The Healthcare Policy Podcast ® Produced by David Introcaso

Listen NowWhat accounts for so called patient compliance or adherence or why is it the case physicians and other providers are frequently unable to successfully engage their patients.  Why is it the case, for example, that patients adhere to highly toxic regimens of such as chemo therapy and not to more tolerable drugs such as statins.  What explains adherence or non-adherence?         During this 22-minute conversation Dr. LaFountain explains why, using her phrase, the "epidemic of non-adherence" persists. She discusses the "importance of differentiation," the application of "cognitive profiling" or "cognitive restructuring," and provides examples using treatments for ADHD, breast cancer and diabetic patients at the Cleveland Clinic.Dr. Andrea LaFountain is CEO of Mind Field Solutions Corporation, a firm specializing in the application of cognitive neueroscience to health behavior and patient engagement.   Prior to establishing Mind Field, she worked for AstraZeneca Pharmaceuticals leading consumer research and analytics for their oncology portfolio.   Before moving to the US, Dr. LaFountain was a Lecturer at The University of Liverpool.   She is a fellow of the American Psychological Association and the British Psychological Society and a scientific reviewer for the International Society of Pharmaco-economic Outcomes Research.  Dr. LaFountain earned her Ph.D. in pre-frontal cortex executive functioning at Imperial College, London.  For information concerning Dr. LaFountain's work go to: http://www.amazon.com/How-Patients-Think-Science-Based-Engagement/dp/069266095X. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowSince, in part, April is recognized by DHHS as National Minority Health Month (this year's theme is "Accelerating Health Equity in the Nation") it is thoroughly appropriate to discuss Professor Daniel Dawes's recent work, "150 Years of Obamacare."  Professor Dawes's work begins with a discussion of efforts since the Civil War to reform national health care policy beginning with the 1865 Freedmen's Bureau Act.  The work moreover provides an accounting of his and others efforts to lobby successfully for health equity provisions in passing the 2010 Affordable Care Act ( ACA).  During this 31-minute conversation, Professor Dawes discusses passage of the ACA, i.e., "Obamacare,", e.g., Republican opposition to the legislation and moreover the importance of the sixty plus health equity-related provisions in the legislation and what are his priorities for furthering health care equity or reducing disparities in health care delivery and outcomes - that sadly remain pronounced.   Attorney and Professor Daniel E. Dawes is the Executive Director of Health Policy and External Affairs at the Morehouse School of Medicine and a Lecturer within Morehouse's Satcher Health Leadership Institute and the Department of Community Health and Preventive Medicine.  He founded and chairs the Working Group on Health Disparities and Health Reform and is the co-founder of the Health Equity Leadership and Exchange Network (HELEN).  Previously, Professor Dawes held positions with the Premier Healthcare Alliance, the American Psychological Association and served on the Senate HELP (Health, Education, Labor and Pensions) Committee under Senator Edward Kennedy.   He is the recipient of numerous award including the Congressional Black Caucus Leadership and Advocacy Award.  He earned his JD from the University of Nebraska and his BS from Nova Southeastern University.For more information concerning Professor Dawes's work, go to: https://jhupbooks.press.jhu.edu/content/150-years-obamacare.   This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowAs a follow up to my April 1st conversation with Jim Gera concerning bundled payments, during this podcast Dr. Richard Morel discusses Medicare's other major payment reform program, Accountable Care Organizations (ACOs), or WESTMED Medical Group's three year experience as a Track 1 ACO.   The Medicare ACO program is a creation of the 2010 Accountable Care Act and participation in the program began in 2012.   Currently, there are 434 ACOs (over 90 percent participating in the "no risk" Track 1) caring for approximately 7.5 million Medicare beneficiaries.  The program to date has been a mixed success.  After two performance years (2013 and 2014) only 25 percent of participants have been successful, i.e., have earned shared savings.  (Performance year three or 2015 performance will be made known this September.)  CMS is currently in the process of revising how the agency calculates an ACO's reset financial benchmark.  It is anticipated these changes will improve program performance, or improve both provider interest in participating (or continuing to participate) in the program and participant success in earning shared savings.   During this 21-minute conversation Dr. Morel provides an overview of WESTMED, explains the organization's interest in becoming a Medicare Shared Savings Program or ACO participant in 2013, WESTMED's experience under their first three year agreement, what explained their success, challenges they've found with the program, how the program could be improved and their expectations now as a second agreement period Track 1 ACO.Dr. Richard Morel is the Co-Medical Director of WESTMED Medical Group in Yonkers, New York.  