during the colloquium. It was brought up numerous times that pharmacists, being the medication experts, can play a crucial and valuable role in patient safety by becoming involved in medication safety. As a pharmacist, I am inspired by all that I heard, and am energized to utilize those principles in my fellowship.



I look forward to the opportunity to attend more conferences and sessions like the Tenth Quality Colloquium in the future.

Wednesday, August 17, 2011

The 10th Annual Quality Colloquium at Harvard





For four days this week the leaders in the quality and safety movement from all over the nation converged on the campus of Harvard University for the 10th Annual Quality Colloquium co sponsored by the Jefferson School of Population Health. In the first morning of the program, three key leaders, including the CEO of the IHI in Boston, the National Patient Safety Foundation, and the AHRQ, set the tone for the rest of the week by challenging the audience to get further engaged in the movement.These leaders reminded us all that medical error remains the fourth leading cause of death in the US and more must be done to protect our patients from harm. The research presentations covered a wide range of topics including the latest research on safety improvement in both the hospital and the office setting. Others presented an update on the role of hospital governance in quality and called for a renewed commitment on the part of board members to this agenda. In the pre conference workshop, nearly 100 persons spent a day in a special "boot camp", with myself and my colleage Dr Ed Walker from the University of Washington in Seattle. Together, we gave a day long overview of the field and we too challenged the attendees to return to their home institutions with a renewed sense of energy and new tools to tackle the epidemic of harmful errors. Our team is already hard at work planning the August 2012 session!! I sure hope that you will think about joining us next summer. DAVID NASH

Wednesday, August 10, 2011

Guest Commentary: Collaborative Care's Crucial Role in Population Health



Amanda Solis, MS

Project Director

Jefferson School of Population Health



A focus on population health requires a creative and collaborative approach to care.

The traditional perspective in healthcare has been fairly physician-focused. As we seek to fulfill the mandate to become more patient-centered in our outlook, it is important to leverage the important roles of pharmacists, physical therapists, nurses, nurse practitioners and physician assistants, health coaches and nutritionists.



To illustrate my point, here is one example of the role a collaborative care team can play in the management of chronic disease that specifically highlights the community pharmacist. Beginning in 2006, the American Pharmacists Association (APhA) launched a program named the “Diabetes Ten City Challenge.” Originally born from the Asheville Project, also conducted by the APhA Foundation and funded by GlaxoSmithKline, this program was aimed at implementing a patient self-management program for diabetes using community-based pharmacies as the base of operations.



The Diabetes Ten City Challenge (DTCC) consisted of 3 main objectives:



1. To implement an employer-funded, collaborative health management program using community-based pharmacist coaching, evidence-based diabetes care guidelines, and self-management strategies designed to keep patients with diabetes healthy and productive.



2. To implement the patient self-management training and assessment credential that equips patients with the knowledge, skills, and performance monitoring priorities needed to actively participate in managing their diabetes.



3. To assess participant satisfaction with overall diabetes care and pharmacist care provided in the program.



Patients in the DTCC program worked with a community pharmacist to develop their knowledge, skills, and performance related to self-management of diabetes. This unique approach established the community pharmacist as a patient coach and leader of the care team. Community pharmacists are in a prime position to serve this role, since they have so much regular contact with patients



DTCC program outcomes included statistically significant improvements in A1C, LDL cholesterol, and systolic and diastolic blood pressure measures. Patients also reported higher rates of influenza vaccinations, and being current in terms of eye and foot examinations.



In addition to improved clinical outcomes, average total health care costs per patient per year were reduced by $1,079 (7.2%) compared with projected costs. Full results and more information can be found here http://www.diabetestencitychallenge.com/index.php.



The DTCC illustrates an important opportunity to shift the model of care, improve health outcomes, and lower cost. As we face a reduction in primary care physicians and an increase in the number of patients with chronic conditions, we need to work toward implementing creative and collaborative solutions to meet the needs of our citizens.

