Guest Commentary: Advocating on Capitol Hill

Jeffrey A. Nafash

Skepticism. Nervousness. Inferiority. These are all words that came to my mind when I prepared to venture to Washington, DC to advocate for an issue on Capitol Hill. Who am I? What do I know about issues? Why would my Senator or Representative want to hear what I have to say?

But, that is just it. I do have a voice. I do have an opinion. And, what I have to say matters.

During the weekend of March 9, I was fortunate enough to be an attendee at the Mid-East Regional Conference for the United Nations Association of the United States of America (UNA). UNA members from Pennsylvania and neighboring states came together and spent all weekend preparing for an advocacy visit on Capitol Hill and learning about the needed support for the United Nations. On Monday, teams of advocates marched to their Congressional representatives’ offices and made appeals for support of the United Nations.

The “ask” (what you are posing to your legislator to support) that we had on these particular Hill visits was for the United States Congress to have continued support for the United Nations and their efforts around the world, specifically to maintain funding for necessary programs, ratifying treaties, such as the Convention on the Law of the Sea. These are key issues that our leaders need to be made aware of!

As a Jefferson Master of Public Health Student, I was surprised at how well I was prepared to talk about Global Health issues as they pertain to the United Nations. Thanks to two classes I’m taking this semester – Public Health Policy and Advocacy, and Global Health – I knew the issues and felt prepared to share my stories. We live in a great nation, which has power on the international stage, and need to compel our leaders to ensure our stance in the future. For example, can you imagine a day where American support and funding to the United Nations is either shrunk or completely defunded? The implications would be dire; the United Nations is a great peacekeeping body on the Earth. The United States’ national security and influence in international issues would become a figment of the past.

To my classmates, friends, and the Jefferson community, I would suggest that you become an advocate. Whether you agree with my trip to Capitol Hill or not, pick what interests you and be a voice. Note that not all advocates are going to Capitol Hill and meeting with our Nation’s leaders. We live in a great city that is ripe with issues to be addressed by our local, city government, and at Jefferson we have the support and resources to make a difference.

Jeffrey A. Nafash is a student in the Master of Public Health Program at the Jefferson School of Population Health.

WHYY RADIO TIMES with Marty Moss-Coane

I’m very much looking forward to Wednesday, March 28th at 10am, when I will be a guest on the acclaimed NPR program Radio Times with Marty Moss-Coane. The show is timed to follow this week’s testimony in the US Supreme Court regarding the constitutionality of health reform (known as the Affordable Care Act), particularly the individual mandate to purchase health insurance. Joining me will be the constitutional scholar Professor Theodore Ruger from the University of Pennsylvania and one of the nation's top political reporters, Dick Polman.

Although I don’t have the expertise to comment as to the constitutionality of the individual mandate, without it we cannot cover an additional 32 million Americans who do not currently have health insurance – it is really that simple. Also, the conversation about the mandate just obfuscates the real issues – we need to rationalize the approach to medical care by paying for value, not volume, reduce medical error and coordinate care. Most importantly, we need to practice population health by engaging in more preventive care and create incentives to change unhealthy behaviors. It promises to be an interesting dialogue…I hope you will have an opportunity to listen, and perhaps call in to share your views.

DAVID NASH

Guest Commentary: Reflecting on The Twelfth Population Health and Care Coordination Colloquium

Paul Terry, PhD

There were two intrepid features of The Twelfth Population Health and Care Coordination Colloquium that I found refreshing. First, the notion that population health and care coordination leaders can leave their respective worlds to present each other with a cogent case for better integration certainly is timely.

As much as one presenter joked that an ACO is an HMO misspelled, I’d venture that most who chose this conference came with an abiding belief that improving population health while reforming health care delivery are overlapping, if not mutually dependent, movements that will require the kind of transformative leadership Dr. Nash brought to this discussion. The ACO movement may eventually be viewed as the turning point for collaboration between public health and medically trained leaders.

Second, I appreciate that this was a colloquium, Latin for discussion, not a conference. An open sharing of ideas will be required if we are to discern what components of an ACO can foster innovation and avoid ACOs becoming HMOs warmed over.

My presentation at the colloquium focused on the role of financial incentives and the policy issues emanating from section 2705 of the health reform act, which provides for medical premium reductions for employees attaining a health standard such as a healthy BMI. I’ve published elsewhere on “progress based incentives” which StayWell believes represent a fairer and more effective strategy for supporting behavior change than the outcomes-based approach enabled by this new legislation.

