The Healthcare Policy Podcast ® Produced by David Introcaso

Listen Now The ACA's open enrollment period ended this past March 31st. Over eight million Americans signed up for health care insurance.  Of these 2.2 million, or 28 percent, were young adults or between the ages of 18 and 34.  In 26 states and the District of Columbia approximately 15 million adults with income below 138 percent of the poverty level became eligible for Medicaid coverage.  (19 states are not participating in the ACA's Medicaid expansion program and five states remain undecided).  During this 21 minute discussion Brian explains the National Association of Insurance Commissioner's (NAIC) work, what we know about the 8 million individuals that signed up for health care insurance under the ACA marketplaces, the most popular plan, what "effectuated enrollment" means, how many individuals already had insurance and prospects for 2015 enrollment.Brian Webb is the Manager of Health Policy and Legislation for NAIC. The NAIC represents the insurance regulators in all 50 states, DC and the five U.S. territories.  Previously, Brian worked on Medicare and Medicaid policy for the BlueCross BlueShield Association and prior still was the Assistant VP for Legislation for the then-Federation of American Health Systems (FAHS).  Brian began working in DC in 1988 as a legislative aide for Congressman Bill Thomas.  After six years with Mr. Thomas, Brian worked for five years in California Governor Pete Wilson’s Washington office as health and welfare aide and Deputy Director.  Brian was graduated with a MPA from The George Washington University and his Bachelor's degree is from Biola University in California.  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 NowThis past April 24th the FDA announced a proposed rule to regulate e-cigarettes.  The FDA is, in part, proposing to ban the sale of e-cigarettes to minors, require manufacturers to disclose e-cigarette ingredients and prohibit manufacturers to claim e-cigarettes are less harmful than tobacco cigarettes without submitting scientific proof.  The proposed rule did not forbid TV advertising and does not ban flavorings such as cotton candy and Gummi Bear.   Are these regulations adequate, or alternatively, even necessary since some claim e-cigarettes are a lifesaver since they can prevent smokers from consuming harmful tobacco.  During this 23 minute discussion Dr. Abrams, in part, provides a brief overview of the Schroeder Institute's work, evaluates the efficacy of e-cigarettes as an aid to smoking cessation (are they a lifesaver), assesses the FDA's proposed regulations and how they might be improved.   David B. Abrams is the Executive Director of the Schroeder Institute for Tobacco Reseach and Policy Studies at the Legacy Foundation.  He is also a Professor in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health and an Adjunct Professor at Georgetown Univeristy Medical Center, Lombardi Comprehensive Cancer Center. Previously, Dr. Abrams directed the Office of Behavioral and Social Science Research at NIH.  He has published over 250 scholary articles and monographs, served as President of the Society for Behavioral Medicine and is the recipient of numerous awards including the Joseph W. Cullen Memorial Award from  the American Society for Preventive Oncology.    He was graduated from the University of Witwatersrand, South Africa with a BS in Computer Science and from Rutgers University with a Ph.D. in Clinical Psychology.For more on the FDA's proposed rule, see: www.fda.gov/TobaccoProducts/default.htm 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 2010 Affordable Care Act created the Center for Medicare and Medicaid Innovation at CMS with $10 billion in funding to test innovation and service delivery models to improve health care delivery and outcomes and reduce costs.   To date the CMS Innovation Center has funded one round of innovation awards throughout the US (a second round of awards are expected to be announced this summer).  In DC, Mary's Center was awarded in 2012 a three-year $15 million grant to create the "Capital Clinical Integration Network" (CCIN).  The CCIN promises to save $17 million over three years by implementing and testing an integrated clinical network to improve care for chronically ill DC residents whom typically rely on emergency room visits for health care.  To do this Mary's Center will, in part, train and hire 44 health care workers to serve as care managers and community-based care coordinators.  During this 18 minute discussion Dr. Pistulka discusses Mary's Center's work generally, how the CCIN is organized, the clinical care and social service support work CCIN is doing via care coordinators and others and results they've been able to achieve now two years into the three year CMMI award.   Gina Pistulka joined Mary’s Center in 2006.  During her 17 years in nursing, she has also worked as a rural public health nurse and as an urban health nurse educator in Minnesota.  She has also done nursing work overseas in Central America.  Her research background includes having done cross-cultural intervention research.   She has also served on boards to further nurse training through Catholic University of America and via the nonprofit organization Truth About Nursing.   