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Expansion of Medicaid – What REALLY Matters?

Quality care diceA new randomized and controlled clinical trial provides fascinating information for Iowa (and other states) to review while policymakers consider whether or not to expand Medicaid. I highly encourage you to read this study, as it helps frame the real issues we must focus on as a state and country.

Published in The New England Journal of Medicine, ‘The Oregon Experiment – Effects of Medicaid on Clinical Outcomes,’ study reviews the potential effects of expanding Medicaid to impact healthy outcomes when health coverage becomes available to low-income adults. As you have correctly guessed, the petri dish for this experiment was the state of Oregon.

When expanding Medicaid for the poor, the primary benefits can be lower depression rates, greater health-care utilization and the elimination of catastrophic medical expenses for those who acquire the insurance. According to the study’s primary author, Katherine Baicker, a Harvard health economics professor, “The purpose of insurance is not to just get you access to healthcare, it’s to protect you from financial ruin if you have an expensive condition.” Dr. Baicker was one of many speakers at Harvard’s “Forces of Change” series on healthcare that I attended in Boston a few years back…she is a wickedly smart and a concise researcher.

In Iowa, a great debate has erupted (mostly along partisan lines) about whether to expand Medicaid or pursue a new but untested plan offered by Governor Branstad. Both approaches have supporters and critics for a number of reasons – arguments founded on facts, emotion and, you guessed it, politics.

So what is the truth?

I don’t pretend to have the answer. However, the Oregon Experiment does give additional insight on the implications for any legislative activity enacted in this state. It is common knowledge that having insurance coverage allows us to seek medical care that will make us healthier and more productive…and we won’t go bankrupt. We also know that having insurance provides each of us a peace of mind, it certainly does for me. Finally, having insurance improves access to healthcare providers and services. Enough said, right?

Not so fast – after learning of this new study, we may need to reassess this logic and maybe qualify it a bit more. The study findings consistently support the importance of delivering QUALITY health care to our population. To borrow a quote from Dr. Ashish Jha, another wickedly smart physician and researcher at Harvard, “The explanation is simple. It’s not about access to healthcare; it’s about access to high quality healthcare.” Baicker’s recent study certainly supports Dr. Jha’s conclusions.

We cannot expect to have a healthier population by merely providing insurance to gain access to necessary care. In fact, there is evidence that shows doctors who spend a great deal of their time serving Medicaid recipients deliver lower-quality care. Insurance will unlock the door to gaining access to care, but having this access does not ensure we receive quality care that will improve our health.

The Affordable Care Act (ACA) attempts to improve access to care for those least fortunate in our society – and most everyone agrees that this is important. However, the ACA does little to control spiraling costs and improve the quality of care being delivered. By adding more insureds into an already dysfunctional, high-cost ‘system,’ will only make our health costs considerably greater and even more uncontrollable over time.

It’s like rearranging the chairs on the Titanic.

Improving the health of our population means that we must pursue logical steps to ensure that high-quality care is being delivered at a reasonable cost. Gaining access to care is not enough…we must commit to having high-quality care accompany this access. Dr. Jha articulated this point very well: “Quality is the link between healthcare services and better health outcomes.”

It is time to make sure this healthcare ship is traveling in the right direction. It’s what we all should demand…it’s what we all deserve!

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Happy 15th Birthday!

Birthday Cake for 2013 Iowa Employer Benefits Study

Our annual Iowa Employer Benefits Study© is about to take place. I’m really looking forward to this year’s survey for these important reasons:

  • This will be the 15th Study conducted since we started this particular survey in 1999. Some ‘birthdates’ are celebrated with more meaning than others…and 15 is a significant amount of time to show trending patterns and establish a credible track record!
  • Three new modules of questions will be added in this year’s Study.

1. The first module will gauge whether employers will keep their health plans (this would apply to those employers with 50+ employees). In addition, we will determine how prepared employers are regarding health reform requirements. This module is extremely relevant because employers will be making decisions for 2014, the first year most health reform provisions will take effect.

2.  The second new module will be added that will determine how Iowa employers view their local community health care providers – specifically hospitals and physicians. Modules two and three will begin to address the upstream portion of ‘Our Health Care River.’ Our newly established company, Heartland Health Research Institute, will then begin to tackle the implications of the results from these two modules.

In this module, employers will grade hospitals and physicians on 11 key issues, including: transparency of costs, outcomes, coordination of care, concern for patient satisfaction, ability to engage patients, and so on. In addition, employers will be asked to measure their TRUST of these providers. Measuring trust is extremely important for a number of reasons. David Shore, Founding Director of the Trust Initiative at Harvard School of Public Health, once said that ‘trust is the currency of commerce.’