It was easy to exchange ideas about the best use of incentives for employer health management programs in my session because we had examples to work from provided in presentations earlier in the day. The medical director from Perdue Chicken disavowed use of incentives in his employee health programs and asserted that his 80% participation rates were a function of smiling nurses and a caring, high-touch approach. He acknowledged the chickens in their “disassembly plants” weren’t quite so lucky. In contrast, a human resources leader from ARAMARK food services described how incentives increased health assessment participation rates to 60% from 20%. Though she didn’t explain whether they based their communications on behavioral economics principles, their employee communications about the loss of premium credits for non-participants suggest they were playing to the principles of “a bird in the hand” and “loss aversion” that I explained in my session.

Finally, Johnson and Johnson, the “granddaddy” of wellness programs, showed how their $500 incentives were yielding consistent 80-85% participation in a range of wellness offerings, which was up from the 26% participation they experienced in the years prior to incentives. For a deeper dive into the science behind best practices in the use of incentives, StayWell has produced a white paper on “The Role of Incentives in Improving Engagement and Outcomes in Population Health Management.”

Each of these progressive company presenters had inspiring success stories to share backed up with impressive metrics. But what I found most attention-getting about these presentations was that they were featured as examples of employers building a “culture of health.” Yet, all of the metrics shared were traditional participation rates, biometric outcomes, or other measures related to individual choices.

We lack a common language for describing our workplace culture of health, not to mention tools for measuring the same. Therein resides a challenge for those of us ready to embrace Dr. Nash’s daunting idea that population health can intersect with care coordination. Culture is defined by how we communicate with each other, our daily rituals, foods we eat, how we treat each other, and what we value and believe in, just to name a few potential measures.

We’re getting increasingly sophisticated about designing individual-level incentives to increase engagement. And as the ACO movement foretells, we’ll continue innovating with pay-for-performance systems and cost-sharing schemes. Our greatest challenge yet will be to define a “culture of health,” invent metrics that quantify its progress, and create incentives that compel organizations to build environments that inspire and support healthy living.

Paul Terry, PhD, is CEO of StayWell Health Management.

Guest Commentary: The Twelfth Population Health & Care Coordination Colloquium

Patrick Monaghan
Director of Communications
Jefferson School of Population Health

If there was one unifying theme to the Twelfth Population Health & Care Coordination Colloquium, hosted in Philadelphia this week by the Jefferson School of Population Health, it’s that patient-centered care appears to finally be at the heart of the way healthcare is delivered in this country. And if it’s not, it’s certainly on the way.

Patient-centered care, and the systems that are helping bring it about, were on the lips of many presenters, from Ed Wagner, Founding Director of the MacColl Institute for Health Innovation, who helped open the Colloquium on Monday afternoon, to Michael B. McCallister, Chairman and Chief Executive Officer, Humana, Inc., whose keynote, Reinventing Health Care: From Treating Sickness to Creating Well-Being, kicked off Day Two of the three-day conference.

Dr. Wagner spoke of medical practices focusing on methods to help patients become effective self-managers in controlling chronic diseases such as hypertension and diabetes, and the key role of building effective clinical teams who can instill confidence in patients and their families to take on a more prominent role in their health care.

James E. Pope, Vice President and Chief Science Officer for Healthways, released results of the Gallup-Healthways Well-being Index for 2011 on Monday afternoon. The index measures which state’s residents have the best sense of overall well-being, based on physical health, happiness, job satisfaction and other factors that affect quality of life. The results? Hawaii (big surprise) came out on top. West Virginia, which ranked at the very bottom, has some work to do in terms of well-being.

Another highlight was the talk given by Dr. Richard Baron, who left his Philadelphia practice last year to join the Center for Medicare & Medicaid Innovation in Baltimore. Dr. Baron’s work is providing solid evidence that when medical practices follow the coordinated care model established by Medical Homes and Accountable Care Organizations, the results point toward better patient outcomes.

Here at the Jefferson School of Population Health, plans are already underway for the Thirteenth Population Health & Care Coordination Colloquium.
The hope here is that, by this time next year, patient-centered care shows even more evidence to becoming the rule, not the exception.