Dr. Todd Olmstead is an associate professor in the School of Public Policy at George Mason University where he conducts economic analyses and research in behavioral health. His current research projects include: (1) estimating the demand for illicit drugs, (2) cost-effectiveness of substance abuse interventions, (3) cost-effectiveness of early intervention programs for youth who are at risk of  future interactions with the mental health and/or juvenile justice systems, (4) cost-effectiveness of providing mental health services to low-income pregnant and parenting women living in public housing systems, and (5) the impacts of
gambling treatment on healthcare service utilization. Prior to joining Mason, Dr. Olmstead was a member of the faculties of the University of Connecticut and Yale University, and he was a Research Fellow at Harvard Kennedy School’s Center for Business and Government. Dr. Olmstead holds degrees in public policy (Ph.D., Harvard University, 2000), operations research (M.S., UNC-Chapel Hill), and industrial engineering (M.S., B.S., SUNY-Buffalo).

Click here to view the full flyer.

This months speaker is the Director of Evaluations at the Office of the National Coordinator for Health Information Technology.

Please click here to view the flyer: Meaningful Use of Electronic Health Records

Aging and Long-Term Care Policy

Mark R. Meiners, Ph.D., is a Professor of Health Administration and Policy in the College of Health and Human Services at George Mason University. Dr. Meiners specializes in the areas of aging and health with emphasis on financing and reimbursement issues. He is nationally recognized as one of the leading experts on financing and program development in long-term care. His most recent work focuses on improving community care coordination between medical and social service providers. He is also working to replicate Long-Term Care Insurance Partnership programs in states across the country.
Among his noteworthy accomplishments is his leadership of the Robert Wood Johnson Foundation (RWJF) Medicare/Medicaid Integration Program, an initiative designed to help states develop new systems of care that better coordinate acute and long-term care. In addition he has led the RWJF Partnership for Long-Term Care, an innovative state-based long-term care insurance program, since its beginning in 1987. His path-breaking research on long-term care insurance has been a major catalyst to the current interest in this topic and his work on Medicare/Medicaid integration has helped advance chronic care improvement strategies for all aged and disabled populations.

Dr. Meiners presentation will focus on the economics of aging and long-term care as it relates to health reform and highlight new opportunities for multi-disciplinary research. The emergence of chronic illness as a key driver in health care costs has prompted new interest in lessons learned from research on long-term care financing and delivery system reform strategies.  Accountable Care Organizations and Medical Homes are just two examples of strategies supported by  the Accountable Care Act that draw on insights gained over many years of research on Medicare and Medicaid and their uneasy relationship with long-term care. The integration of acute and long-term care, cash and counseling payment strategies, long-term care insurance, and informal support strategies are examples of research and program development threads that are being woven together to improve care for seniors and people with disabilities supported by Medicare and Medicaid.

Click here to view the event flyer: HAP CHPRE Seminar December 3rd.

Denise G. Osborn-Harrison, JD, MPH

Center for Medicare and Medicaid Services

Authorized by the 2010 Affordable Care Act (ACA), health insurance exchanges will give millions of people and small businesses access to health coverage.  With less than two years until exchanges must be fully operational in every state, most states have already started planning for and building their exchanges.  However, many policy decisions and implementation challenges remain before these state health exchanges can be up and running by January 1, 2014. Decades of policymaking provide insight to the challenges of interagency collaboration between government entities. The most masterful change agents within State government have championed orderly, focused interagency collaboration between entities such as the Governor’s Office, State Medicaid Agency, the Department of Insurance, the Department of Health and the Department of Financial Services and the State Health Exchange.  This presentation will discuss two examples of state health exchanges that are being developed in Maryland and Oregon. Then, it will provide an overview of key issues for other states in building a health insurance exchange, including building a statewide health information technology (HIT) infrastructure and achieving stakeholder engagement. Finally, the presentation will conclude with suggestions for policymakers.