Prior to joining WESTMED in 2008 Dr. Morel was in private practice affiliated with Columbia-Presbyterian Riverdale Hospital for 12 years.  Dr. Morel is board certified in internal medicine.  He received his medical degree from Columbia University College of Physicians and Surgeons, did his postgraduate training at Columbia-Presbyterian Medical Center and  received his masters of medical management from Carnegie Mellon.  He is a fellow of the American College of Physicians and a member of the American College of Physician Executives.  For information regarding WESTMED go to: http://www.westmedgroup.com/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowToday, CMS launched the agency's second bundled payment demonstration, a mandatory five-year initiative in approximately 800 hospitals nation-wide.  It's titled, the Comprehensive Care for Joint Replacement (CJR).  The CJR essentially reimburses hospitals a predetermined amount for a 90-day hip or knee surgical and rehab episode of care.  CMS is emphasizing hip and knee replacement surgeries because they account for the single largest Medicare dollar amount and highest percent of annual 30 day episode spending.  This demonstration follows CMS's voluntary Bundled Payment for Care Improvement (BPCI) demonstration that provides bundled payments for 48 care episodes (including hip and knee replacements) via four care model designs.  How successfully hospitals, orthopedic surgeons and various post acute providers manage these care episodes will be important if CMS is to better control Medicare spending growth.   (Listeners will recall I discussed moreover the theory of bundled payment arrangements with Harold Miller this past September 23rd.)  During this 29 minute conversation Mr. Gera provides and overview of Signature Medical Group and their orthopedic bundled payment work under both CMS's BPCI and CJR demos.  More specifically, he discusses how hip and knee replacement surgical patients are identified, how the bundled payment care team is assembled, how the care episode is manged, how quality is measured, profit sharing conducted and moreover principles his organization has developed to succeed under these capitated payment arrangements.  Mr. Jim Gera is the Senior Vice President of Business Development for Signature Medical Group, Inc., a multi-specialty group of physicians located in St. Louis and rural Missouri.   Among other related activities Mr. Gera co-authored an Advanced Payment Medical Accountable Care Organization application and a successful CMS Strong Start for Mothers and Newborns grant award.   Recently he has also served as a Chair for several CMS innovation grant reviews.  Mr. Gera's previous experience includes working with other physician group practices, in outpatient facilities and in managed care both in Medicare Advantage and Special Needs Plans.  Mr. Gera received his MBA from Southern Illinois University at Edwardsville.For more on CMS's CJR demonstration see:  https://innovation.cms.gov/initiatives/cjrFor more on Signature Medical Group see: http://www.signatremedicalgroup.com/  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowCalifornia has been long known for health care delivery and payment reform (think, for example, Kaiser Permanente).   With efforts nation-wide to better align health care quality and patient outcomes with reimbursement or savings efficiency, related efforts in California are carefully watched and studied.     During this 23 minute conversation Dr. Jill Yegian briefly outlines the work if the California Integrated Healthcare Association (IHA), provides an overview of the California healthcare payment reform landscape, discusses specifically IHA's value-based pay for performance work involving 10 health plans, 200 physician organizations and nine million Californians, discusses quality measurement including "resource use" and "total cost of care" and identifies lessons learned from IHA's activities.     Dr. Jill Yegian, is the Senior VP for Programs and Policy at the California Integrated Healthcare Association where she oversees IHA's work regarding care integration, performance measurement and reporting and payment innovation.   Previously, she co-directed the American Institutes for Research Health Policy and Research Group, a team of over 70 health services research professionals.   Prior still Dr. Yegian worked with the California Healthcare Foundation where her focus was on improving the state's healthcare financing and delivery system.  Dr. Yegian is the author of numerous peer-reviewed articles and is a frequent conference speaker.  She was graduated from the University of California at Berkeley with a Ph.D. in health services and she earned her undergraduate degree in human biology at Stanford. For more on IHA's work go to: www.iha.org This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowThe Medicare program, now in its 51st year, still does not cover oral/dental health care such as exams, X-rays, cleanings, fillings, tooth extractions and dentures.   (Medicare will cover an oral health procedure if it is incent to a serious accident or disease, for example, for surgery to treat fractures of the jaw or face or if you have oral cancer and need dental services necessary for radiation treatments.)  