Gina was graduaged from Johns Hopkins with a duel Master’s in Public Health and Community Health Nursing and in 2007 received her Ph.D. in Nursing also from Johns Hopkins. To learn more regarding CMMI's innivation awards see: http://innovation.cms.gov/initiatives/map/index.html. 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 the 1960s Community Health Centers (CHCs) have been providing health care services to moreover minority populations, the poor and the uninsured.  Today there are approximately 1,200 health centers providing health care to over 20 million Americans in all fifty states.  They our the nation's true safety net.  The Affordable Care Act created the CHC Fund that provided $11 billion over five years for the expansion of health centers and services throughout the country.   During this 20 minute discussion Michelle Proser discusses the work of the National Association of Community Health Centers, how CHCs work to reduce health care disparities, what work CHCs have been doing with ACA's $11 billion in  funding and the potential effect should CHC Fund moneys not be renewed when they expire later next year. Michelle Proser is the Director of Research at the National Association of Community Health Centers where she conducts research and policy analysis on a variety of topics used to empower health centers and educate policymakers and the public.  Michelle also directs NACHCs’ efforts to build health center capacity for community-directed translational research.   Previously, Michelle served as a research analyst at the Center for Health Services Research and Policy at The George Washington University.   Michelle received her MPP from George Washington and is presently a Ph.D. candidate at GWU. 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 1992 use of the RBRVS (Resource Based Relative Value Scale) has been the prevailing method by which physician procedure prices are determined.  The method or formula for determining prices is managed by the AMA's RUC (or the Relative Value Update Committee).  In recent years the RUC has come under increasing criticism largely because their work perversely incents the use or overuse of higher priced medical procedures. The RUC has been a topic of Congressional hearings over the past few years and just this past week the Congress included a provision in the so called "doc fix" bill to have the DHHS Secretary begin to collect information on physician services to better determine relative values in setting physician fees.  During this 23 minute conversation Kavita discusses how the RUC determines prices, the AMA's defense of the RUC process, what effect price skewing has on the practice of primary care and how the RBRVS might be reformed.   Dr. Kavita Patelis a Fellow in the Economic Studies program and Managing Director for clinical transformation and delivery at the Engelberg Center for Health Care Reform at the Brookings Institution.  She is also a practicing primary care internist at Johns Hopkins Medicine.  She served previously in the Obama Administration as Director of Policy for the Office of Intergovernmental Affairs and Public Engagement in the White House.  Dr. Patel also served as Deputy Staff Director for the late Senator Edward Kennedy.  She too has an extensive research and clinical background having worked as a researcher at the RAND Corporation and as a practicing physician in both California and Oregon.  She earned her medical degree from the University of Texas and her masters in public health from the UCLA. 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 Corporate Owned Life Insurance are life insurance policies corporations buy on their employees whereby the corporation is the named beneficiary.  This practice, at least initially, was adopted as a way of insuring a company against the loss of a limited number of key executives.  These policies also became attractive because both premium returns and benefits paid were not taxed.  Over time large companies, like Walmart, purchased these policies on millions of employees increasingly for the tax advantages and, industry executives argued, to provide or afford employee and retiree medical benefits.  Beyond the moral objection of profiting from an employee's death, even in instances where the person dies years after they left their employer, these polices perversely incent companies to compromise on insuring employee health and workplace safety.  While regulatory limitations have been placed on these policies, in 2007 dead peasant's insurance was estimated to account for 30% of the life insurance market.  During this 22 minute podcast Peter explains what is an "insurable interest," whether we know how corporations use the income derived from these policies, whether  employee consent is required, the outcome of law suits filed by surviving family members against corporations for this practice, reforms made in 2006 to better regulate this practice and whether these policies do indeed on balance undermine insuring worker safety and health status.   Professor Peter Kochenburger is the Executive Director of the University of Connecticut's Law School’s Insurance Law Center.  