Denise G. Osborn-Harrison JD, MPH serves as a health insurance specialist at the U.S. Department of Health and Human Services for the Centers for Medicare and Medicaid Services (CMS), Division of State Systems Team, Data and Systems Group of the Center for Medicaid and CHIP Services (CMCS). Denise works with state policy makers, federal agencies and technology vendors helping to create statewide information technology infrastructures for eligibility and enrollment systems.  These systems directly enable Medicaid expansion and health insurance Exchanges as defined within the Affordable Care Act (ACA).  She has provided expertise to stakeholders including state agencies, federal agencies (SAMSHA, CDC, HHS, NHTSA and HRSA) non-profits and healthcare providers both nationwide and abroad. As a continuing education provider she has trained nurses and physicians on how to conduct root cause analysis to support enterprise wide patient safety and quality initiatives.  For over twenty years Denise has been adjunct faculty for college level paralegal and healthcare administration programs.  She attributes her commitment to and interest in health policy to the time that she spent working as a staffer on The Hill for a member of the U.S. Congress.   Denise is an alumnus of U.C. Irvine, the University of San Diego Law School and the George Washington University School of Public Health.  She holds a license to practice law from California and was admitted to the United States Court of Appeals for the 9^th Circuit.

To view the event flyer click here: HAP CHPRE Seminar Flyer – Denise Osborn-Harrison

Bradley Herring, Ph.D.

Johns Hopkins University

Wednesday, October 10, 2012 

12:00 – 1:30pm

Johnson Center Gold Room

State Health Exchanges and Medicaid Expansions

Denise Osborne-Harrison, J.D., MPH

Centers for Medicare and Medicaid Services

Monday, November 19, 2012

12:00 – 1:30pm

Johnson Center Gold Room

Aging and Long-Term Care Policy

Mark Meiners, Ph.D.

George Mason University, HAP Faculty

Monday, December 3, 2012

12:00 – 1:30pm

Johnson Center Gold Room

Click to see the Save the Date flyer 

“Who Really Pays for Employment-Based Health Insurance and Why Does It Matter for Healthcare Reform?”

Do workers bear the cost of health insurance premiums in the form of lower wages?  Brad Herring will present work in which he and his colleagues conduct an empirical test of this question by examining how changes in premiums over time affect changes in wages for a sample of wage‐earners from the four‐year 2004 panel of the SIPP linked to data on average employer contributions to premiums from the MEPS-IC.  Dr. Herring will then highlight the policy significance of this wage/benefit tradeoff by discussing the implications of two particular provisions of the 2010 Affordable Care Act – the 2014 “play or pay” mandate on employers to offer health benefits and the 2018 “Cadillac Tax” on high-cost plans.

Bradley Herring, Ph.D., is an Associate Professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and is the Director of the Ph.D. Program in Health Economics and Policy.  Dr. Herring’s research focuses on a number of economic and public policy issues related to private and public health insurance coverage.  He has published articles in the Journal of Health Economics, Health Affairs, and New England Journal of Medicine, and is co-author of the book Pooling Health Insurance Risks.  His research has been funded by the Robert Wood Johnson Foundation, Organization of Economic Cooperation and Development, U.S. Health and Human Services ASPE, and AHRQ.  Dr. Herring earned his Ph.D. from the Wharton School at the University of Pennsylvania, received a two-year RWJF Scholars in Health Policy fellowship at Yale University, and served for a year with the White House’s Council of Economic Advisers.

To view the flyer click here.

Courtesy of Dr. Chapin White

HAP/CHPRE Seminar Series hosted by the Center for Health Policy Research and Ethics

Members of the Mason community were invited to attend the third Seminar Series of the Spring semester, co-sponsored by the Center for Health Policy Research and Ethics and the Department of Health Administration and Policy.

Chapin D. White, Ph.D., presented his talk “The Big Unknown in Scoring Health Reform: What Happens When Expanding Demand Meets Contracting Supply?”

The Affordable Care Act (ACA) has two major pieces: an expansion of insurance coverage to roughly 30 million uninsured, and a permanent reduction in the rate of growth in the prices that Medicare pays medical providers. Those two pieces tend to push health care utilization and spending in different directions, and we do not currently have an adequate economic model to predict how the resulting pressure will be resolved. In this seminar, Dr. White will: 1) describe how the federal government used a demand-driven model to project the effects of health reform on total health care utilization and spending, 2) lay out the shortcomings of the demand driven model, 3) propose a new model of total health spending that reconciles supply- and demand-side pressures, 4) show how the predictions of the new model differ from the official projections, and 5) lay out a research agenda that  would refine the parameters in the new model.