Tuesday, August 2, 2011

The work to improve medication safety





For more than twenty years, I have been a member of our hospital's P and T Committee---an important committee whose job, among other things, is to maintain and update the formulary AND to monitor and improve the safety of medication at all times. I have chaired a subcommittee on Medication Safety for more than a decade. Each year around this time, we issue a summary of our progress in this struggle. I would like to hit the highlights of the current summary. In this past year the team reviewed quarterly medication event and adverse drug reaction reports and made many recommendations to address key safety issues. We benchmarked our own data against national data from hospitals just like us who are members of the University Healthsystem Consortium in Chicago. In other words, we put our dirty laundry out to dry and explicitly compared our progress to a national peer group--not an easy job!! We invited national experts from the ISMP, the Institute for Safe Medication Practice ,to come inside our tent and to make specific recommendations as to how we might improve our internal control processes. We tackled some specific clinical challenges in caring for patients with a wide range of diseases including diabetes, heart disease,many types of cancers, and others. In each clinical condition, we carefully tracked medication safety from quarter to quarter and year to year. We empowered multidisciplinary teams to "tell us like it really is" and we listened closely to their reports. In a word, we spent a year of tough self evaluation---asking difficult questions and sometimes getting answers that we did not like. However, we never lost sight of the real goal---to do no harm and to improve every day. The staff involved here are the unsung day to day real heroes of hospital care. What are you doing to improve the safety of medication where you work?? DAVID NASH

Friday, July 29, 2011

Guest Commentary: It’s Always Sunny in Philadelphia



Alexis Skoufalos, EdD
Associate Dean for Continuing Professional Education
Jefferson School of Population Health

Thursday, July 21st was sunny and stiflingly hot – one of the most brutal summer days we’ve experienced in Philadelphia in many years. And yet, over 150 of JSPH’s colleagues came together on the Jefferson campus to share with us their thoughts about important issues in population health.

In an odd way, it was a birthday party of sorts. July marks JSPH’s birthday month – it was only 3 years ago that we toasted the beginning of our journey to create a new school dedicated to educating leaders that would help us improve the quality of health and health care in America.

In that time, we’ve developed new academic programs, published two books, convened multiple conferences, conducted cutting-edge research, added stellar new leaders, faculty and staff to our team, and encouraged some of our most valued colleagues as they moved on to new endeavors.

In 3 short years, we have assembled a diverse and talented team with a passion for making meaningful change. The challenges we face have only become more complex in the last few years, and the stakes have never been higher.

While we have much to celebrate, there is so much more to do. And we can’t do it alone; we need to hear from you about the type information you need, the challenges you face that we can help address, and the programs we should focus on in the future.

We are committed to making a world of difference in health care. Let us know how we can help you by contacting any one of the leaders listed below.

JSPH Program Contacts:

Caroline Golab, PhD
Associate Dean, Academic and Student Affairs
(215) 503-8468
caroline.golab@jefferson.edu

Joseph D. Jackson, PhD
Program Director, Applied Health Economics and Outcomes Research
(215) 955-4755
joseph.jackson@jefferson.edu

Kathryn M. Kash, PhD
Program Director, Chronic Care Management
(215) 955-9549
kathryn.kash@jefferson.edu

Mark Legnini, DrPH
Director, Center for Value in Healthcare
(215) 955-0427
mark.legnini@jefferson.edu

David B. Nash, MD, MBA
Dean, Jefferson School of Population Health
(215) 955-6969
david.nash@jefferson.edu

James Pelegano, MD, MS
Program Director, Healthcare Quality and Safety
(215) 955-3888
james.pelagano@jefferson.edu

Rob Simmons, DrPH, MPH, MCHES, CPH
Program Director, Public Health
(215) 955-7312
rob.simmons@jefferson.edu

Alexis Skoufalos, EdD
Associate Dean for Continuing Professional Education
(215) 955-2822
alexis.skoufalos@jefferson.edu

Saturday, July 16, 2011

More on Accountable Care Organizations



The Jefferson School of Population Health just finished hosting a special two day invitation only advisory board on the current status of Health Reform. We had one dozen experts from all around the nation convene on our campus for a two day discussion of the details and an update on implementation challenges. It was sobering indeed!! At this juncture, I believe that most organizations are NOT culturally ready for the hard work of true accountability.The heart of a real ACO, whether with Medicare or commercial patients, is the realization that clinicians will have to self evaluate, measure what they do everyday, and be willing to engage in the gut bustingly difficult work of improvement. The "shared savings" may in fact be minimal, especially in the early stages. It will take a commitment to practicing based on the evidence and a willingness to benchmark performance against regional and national leaders. A tall order for any organization and in my view, most are not at all ready for this cultural paradigm shift. Who will make it---organizations with a hierarchical doctor culure, accustomed to profiling and willing to police members within their own ranks. The Ochsners, Geisingers and Mayos of the world will be able to make it work, very few others have the skill sets necessary at this juncture. Stay tuned for more posts from our amazing advisory board and for publications that will come from our deliberations together. DAVID NASH

Thursday, June 30, 2011

Guest Commentary: JSPH Fellowship Program Celebrates 17 Years



Joe Couto, PharmD, MBA
Assistant Professor, Jefferson School of Population Health
Director, Fellowship Program

On Monday, June 27th JSPH hosted our annual Fellow’s Day, where we celebrated 17 years of training Fellows in health economics and outcomes research. The half-day program began with a keynote from one of our own, Joe Doyle, who completed the fellowship in 1998. Joe gave a detailed account of work he recently had published in Health Affairs along with another Jefferson fellowship graduate Feride Frech-Tamas and several other colleagues at Novartis and Thomson Reuters. Their article was entitled “A Value-Based Insurance Design Program At A Large Company Boosted Medication Adherence For Employees With Chronic Illnesses,” and examined the impact of value based insurance on asthma, cardiovascular, and diabetes medication use over a 3 year period.