This is unfortunate when you consider for example: poor oral/dental health worsens overall health; less than five percent of older Americans have dental insurance of any kind; one-third of adults over 65 have untreated dental caries and over 40 percent have periodontal disease; the Affordable Care Act did not name adult oral/dental benefits as an "essential health benefit"; an overwhelming majority of adults believe dental coverage should be part of overall health coverage; for all of CMS's "innovation" demonstrations (now numbering well over 50) there are none that address improving oral/dental health for seniors; and, oral/dental health disparities are, according to the CDC, "profound."  During this 20-minute conversation Dr. Vujicic provides his assessment of the oral/dental health of American seniors, his understanding of why the Medicare program still does not cover routine oral health care and what can be done to improve access and (insurance) coverage of oral health for seniors or Medicare eligible individuals.Dr. Marko Vujicic is the Chief Economist and Vice President of the Health Policy Institute at the American Dental Association (ADA).  Prior to joining the ADA Dr. Vujicic was a Senior Economist at The World Bank and also a Health Economist with the World Health Organization in Geneva, Switzerland.  Dr. Vujicic is the lead author of the book, "Working in Health" and has authored additional essays and book chapters on various health policies.  He is published in the New England Journal of Medicine, Health Services Research, Health Affairs and other policy and scholarly journals.  Dr. Vujicic is also a visiting professor at Tufts University in Boston.   Dr. Vujicic earned his Ph.D. in Economics from the University of British Columbia and his undergraduate degree at McGill University in Montreal.For more on the work of the ADA's Health Policy Institute go to: http://www.ada.org/en/science-research/health-policy-institute This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowMuch of the health care industry's effort to improve health care payment and delivery centers around improving primary care. This is largely because Americans suffer more disease/disease burden throughout their life spans compared to individuals in other industrialized countries.   This therefore makes obvious sense since primary care is the foundation upon which an effective and efficient health care/medical care program is built.  When done well primary care promotes wellness, prevents disease onset, progression, exacerbation and prevents premature death.  Primary care also moderates the need for higher cost specialty care and improves population health.  For numerous reasons, not least of which is inadequate reimbursement, primary care delivery has been sub-optimal.   New models of primary care are emerging, one termed direct primary care (noted in the ACA under Section 1301 (A) (3) and now recognized in 13 states) is showing promise in improving quality, improving patient satisfaction and lowering cost growth.      During this 21 minute conversation Dr. Judge discusses moreover the impetus for the creation of Iora Healh, how Iora's primary care delivery model works or how it is different from traditional primary care delivery, how Iora's model is staffed, IT supported and reimbursed, with whom and how it contracts and what Iora's performance data demonstrates to date. Dr. David Judge serves as Iora Health's Chief Medical Officer.  Dr. Judge joined Iora in 2014 to continue his work in improving and redesigning of primary care.  Priorto , he helped found and was the Medical Director of the Ambulatory Practice of the Future at Mass. General Hospital.  David received his undergraduate degree in biomedical engineering and public health studies at Brown University and attended University of  Mass. Medical School.  He completed his residency training in internal medicine at Columbia Presbyterian Medical Center in New York City. For more on Iora Health go to: http://www.iorahealth.com/ This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowJanuary 1st will mark the Affordable Care Act's (ACA) third health insurance expansion year.  Under the ACA individuals with income below 400% of poverty are eligible for insurance subsidies and individuals with incomes below 138% of the federal poverty level are eligible for state Medicaid coverage (or in the 31 states that have to date chosen to expand Medicaid coverage).  As of 2015 the ACA has expanded coverage to approximately 12 million Americans.   Medicaid expansion has added another 14 million lives.   Despite significant gains in the number of insured approximately 25 million non-elderly adults or about 11% remain without coverage.  Roughly half of these are undocumented immigrants whom are ineligible for coverage under the ACA.   Despite subsidies the cost of insurance remains the reason individuals go without coverage that frequently results in individuals going without needed care.      During this 24 minute conversation, Ms. Corlette discusses expected 2016 enrollment numbers, premium prices, the impact pharmaceutical cost growth has had on premium costs, to what extent individuals comparative shop for plans, the number of and reasons for the un-enrolled, insurer participation and the issue of risk corridor funding (recently a presidential campaign issue). Sabrina Corlette is a Senior Research Fellow and Project Director at the Center on Health Insurance Reforms (CHIR) at Georgetown University's Health Policy Institute.  