Chapin D. White, Ph.D., is a senior health researcher at the Center for Studying Health System Change in Washington, D.C. At HSC, he is focusing on policy analyses relating to the implementation of health reform and original research quantifying the likely impacts of health reform. White was formerly a principal analyst at the Congressional Budget Office (CBO), where his work focused on microsimulation modeling of health reform, long-term trends and geographic variation in health spending, medical malpractice, nonprofit hospitals, and Medicare payment policy. Prior to joining CBO, Dr. White was a post-doctoral fellow at the National Bureau of Economic Research, a consultant to the Medicare Payment Advisory Commission and an analyst at Abt Associates. White earned his doctorate in health policy from Harvard University, a master’s degree in public policy from Harvard’s Kennedy School of Government and a bachelor’s degree in social anthropology, cum laude, from Harvard.

Click here for a PDF version of the presentation: Chapin White Presentation April 26, 2012

Click to here view the event flyer.

If you have any questions about the event, please contact Caryn Sever at 703.993.9490 or csever@gmu.edu

Zeke Emanuel. Photo by Samuel Masinter from Wikipedia Commons

Dr. Ezekiel Emanuel, one of the architects of the Obama health reform plan,  presented his talk  ”How Obamacare Will Save American Healthcare” to George Mason University students, faculty, and staff “ on Monday, April 16 at 1:30 P.M. in the Johnson Center Cinema.

The lecture is sponsored by the Department of Public and International Affairs and the Center for Health Policy Research and Ethics.

Dr. Emanuel is an oncologist and former chairman of the Department of Bioethics at the National Institutes of Health.  From 2009 until 2011, he was a key player in the White House health reform team, assigned to the Office of Management and Budget. His brother, Rahm, was White House Chief of Staff and is now mayor of Chicago.  Dr. Emanuel’s writing on health policy issues now appears regularly in the New York Times. He is also a regular commentator on MSNBC.

CHPRE Graduate Assistant Colleen Tallant was in attendance.

Health Care Reform and the Future of American Medicine

Perspective from Ezekiel J. Emanuel, MD, PhD

 Colleen Tallant

 “Zeke,” as he is commonly known, has an extensive background from which to draw plausible solutions to the compromised United States Health Care system. His MD and PhD were both achieved from Harvard University, and Dr. Emanuel currently practices as an oncologist as well as Health Policy Advisor to President Barack Obama. Dr. Emanuel’s success is also supported by his position as Vice Provost of Global Affairs and recognition as the “University Professor” at the University of Pennsylvania.  Beyond his presentation this past Monday at George Mason University, one can find more of Dr. Emanuel’s views and opinions (through interviews and original writings) in the MSNBC archives, as well as the New York Times.

 Dr. Emanuel began his discussion about health care reform with a brief review of the country’s economic choices in this venue. Directly from his slides came the startling reality that the U.S. spent $2.6 trillion on health care alone in 2010. Although this probably was not new information for many in the audience, this fact never gets any easier to swallow. He had an interesting analogy to put this into better perspective (the sum of trillions of dollars is a concept quite difficult to grasp); if $1 bills were to be stacked one on top of another, $2.6 trillion would be 2/3 the distance to the moon.

 The United States has the fifth largest health care economy in the world; however, our life expectancy rates are not proportional to these figures. Dr. Emanuel has examined the country’s costs by “type,” and then delved further into these areas of spending to verify which have experienced the greatest proportion of growth. The highest costs were found to be in hospital care and physician/physician services payments. A considerable amount of money is also spent every year towards Medicare.  Surprisingly, fears of the “aging population” as a primary source of growth in health care spending are not supported; Dr. Emanuel stated that this aspect of medicine only accounts for about 2% of growth. Income growth, on the other hand, accounts for 5-20%. Insurance demand follows, responsible for 10% of health care spending growth.

 Health care reform has been attempted several times, unsuccessfully, in the past.  Since 1912, under Teddy Roosevelt, through the Patient Protection and Affordable Care Act (PPACA) March 23, 2010, our country has consistently been seeking out the best way to reduce costs and make our health care system more efficient.  Dr. Emanuel is convinced that by 2020 the United States health care system will in fact be better.  In terms of coverage, everyone will have access to insurance which will improve the system.  In terms of cost, the United States will move away from fee-for-service payment models, especially for those with chronic conditions.  Quality changes will include inter-operable electronic health records (EHR) and evidence-based medicine, which in turn will result in fewer medical errors and more information available to physicians.  Insurance reform will eliminate rescissions and Medicare donut holes.  Optimistic?  Dr. Emanuel agrees that his expectations are positive and hopeful, but this is what he truly believes will be the future of medicine in our country.