To learn more about the trust issue in health care, please see my earlier blogs:

The Currency of Commerce (Part 1)
Trust – A Distinguished Healthcare Trait (Part 2)
Trust – Now is a Good Time (Part 3)

3.  The third module will address the type of data needed by employers to manage employee health costs. It will help identify who should have the responsibility to supply the primary source of this data to employers and their employees (i.e. health insurers, government or health providers – such as hospitals or physicians.) In addition, we will learn how knowledgeable employers are regarding the Iowa-based web resources currently available on our Iowa hospitals.

Rest assured, we will continue to ask our core questions about the benefit components being offered by Iowa employers. After all, this is the initial reason we began this groundbreaking Study 15 years ago. One thing I have learned over the years of conducting this Study is the importance of constantly monitoring the marketplace — asking fresh questions and addressing new and potential trends.

If your organization is randomly selected to participate in this year’s Study, we highly encourage you to share in our celebration by participating in the survey. Here’s to adding the 15th candle to our cake!

To learn more, we invite you to subscribe to our blog.

A New Approach: Heartland Health Research Institute (Part 2 of 2)

HHRILast week’s blog, “A Bystander – No More!” has set the table for this week’s blog.

I have recently founded another organization with the vision to advance the transparency of facts through objective research and innovative solutions in the delivery and payment of health care. Our mission is to provide meaningful health care information to improve decision-making for consumers, employers, health care providers, policymakers and the general public.
The name of our new organization is Heartland Health Research Institute (HHRI).

Dr. Yogesh Shah

Dr. Yogesh Shah
Associate Dean of Global Health
Des Moines University

HHRI is a collaboration between Dr. Yogesh Shah and me. Dr. Shah serves as associate dean for Global Health at Des Moines University (DMU) – a position created to establish and increase international rotation opportunities, medical service sites and other global health experiences sought by DMU students. His passion includes improving the health of people around the world.

Dr. Shah is triple-board-certified in family medicine, geriatrics and hospice and palliative care. He is very involved through the World Health Organization (WHO) and was instrumental in making Des Moines a member of the WHO network of age-friendly cities. Dr. Shah led the creation of the Heartland Global Health Consortium, a collaboration of Iowa educational learning opportunities for students. He was awarded a Fulbright scholarship to develop a palliative care program in Rwanda. Dr. Shah was born in Mumbai, India.

Dr. Shah and I met a year ago while jointly working on a research project for Capital Crossroads. Through this interaction, we realized our passions about health care were very similar, and our seemingly disparate backgrounds are actually complimentary to one another. It was through our discussions that HHRI was conceived.
So what will HHRI do?
An ongoing need exists for objective, unbiased information regarding the local health care system, so that decisions affecting our system will be based on verifiable facts. HHRI was founded to conduct research and provide education focusing on a broad spectrum of health care issues. Topics covered are specifically from the patient’s perspective and measure patient confidence and trust in the health care system today and into the future.
HHRI will function strictly in an objective and unbiased manner and not as an advocate or opponent for any position. Frankly, we are not about advancing any particular political agenda, but rather, advancing factually-based evidence that will attempt to make sense out of this very complicated health care world in which we live. Topics addressed by HHRI may include:

  • Transparency in costs and outcomes
  • Quality of health care
  • Patient engagement and activation
  • Palliative care
  • End-of-life care
  • Employment-based health benefits
  • The value of health coverage
  • Population-based health
  • Attitudes toward health care reform
  • Identifying and understanding the unintentional consequences of public policies
  • Other tangential issues

HHRI is a knowledge-based organization serving Iowa and other Midwestern states, and will focus on:

  • Data to reveal major health challenges and opportunities.
  • Credible, reliable and objective research for decision-makers, policymakers, employers, media and the general public.
  • Exploring and presenting key health care issues with thought leaders from all sectors.

We want to provide understandable information that can be used to solve the problems our health care system suffers from today. Our work must provide clear results that will be applied to everyday decision-making by employers, employees, policymakers, media and the general public. Having a healthy, robust workforce and population is critical to the economy of Iowa and other Midwestern states.

In the future, I will continue to monitor the downstream of Our Health Care River using the annual Iowa Employer Benefits Study. With the advent of HHRI, we will now be able to move upstream and pursue critical issues inherent within our health care world.
HHRI is new and fresh and created to make a real difference. You will be learning much more about our work in the months ahead! Should you have further questions about HHRI, I encourage you to contact Dr. Shah or me.

To learn more, we invite you to subscribe to our blog.