Prior to joining the Georgetown faculty, Ms. Corlette was Director of Health Policy Programs at the National Partnership for Women and Families.  From 1997 to 2001, Ms. Corlette worked as a professional staff member for the Senate Health, Education, Labor and Pensions (HELP) Committee.   After leaving the Hill Ms. Corlette also served as an attorney at Hogan Lovells.  She received her JD with high honors from the University of Texas and earned her undergrad degree also with honors from Harvard. For more on CHIR go to: http://chir.georgetown.edu/.   This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowTelehealth and remote monitoring services generally enable physicians to treat patients and monitor their health status remotely.  Because of advances in wireless communication and biosensor technology these services are increasingly being used in the commercial health care market and as well in the Medicaid program and the VA because research shows these services can reduce acute care visits and lengths of stay, iatrogenic harm and improve patient adherence to care.  Nevertheless, the Medicare program restricts reimbursement for these services largely because CMS (the Congress and the CBO) see them moreover as duplicative (v. substitutive) services.   For example, in 2014 Medicare spent just $14 million on telehealth service reimbursement.  (Total Medicare spending in 2014 was well north of $500 billion).    During this 18 minute conversation Ms. Drobac discusses in part how and why reimbursement for telehealth and remote monitoring services are limited under Medicare, how other payers and providers are using telehealth and remote monitoring, what the research literature suggests regarding clinical effectiveness and cost efficiency, proposed Congressional legislation and related regulatory action to broaden Medicare coverage and chances for legislative and regulatory success. Krista Drobac leads the Alliance for Connected Care, a 501(c)(6) coalition formed to create a statutory and regulatory environment in which providers are able to deliver and be adequately compensated for providing telehealth and remote monitoring services regardless of delivery location or technological modality.   Ms. Drobac was previously Director of the Health Division at the National Governors Association's Center for Best Practices.  Prior to that she was senior adviser at CMS, Deputy Director of the Illinois Department of Healthcare and Family Services and spent five years on Capital Hill where she was a Health Adviser to the Senate Majority Whip Senator Richard Durbin and served as a John Heinz Senate Fellow for Senator Debbie Stabenow.  Ms. Drobac earned her BA from the University of Michigan and her MPP from the Kennedy School of Government at Harvard. For information on the Alliance for Connected Care go to: http://www.connectwithcare.org/  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen Now In 2011 a 78 year old blind, amputated Vermont woman, Ms. Glenda Jimmo, was denied physical therapy services under Medicare because her condition was determined to not likely improve. Because Medicare therapy services via skilled nursing, home health and outpatient care never required the patient "improve" in order to receive services and because thousands of other Medicare beneficiaries along with Ms. Jimmo had been denied therapy the Center for Medicare Advocacy and Vermont Legal Aid filed a class action suit against the federal government, i.e., Jimmo vs. Katheleen Sebelius.  After 11 months of negotiations, a settlement agreement was reached in late 2012 that affirmed there is no "improvement standard" required to be met for beneficiaries to receive therapy services.  That is care would no longer be denied due to a Medicare beneficiary's lack of restoration potential. During this 18 minute discussion Ms. Murphy explains the impetus for the case, speculates why DHHS did not act on its own in resolving the problem, how well or effectively CMS has implemented the terms of the settlement agreement (not very well) and why the decision has received so little attention over the past three years.   Margaret Murphy is the Associate Director of the Center for Medicare Advocacy where she works to develop the Center's legal policy and litigation strategies.  Ms. Murphy has been counsel or co- counsel in several of the Center's federal class action suites.  She serves on the Steering Committee of the Complex Care Committee of the Connecticut Medicaid Medical Assistance Program Oversight Council.  She has also been appointed by the Connecticut probate courts to represent incapacitated adults. She has also taught as an adjunct professor at Quinnipiac University Law School.   Prior to joining the Center Ms. Murphy worked for more than 20 years a a trust and estate attorney.   She is a member of the Connecticut Bar Association, serves as the Secretary of the Executive Committee of the Elder Law Section and is a member of Swift's Inn in Hartford.  Ms. Murphy earned her JD degree from the University of Connecticut School of Law and her BA from Mt. Holyoke College.   This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com