Category Archives: Health policy

Facing growing health care costs, Mass. tries containment #ahcj13

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Priyanka Dayal McCluskey

About Priyanka Dayal McCluskey

Priyanka Dayal McCluskey is a business reporter at the Worcester (Mass.) Telegram & Gazette. She is attending Health Journalism 2013 on an AHCJ-Healthier Beat Fellowship, which is supported by The Leona M. and Harry B. Helmsley Charitable Trust.

Massachusetts is famously ahead of other states when it comes to health insurance coverage. Ninety-eight percent of Bay State residents have insurance.

But the state is also way ahead in another area: health care costs. The cost of care is the highest per capita in the country and, consequently, the world, according to Andrew Dreyfus, president and CEO of Blue Cross Blue Shield of Massachusetts.

Insurers, providers and government regulators have been working, with some success, to curb the rate of health care costs in Massachusetts. Continue reading →

Higher quality health care at a lower cost: challenging and achievable #ahcj13

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Anna Gorman

About Anna Gorman

Anna Gorman is a staff writer at the Los Angeles Times. She is attending Health Journalism 2013 on an AHCJ-California Health Journalism Fellowship, which is supported by The California HealthCare Foundation.

Working together in teams and investing in primary care can improve health outcomes and reduce spending in the American health care system, a panel of experts told a packed room at Health Journalism 2013 Friday afternoon.

“You cannot tell me that better care and lower costs don’t go together because I’ve seen it,” said Donald Berwick, former administrator of the Centers for Medicare and Medicaid Services. The best examples come from communities not policymakers, he said during the session entitled, “Controlling health care costs while improving quality.” And they inevitably involve patients, doctors, nurses and other providers working together, he added.

Berwick cited a healthcare project in Alaska, where team-based care has resulted in 50 percent fewer hospital bed days, 53 percent fewer emergency department admissions and 65 percent fewer specialty visits.

Berwick said the fact that the U.S. health care system continues to provide low value at high-cost is a “crisis” and people are scrambling to figure out how to fix it. Among the biggest problems that have led to waste in the health care system are pricing failures, uncoordinated care and unnecessary treatment, Berwick said. “More is not better,” he said. “We are going to have to change the way we think.” Continue reading →

Mass. governor welcomes journalists, focuses on cost containment #ahcj13

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Larry Dreiling

About Larry Dreiling

Larry Dreiling is a senior field editor at the High Plains Journal. He is attending Health Journalism 2013 on an AHCJ-Rural Health Journalism Fellowship, which is supported by the Leona M. & Harry B. Helmsley Charitable Trust. Follow him on Twitter at @ldreiling.

Photo by Len Bruzzese

Expanding access to health care and improving quality while containing costs are issues Massachusetts Gov. Deval Patrick says are central to his administration.

Patrick delivered the opening welcome to members of the Association of Health Care Journalists on March 14 in Boston, where the group is holding its annual meeting, Health Journalism 2013.

The governor called the 2006 Massachusetts health insurance reform law a success in that it gives residents nearly universal care, with more businesses offering health care and nearly 90 percent of residents having a primary care physician.

He said more cancer screenings are being performed than before while visits to emergency departments have decreased.

“We are healthier because of it,” Patrick said. “Women, minorities and low-income people have experienced the biggest health improvements, but it’s been true, really, across the board.”

Continue reading →

Insurance co-ops faded from view but still ripe for analysis

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Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Former AHCJ president Trudy Lieberman, in a CJR “Second Opinion” post, recently pointed out a story that was largely untold– and put it in a helpful national and political context for those of you who may still tell it. That’s the “incredible shrinking insurance co-ops.”

The co-ops’ funding was slashed in the New Year’s fiscal cliff deal. With all the other economic and political aspects of the “cliff,” the co-op story was not widely reported, including in some of the states where they may have made a difference.

Why does it matter? Remember the long battle in 2009-10 over the “public option?” The Consumer Operated and Oriented Plans were the alternative – arguably a sort of consolation prize – to the public option. The co-ops were a way to have a nonprofit health plan alternative to the largely private commercial plans expected to dominate the exchanges.

Lieberman quotes John Morrison, Montana’s former insurance commissioner, now president of the National Alliance of State Health Cooperatives, as saying the co-ops were scrapped not so much to save a few billion dollars for the fiscal cliff deal but as “a gift to the insurance companies” that didn’t want to compete with them. They were expected to have been particularly useful in giving small businesses more choice in rural areas dominated by one or two health insurance carriers. Continue reading →

Aging adults face universal issues of access to care, poverty, discrimination

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Judith Graham

About Judith Graham

Judith Graham (@judith_graham), a Colorado-based freelancer, is AHCJ’s topic leader on aging, and as such curates related material at healthjournalism.org. She welcomes questions and suggestions on aging issue resources and tip sheets at judith@healthjournalism.org.