We then heard from current Fellows Kellie Dudash and Sangtaeck Lim, who each presented an outcomes research project they completed during the first year of their fellowship. Next Joe Jackson, the program director for our Applied Health Economics and Outcomes Research master's degree, outlined plans for the new program that will be launching in September of this year. This new degree program has especially exciting implications for our fellowship program, as it will offer future Fellows the opportunity to earn a formal degree in the field in which they are training. We ended the morning on a bittersweet note as we graduated an exceptional class of second year Fellows: Eddie Lee, Lane Slabaugh, and Anita Mohandas. My fellowship overlapped with Eddie, Lane, and Anita and it was my distinct pleasure having worked with all three of them.

Fellows Day is first and foremost a celebration of the accomplishments of our current Fellows. However the entire morning served as yet another reminder to the faculty and staff of JSPH, our fellowship sponsors, invited guests, and former fellows in attendance of the rich history of our fellowship and its role in shaping the science of health economics and outcomes research.

Sunday, June 19, 2011

Health Reform and Comparative Effectiveness Research



The Patient Centered Outcomes Research Institute is up and running!! So, what does PCORI mean for those of us interested in the science of Comparative Effectiveness Research and the intersection with Health Economics and Outcomes Research? First, lots of jargon here and some of it pretty turgid. CER has been discussed in our blog several times but in a nutshell---trying to figure out what really works in clinical medicine so we can improve care, lower costs, and reduce errors. PCORI will be handing out some new money to support CER. We hope the Jefferson School of Population Health will be the beneficiary of some of this new funding soon. We are also launching our unique, on line Masters Degree in Applied Health Economics and Outcomes Research in September 2011. In my many speaking engagements, esepcially those with the pharmaceutical and biotech industries, I have been emphasizing the following---do not shy away from CER, rather, embrace it!! The Accountable Care Organizations of the future will want products that work, and that are cost effective. ACOs, especially those that have risk, will want to make sure that they are practicing evidence based medicine and using products that are supported by that evidence. I know that these terms are confusing, but stay tuned in this space for more on PCORI, HEOR, CER, ACOs and all the rest. We will continue to try to clear the fog of jargon and help to make sense out of some very important new policies. DAVID NASH

Thursday, June 16, 2011

Guest Commentary: A Lesson in Communications from Richard Foster



Rob Lieberthal, PhD
Faculty, Jefferson School of Population Health

I went to the Society of Actuaries Spring Health meeting in Boston to improve the quality of my research. I wanted to learn the actuarial perspective on comparative effectiveness research, learn about new SOA initiatives that I can get involved in, and find new sources of data. My plan was to improve my technical skills. The main lesson I got was an amazing perspective on the importance of communication.

Richard Foster, the Chief Actuary at the Center for Medicare and Medicaid Services, was the keynote speaker of the conference. The main theme of his speech was communicating technical results to difficult audiences. Mr. Foster’s most powerful example of a difficult audience was the Medicare administrator who tried to suppress his estimates of the Medicare Modernization Act (see his take here). He cautioned that a more common problem is that politicians can’t, or don’t want to, understand the opinions he gives as CMS’s chief actuary. His feeling is that the miscommunication is getting worse with rising partisanship. Mr. Foster works hard to make sure his estimates are not misquoted or misconstrued. He went as far as to publicly contradict then health reform director and current White House deputy chief of staff Nancy-Ann DeParle.

I have been thinking about how that standard of behavior applies to the problem of communicating the results of comparative effectiveness studies today. Many of the technical issues that held back research in the past, like computer resources or lack of data, have become less important. The communication problems have become more difficult, largely because the work we do is being taken more seriously. Richard Foster has issued a challenge not only to health actuaries but to all of us who work in quantitative roles in health care. Can we communicate our work to non-experts? And can we do it in such a way as to minimize the chance that it will be misused? I feel that answering this challenge is the key to research that is not only technically correct, but also has an impact on population health.