He also serves as Director of the Law School’s graduate program, is a Consumer Representative for the National Association of Insurance Commissioners and is an Associate Editor for the ABA Tort Trial & Insurance Practice Law Journal.  Before joining UConn. in 2004 Professor Kochenburger spent eleven years as Counsel at Travelers Property Casualty, where he managed coverage and bad faith litigation, as well as legislative and regulatory affairs across such subjects as workers compensation, OSHA, guaranty funds, tort reform, antitrust, and environmental issues.  His professional experience also includes serving as an Assistant Attorney General in the Consumer Protection Division of Iowa’s Department of Justice and from 1986-1988 he served as Special Assistant to the dean of the Harvard Law School.  He is a graduate of Yale University and Harvard Law School.Related articles'Dead Peasant Insurance' Still Alive in Corporate America 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 NowConcierge medicine (also termed membership medicine, direct pay or cash only practice) has become a rapidly-growing care model moreover among primary care physicians.  In concept, physicians charge patients a monthly or annual fee that can vary widely from approximately $50 per month to $25,000 per year (or accept cash only per visit).  In exchange patients are promised greater access, longer appointment times and possibly services not typically reimbursed by payers.  The current number of physicians practicing concierge medicine is today small, approximately 5,500 nationwide, however, concierge practices are expected to continue to grow at a healthy rate, currently estimated at 25% per year.  While these fees enable physicians to reduce patient panel size and presumably improve physician satisfaction, the model by definition posses access problems for the sickest patients, typically those least able to afford a concierge fee.  For example, among Medicare beneficiaries, in 2012 half of all had annual incomes less than $22,500 and for African American and Hispanic Medicare beneficiaries annual income was less than $15,000. During this 21 minute discussion Ms. Schwarz explains the intersection between concierge medicine and the Medicare program, related investigative efforts by CMS and the DHHS Office of the Inspector General, whether there is any data showing improved care quality and/or reduced health care system costs, whether the practice of concierge medicine constitutes patient abandonment and what would the Medicare Rights Center tell a beneficiary if they called the Center inquiring about the appropriateness and merits of concierge medicine.    Ms. Casey Schwarz is currently the Policy and Client Services Counsel at the Medicare Rights Center in Washington, DC.  Among other duties Ms. Schwarz represents individuals in appeals and directly counsels individuals with complicated Medicare questions.  She works closely with the Medicare statute, regulations, and guidance on a daily basis, including drafting responses to proposed regulatory changes.  She also provides trainings for legal and other professionals working with Medicare clients.  Prior to her Rights Center work Ms. Schwarz served as a Court Attorney in the New York County Supreme Court.  Ms. Schwarz is a graduate of Brown University and the New York University School of Law.  She is a member of the New York  and Maine State Bars. 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 term "medical home" was first introduced in the 1960s by the pediatric profession.  Still to date this model of care emphasizes team-based comprehensive, continuous and coordinated care.   The care model is intended to improve primary care generally via improved patient communication, care quality, safety and outcomes.  In several ways the ACA encouraged the adoption of the, now termed, Primary Care Medical Home/PCMH for both the Medicaid and Medicare programs and among private health insurers.   (In some ways the PCMH is seen as a precursor for providers interested in becoming an Affordable Care Organization (ACO), i.e., taking on reimbursement risk.)  Over the past few years PCMHs have become widely adopted.  Over forty state Medicaid programs are experimenting with the model along with 90 commercial health plans and three federal initiatives. During this 23 minute discussion Dr. Nielsen discusses the PCPCC's purpose and goals, more specifically what is the PCMH model of care, the varying ways PCMH's are reimbursed, what does the research to date show regarding PCMH effectiveness and challenges in adopting this new model of care.Dr. Marci Nielsen currently serves as CEO of the Patient Centered Primary Care Collaborative (PCPCC), an organization dedicated to advancing an effective and efficient health system built on a foundation of primary care.  Prior to the PCPCC, Dr. Nielsen served as Vice Chancellor for Public Affairs and Associate Professor at the University of Kansas School of Medicine’s Department of Health Policy and Management.  Dr. Nielsen was appointed by then-Governor Kathleen Sebelius as first Executive Director and Board Chair of the Kansas Health Policy Authority (KHPA).  She worked as a Legislative Assistant to Senator Bob Kerrey and later served as the health lobbyist for the AFL-CIO.  