The aging of the population is a global trend, and one that will affect developing countries even more than the United States and Europe.

Judith GrahamJudith Graham (@judith_graham), has served as AHCJ’s topic leader on aging for more than a year. She has been vital to our goal of building the best resources for journalists on this topic. We thank her for her service and look forward to following her and continuing to learn from her.

If you are interested in being the new topic leader on aging, read more about the position and how to apply.

I wrote about this for The New York Times’ New Old Age blog, using as a hook the publication of a major report on the topic from the United Nations Population Fund.

That study is worth reading if only to understand how the issues we’ve been talking about on AHCJ’s aging website are playing out across the world.

It changes your perspective as a reporter when you realize this beat isn’t limited to what’s going on in your city or your state: It concerns an amazing, unprecedented development – the lengthening of the human lifespan – occurring everywhere on this planet.

Here, we’ve been discussing key problems that older people face, such as ageism, age discrimination and elder abuse. When the U.N. Population Fund asked an international sample of 1,150 adults age 60 and above about their experiences, this is what they said:

  • 67 percent said they believed age discrimination affects older people
  • 37 percent said they had experienced age discrimination personally in the last year
  • 43 percent said they were afraid of personal violence
  • 49 percent said they were treated with respect. Flip this around and it means more than half indicate not being treated with respect.

That last statistic brings a knot to my throat.

We’ve also talked here about what can happen when older people lose jobs, see their nest eggs shrink, delay retirement, and struggle with insufficient incomes. The fact of the matter is that poverty isn’t good for any older person’s well being or health, whether she lives in the United States or Bangladesh.

This is what people 60 and older said when asked about this topic for the UN survey:

  • 66 percent wanted to work for money, if only they had the opportunity
  • 33 percent said they had paid employment in the last month
  • 53 percent found it hard or very difficult to pay for basic services
  • 47 percent said they found themselves “always” or “very often” worried about problems with money
Core Topics
Health Reform
Aging
Oral Health
Other Topics

Hardship. That’s what characterizes the life of too many older people across the world.

Adding to that is a substantial burden of poor health and disability that I mention in my New York Times’ piece but that’s worth repeating here. Again, from the UN survey:

  • 44 percent of adults age 60 and older say their health status is fair
  • 22 percent say their health status is bad or very bad
  • 34 percent say it’s difficult or very difficult to access health care when they need it
  • 16 percent say they are very often or always lonely

You’ve probably heard it said, as I have, that how we treat the most vulnerable among us – children, the severely disabled and the elderly – is a measure of who we are, both individually and as a society.

The perceptions of aging documented in the United Nations survey pose a challenge. Is this good enough, the way we’re treating the oldest among us? Can we hold our heads high and feel that we have done all we should?

Personally, when I write about these issues I hope to contribute, in some small measure, to sparking these kinds of questions in peoples’ minds as well as thoughtful policy exchanges.

It’s been a pleasure serving as editor of the aging site this past year. As some of you may know, I’m stepping down as editor to pursue other endeavors. Good luck to all of you.

Related

AHCJ seeks its next topic leader on aging; learn more

Hospitals to workers: Get flu shot or get fired

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Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In a story that could be replicated in many areas, The Morning Call‘s Tim Darragh writes that hopitals, both locally and nationally, are pushing hard for workers – both medical and otherwise – to get flu vaccines, as the Joint Commission moves toward stiffer requirements and CMS threatens to cut reimbursement rates for non-compliant hospitals.



Photo by Lance McCord via Flickr

Some of the Lehigh Valley region’s hospitals…. are mandating employees get flu vaccines if they have contact with patients — even if the employees don’t want the shots. If they don’t comply or get a valid exemption, they will be fired.

The list of staff affected by the policy is broad. It includes not only doctors and nurses and others directly involved in patient care but also housekeeping and maintenance workers.

Across the country, the stricter regulations seem to be making a difference, Darragh reports. A health system in Ohio has already issued termination notices to non-vaccinated workers, and even civil rights advocates known for taking the workers’ side admit that it is difficult to argue that hospital workers shouldn’t be vaccinated.

The ever popular (and quotable) Dr. Arthur Kaplan agrees.

Without greater compliance, the work environment won’t attain a level of immunity that will provide sufficient protection to the sick, said Dr. Arthur Caplan, a bioethicist at New York University’s Langone Medical Center. “You don’t get the ‘herd immunity’ until you hit 90 percent,” said Caplan, a proponent of mandatory vaccinations.