Thursday, June 9, 2011

Guest Commentary: JSPH Graduation 2011



Patrick Monaghan
Director of Communications
Jefferson School of Population Health

The Jefferson School of Population Health graduated its second-ever class last Thursday morning, during commencement ceremonies held at the Kimmel Center for the Performing Arts. Ten JSPH students walked during the ceremony, which featured keynote remarks from Donna E. Shalala, PhD, President of the University of Miami and the former Secretary of Health and Human Services.

The location – one of the foremost concert halls in the nation – was not lost on Dr. Shalala, who referenced famed Philadelphia Orchestra Music Director Eugene Ormandy in her comments, comparing the newly minted healthcare professionals to the skilled musicians who usually “work the room.”

TJU President Robert L. Barchi, MD, PhD, lauded the graduates for their academic accomplishments, underscoring how desperately our nation’s ailing healthcare system is in need of an infusion of new leaders. JSPH Dean David B. Nash, MD, MBA, reminded the graduates that they stand at an important crossroad in population health, one framed in part by the Affordable Care Act, the landmark healthcare legislation enacted a little over one year ago.

For the graduates, the real work is just beginning. They’re now part of a new generation of healthcare leaders – those who will work to reduce the unexplained variation in health care services, abolish disparities in how care is delivered, improve the coordination of care and improve the quality and safety of the care they deliver.

Congratulations and continued success to the Class of 2011!

Monday, May 30, 2011

ISPOR and the JSPH



For more than a decade and a half, our team from the Jefferson School of Population Health (and its predecessor department and office) has been very well represented at the annual meeting of the International Association of Pharmacoeconomics and Outcomes Research or ISPOR!!! ISPOR is the global leader in research on what works and what doesn't and all of the economic implications for pharmaceutical agents world wide. The annual meeting now draws more than 2,300 persons from all over the globe and it spans nearly a week, counting the pre-courses and related activities. Today, I think ISPOR is more important than ever as health reform and Comparative Effectiveness Research have pushed this agenda to the front page. The cost of pharma agents continues to rise, particularly in the oncology arena. We cannot continue to spend money on products without better proof of their comparative effectiveness and possible role in evidence based care moving forward. ISPOR uniquely fills this research void. This year, one of our fellows, Dr. Kellie Dudash, won acclaim for her podium presentation and came away with the prize for best new investigator---a real coup for her, and for our entire research team too. I am particularly proud of Kellie, Dr. Joe Couto and of course, Neil Goldfarb, our long time Associate Dean for Research. This is further confirmation for me that the JSPH is a national leader in interpreting the outcomes of the ACA and leads the way from an academic perspective in doing research in this arena. Our research supports the notion, covered in this blog many times, that the future means -- NO OUTCOME, NO INCOME!! DAVID NASH

Wednesday, May 25, 2011

Guest Commentary: Albert Schweitzer Fellowship Celebration of Service




Nicole Cobb Moore, MA
Greater Philadelphia Program Director
Albert Schweitzer Fellowship

The Albert Schweitzer Fellowship (ASF) – Greater Philadelphia Program held its fifth annual Celebration of Service on May 18th at Thomas Jefferson University. The cocktail reception that started the event was warm and buzzing as newly selected Fellows mingled with graduating Fellows, Schweitzer Fellows for Life and a host of academic and community site mentors, local advisory board members, family, friends, and funders.

The ceremony was attended by many distinguished guests and highlighted by keynote speakers, Dr. David B. Nash, Greater Philadelphia Schweitzer Program Chair and Dean of the Jefferson School of Population Health, Sally Harris, Vice Chair of the Schweitzer National Board of Directors, and Sylvia Stevens-Edouard, Executive Director of The Albert Schweitzer Fellowship.

The history of the Greater Philadelphia Program was shared by Dr. Nash, while Sally Harris gave a personal perspective on Albert Schweitzer and the U.S. based Schweitzer Fellowship. Unfazed by major travel challenges to attend this event, Sylvia Steven-Edouard disclosed how she sometimes looks at pictures or reflections of Fellows to rejuvenate her inspiration for the important work that we are doing. Each speaker shared the impact Schweitzer Fellows have on the individuals and communities they serve.

Fellows prepared posters that were presented during the celebration, highlighting their year-long Schweitzer Community Service Projects. Fellows also shared a few words about their Fellowship experience. I would like to share one particular concept that exemplifies the challenges and rewards of the Schweitzer program. When conducting a Schweitzer Project, challenges will inevitably arise, and we label these obstacles “boulders.” Learning to overcome boulders over the course of the Fellowship is one of the most important accomplishments of Schweitzer Fellows. This Schweitzer quote will help explain the symbolism of boulders:

“Anyone who proposes to do good must not expect people to roll stones out of his way, but must accept his lot calmly if they even roll a few more upon it. A strength which becomes clearer and stronger through its experience of such obstacles is the only strength that can conquer them.” -Albert Schweitzer

Throughout the initial Fellowship year, Fellows are reminded of this quote as they conduct their Schweitzer Community service projects, attend graduate level classes and continue to live extraordinary and exceptional lives as our country’s future Leaders in Service.