Dr. Nielsen is a board member of the American Board of Family Medicine and also a committee member for the Institute of Medicine’s Leading Health Indicators for Healthy People 2020 and Living Well with Chronic Illness: A Call for Public Health Action.  Early in her career she served as a Peace Corps volunteer in Thailand and served for six years in the US Army Reserves.  Dr. Nielsen earned her MPH at The George Washington University and her Ph.D. from the Johns Hopkins School of Public Health.The PCPCC's 1/14 PCMH impact on cost and quality report can be found at: http://www.pcpcc.org/newsletter/annual-report-pcmhs-impact-cost-quality-2012-2013. 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 NowIn late January in a case involving a Catholic charity, the US Supreme Court issuesd a ruling temporarily exempting religious-affiliated non-profits from providing ACA-required contraceptive coverage.  (The ACA coverage requirement was based on an IOM recommendation that found birth control is "medically necessary."  The requirement took effect January 1st).  While churches and houses of worship are exempt, owned or controlled religious organizations can opt out of the contraceptive coverage requirement by completing and signing a form explaining their objection.  However, opponents say by opting out - that then allows the employee to obtain contraceptive coverage through a separate insurance policy - they are complicit in immoral conduct, i.e., they too should be exempted outright.  In addition, the Supreme Court has agreed to hear two cases that involve for-profit companies similarly objecting to the requirement.  During this 20 minute conversation Mr. Sonfield discusses the specifics of the ACA contraception coverage requirement and why it was included as an "essential health benefit, exemptions to it including how religiously affiliated non-profits can avoid providing coverage and moreover, in light of the recent legal challenges to the contraception mandate, what the research shows regarding the benefits of women's contraception.              Adam Sonfield joined the Guttmacher Institute in Washington DC in 1997.  (Guttmacher is a non-partisan reproductive health and rights research and policy shop.  Its goal is to "ensure the highest standard of sexual and reproductive health for all people worldwide.")  Adam currently serves as a Senior Public Policy Associate.  He is the managing editor and a regular contributor to the Institute’s public policy journal, the Guttmacher Policy Review.  Mr. Sonfield’s portfolio includes research and policy analysis on public and private financing of reproductive health care in the United States, the rights and responsibilities of health care providers and patients, and men’s sexual and reproductive health. He also writes a quarterly Washington Watch column for Contraceptive Technology Update.  Mr. Sonfield earned an A.B. with honors in social studies from Harvard and a Master of Public Policy, focusing in health policy, at Georgetown University.The Guttmacher Institute's Supreme Court amicus brief can be found at: http://www.guttmacher.org/media/inthenews/2014/01/31/index.html, 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(This podcast is a companion to the November 13th interview with Infectious Diseases Society of America's Amanda Jezek.)  As previously noted, conservative estimates show hospital-acquired infections (HAIs) alone sicken two million Americans, directly kill 23,000 and contribute to a total of 100,000 deaths each year.  The bacterial infection C. diff (Clostridium difficile) alone causes 250,000 people to be hospitalized annually.  The US has some one of the highest infection resistant rates among developed countries and within the US infection rates are highly variable.     During this 25 minute conversation Dr. Anthony Harris discusses why comparatively US infection resistance rates are high, why hand hygiene compliance rates remain persistently high (despite the fact hand contamination contributes substantially the the spread of infections), what acute care providers can do to reduce infections, what activites SHEA is pursuing to help reduce infection rates and what more can be done nationally, specifically regarding quality metrics, to lower rates. Dr. Anthony Harris is currently a Professor of Epidemiology and Public Health at the University of Maryland's School of Medicine and is the President-Elect of SHEA.  His research interests include emerging pathogens, antimicrobial-resistant bacteria, hospital epidemiology/infection control, epidemiologic methods in infectious diseases and medical informatics.  He has published over 100 research papers and currently receives funding from the NIH, CDC and AHRQ to study antibiotic resistant infections and hospital epidemiology.  Dr. Harris received his medical degree from McGill Univesity and his MPH from Harvard. For information on SHEA's compendium of strategies to prevent health care associated infections see:  http://www.shea-online.org/HAITopics/CompendiumofStrategiestoPreventHAIs.aspxFor information on SHEA's research network of 200 hospitals see:  http://www.shea-online.org/Research/SHEAResearchNetwork/SRNStudiesandResources.aspx 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