Tips for finding local stories about health reform

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Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Last week, Stacey Singer, of The Palm Beach Post, and I led a workshop on  “Ten Local Health Stories” (actually we sort of went quite a bit over the “10″ limit) for the Excellence in Journalism (EIJ12) conference, sponsored by SPJ and RTNDA in Fort Lauderdale. We’ve posted my overview, Stacey’s very hands-on and helpful local take, and a resource list (adapted from, but not identical too, the resources we’ve been assembling for more than a year on the AHCJ Health Reform core topic pages).

Core Topics
Health Reform
Aging
Oral Health
Other Topics

We also wanted to thank the Alliance for Health Reform for shipping to Florida a box of its very handy resource guide . (Disclosure: I wrote one of the overview chapters, although wasn’t involved with the more recent updates to it.)

The session went on for more than an hour, so I’m not going to try to describe it all, but wanted to just share a few points we made: Continue reading →

Coming soon: Three new films about health care

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Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

We know of at least three new movies coming out on health care – overtreatment, undertreatment, cost, quality, the uninsured, the underinsured, the safety nets.  We haven’t seen them all so we can’t vouch for them but they all sound promising. We’ve interviewed the people who made one of the films and will post that soon. In the meantime, these links take you to pages that tell you a bit about each film and where you can see it in your community or on one of your many “devices.” Continue reading →

Business groups may change tune on Medicaid expansion

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Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

We’ve all been reporting on how  health care providers – particularly safety nets and public hospitals – are going to be pushing their states to go ahead with the Medicaid expansion under the health law.  But there’s a whole other constituency that I hadn’t even thought of until a source pointed it out to me: business.  Particularly groups that represent businesses with many low-wage workers, like retailers or restaurants.

Core Topics
Health Reform
Aging
Other Topics

Sound counterintuitive? These are the same groups that are pushing for  repeal or at least watering down of the Affordable Care Act. Why are they going to want Medicaid expansion?

Employers with fewer than 50 employees aren’t obligated to cover their workers in 2014.  Some of those who do may qualify for tax subsidies. But employers with 50 or more employees do have to cover them – and the coverage must be affordable to the worker.  Otherwise the business faces penalties. (Here’s a summary of how the law affects employers from the National Association of Insurance Commissioners.)

But if the worker qualifies for Medicaid – or expanded Medicaid which means an income up to about $14,800 right now, probably more by 2014 – there is no penalty to the worker. So with expansion, a worker making  just under $15,000 (133 percent of federal poverty rate) gets  Medicaid. Without expansion, that same worker with the same income  is on the employer’s tab. Continue reading →

Candidates to answer questions on science, policy

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Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

President Barack Obama and presidential candidate Mitt Romney will answer a series of questions about science and related policy. The questions, developed by ScienceDebate.org with the help of a group of science and engineering organizations.

While all of the questions – and their answers – will be of interest to health journalists, here are five that are directly related to health:

Pandemics and Biosecurity. Recent experiments show how Avian flu may become transmissible among mammals. In an era of constant and rapid international travel, what steps should the United States take to protect our population from emerging diseases, global pandemics and/or deliberate biological attacks?

Food. Thanks to science and technology, the United States has the world’s most productive and diverse agricultural sector, yet many Americans are increasingly concerned about the health and safety of our food. The use of hormones, antibiotics and pesticides, as well as animal diseases and even terrorism pose risks. What steps would you take to ensure the health, safety and productivity of America’s food supply?

Fresh Water. Less than one percent of the world’s water is liquid fresh water, and scientific studies suggest that a majority of U.S. and global fresh water is now at risk because of increasing consumption, evaporation and pollution. What steps, if any, should the federal government take to secure clean, abundant fresh water for all Americans?

Science in Public Policy. We live in an era when science and technology affect every aspect of life and society, and so must be included in well-informed public policy decisions. How will you ensure that policy and regulatory decisions are fully informed by the best available scientific and technical information, and that the public is able to evaluate the basis of these policy decisions?

Vaccination and public health. Vaccination campaigns against preventable diseases such as measles, polio and whooping cough depend on widespread participation to be effective, but in some communities vaccination rates have fallen off sharply. What actions would you support to enforce vaccinations in the interest of public health, and in what circumstances should exemptions be allowed?

See the full list of questions on the ScienceDebate.org website. The group expects to have the candidates’ answers within a week. Follow @shawnotto, co-founder of ScienceDebate.org, on Twitter or join their Facebook group to find out the answers.  An email from the organization also advised signing up on the website for early notification, but that web page doesn’t say anything about notification; it does require your name and mailing address and has a box that you must uncheck if you don’t want to be listed on the site as a supporter.