The celebration this year was enhanced by the first presentation of the Schweitzer-Spirited Award to Neil I. Goldfarb for his humanitarian efforts in the region and for serving as the first program director for the Greater Philadelphia chapter of the ASF.

For more information about the Albert Schweitzer Fellowship – Greater Philadelphia Program, click here.

Monday, May 16, 2011

Guest Commentary: Humana CEO Charts Course to Better Health Care



Patrick Monaghan
Director of Communications
Jefferson School of Population Health

Mike McCallister didn’t mince any words as he addressed the capacity crowd gathered on May 12 in Connelly Auditorium for the 20th Annual Dr. Raymond C. Grandon Lecture.

“We have an absolute disaster on our hands if we don’t address population health,” the Humana, Inc. chairman of the board and CEO noted. “If we don’t get ahead of this, we’re toast.”

McCallister’s talk, “A Roadmap to Creating a Real Health Care System,” touched on the unintended consequences of health reform; how real problems persist and are getting worse in the wake of reform, and how behavior change – one person at a time – can help fix our broken system. He dispelled a myth or two about what is driving health care costs (hint: it’s not insurance company profit margins), while pointing (poking?) a not-too-indirect finger at America’s collective midsection.

We’re simply not taking care of ourselves and are therefore becoming an obese nation, McCallister said, leading to diabetes and other chronic illnesses.

This came as no surprise to the health care professionals gathered for the lecture. What was surprising, perhaps, were a series of pilot programs put into place by Humana to address the issue within its own ranks. The goal is “to help people achieve lifelong well-being.” Based on some numbers disclosed by McCallister, it seems to be working at Humana.

The “Well-Being Pilots” introduced to Humana associates include:

• Personal Health Score:
- Purpose: Provide objective clinical data coupled with actionable information to drive health improvement
- Results: More than half (55%) of associates improved their individual score

• Personal Well-Being:
- Purpose: Improve participants’ sense of their own overall well-being
- Results: After five months, associates’ “thriving” self-assessment increased from 26%to 41% and “suffering” decreased from 10% to 6%

• The BiggestLoserClub.com:
- Purpose: Deliver a social, mobile and virtual weight loss pilot for associate participants who have a BMI ≥ 28 and a desire to adopt healthy behaviors
- Results: Total pounds lost for all members = 3,474.40 lbs.

• Win, Place, Show Me The Money:
- Purpose: To understand the efficacy of financial incentives in facilitating behavior change and healthy weight maintenance relative to weight loss over time
- Results: Total net weight loss across all participants = 8,657.81 lbs.

McCallister’s talk – and the pilots he outlined – received rave reviews from Thomas Jefferson University Panel Reactors Janice Burke, Rebecca Finley and Mary Schaal. They liked the idea of such programs, designed to “make healthy things fun and fun things healthy.” Such ideas need to take root across the country in order for real change to occur, noted Mary Schaal – a real health care revolution, if you will.

We’d all love to see the plan.

Wednesday, May 11, 2011

Humana CEO Mike McCallister to visit JSPH on 5/12/11



The Jefferson School of Population Health plays host to a very special guest this Thursday when Humana CEO Mike McCallister visits campus to speak at the 20th Annual Dr. Raymond C. Grandon Lecture.

During Mike’s tenure as CEO, Humana has gained a reputation as the industry’s leading consumer company, leveraging innovative products, processes and technology to better serve more than 10 million health plan members nationwide.

As befits an industry leader, Humana is well positioned to be responsive to the changing demands in this era of health reform as they transform their offerings to focus on prevention and wellness. The company has already begun implementing pilot programs in accountable care; I’m looking forward to hearing some of Mike’s insights on how ACOs will move from the conceptual phase to real-world application.

Moreover, Mike has personally met with President Obama to discuss health reform. It’s an honor to host someone who has the President’s ear on this key topic and we here at JSPH are thrilled and looking forward to Thursday. Hope to see you there!

The 20th Annual Dr. Raymond C. Grandon Lecture, “A Roadmap to Creating a Real Health Care System,” is scheduled for noon to 2 pm Thursday, May 12 in Connelly Auditorium in the Dorrance H. Hamilton Building, 1001 Locust Street, Philadelphia.