 What changes will be in place and how will they be implemented successfully to give rise to Dr. Emanuel’s expected outcomes?  He believes that several models are being trialed; including “Medical Homes” which have approached the health care budget concerns with structural and team changes to make medical care more efficient.  The Urban Medical Group in Boston, MA, Lean Medical Centers, CareMore Medical Group in AZ and NV, and Redlands Family Practice in CA are just some of the locations with marked outcomes.  Physicians have already started to limit their patient pools so that increased amounts of time can be spent with each individual patient to discuss and review their best treatment options.  If tests are abnormal, patients are called directly to alert them of the results and to make adjustments to their medical plan if necessary. These amendments have already resulted in a 29% decrease in Emergency Room visits, a 6% decrease in Primary Care visits, and a 1.5:1 return on investment.

Are the “Accountable Care Organizations (ACOs)” of PPACA now considered an antiquated innovation?  27 ACOs have still been selected to start practice and hospital transformations as of April 1, 2012.  Dr. Emanuel expects many to fail, but not because of the projected structure of these organizations, but instead due to the fact that this is a “new” concept that many will be unable to acclimate to, or not in a beneficial amount of time.  Sacramento ACO already has results from their pilot after 1 year, with reductions in patient overuse of facilities and procedures (i.e. hysterectomies, elective knee surgeries), reductions in hospital readmission rates, and lower use of out-of-network care.  The answer then is “no,” and the results that have already been produced from the restructuring and “lean” approaches of ACOs even help to prove Dr. Emanuel’s theory that this country CAN achieve lower health care costs through innovation, instead of “rationing care.”

 “Innovation” should not be understood as new drugs or devices; it can simply mean changes to expensive procedures or practices that we have become too comfortable using. Dr. Emanuel gave an example from DePuy, an orthopedic device company (division of Johnson and Johnson). Instead of asking physicians to purchase expensive metal operating room instruments, the company devised a disposable version of these instruments at 10% of the original price.  This DOES appear to be a savings of 90% and I’m sure there are other benefits to using plastic instruments (i.e. their sterility won’t ever be questioned and it’s one less job for sterile processing of the hospital), but in my experience instrument trays used in the OR were rarely purchased. Trays instead were provided by vendors and placed on “consignment” at the hospital for future use. Vendors pay a price to keep trays on the shelves of facilities, so there’s monetary gain as well as the preservation of physician’s ability to update product usage and technology without penalty.  There may still be savings attained through the use of plastic instruments as opposed to metal ones, but I highly doubt we will ever be able to validate a reduction by as much as 90%.   Still, other innovations have indicated more than just monetary gain. Some hospitals have started to “reinvent” hospital bedside tables so that they don’t have as many corners, and are made of plastic instead of wood.  These simple modifications may help to reduce high rates of nosocomial (hospital-acquired) infections by the elimination of bacteria from commonly used surfaces.

Dr. Emanuel did present an “ideal” set of outcomes for the health care community, which many may perceive to be unrealistic expectations.  From my perspective, the filled auditorium with students and adults alike, eager to listen to solutions to this country’s health care issues, is maybe a small example that the U.S. is in fact united.  It shows the promise that we will work together until resolve, and as described is already happening one hospital system at a time.

All notes were taken from Dr. Ezekiel Emanuel’s presentation at George Mason University Monday, April 16, 2012. 

 You can also view further information in a posting by GMU news through this link.

Please see the flyer through this link. Zeke Emanuel Flyer.

Social Media and Health Care

On February 23, 2012, The Center for Health Policy Research and Ethics and the Department of Health Administration and Policy hosts the Seminar Series.  Dr. Priya Nambisan presents her talk titled Social Media and Health Care. 

The confluence of social media and health care has garnered considerable interest among both practitioners and researchers in recent years. Social media relates to any Web-based communication media (that uses Web 2.0 technologies) with user-generated content that facilitates social networking broadly defined. Much of social media is now accessible using mobile devices. To date, some of the most popular social media include online forums/communities; blogs; virtual worlds (e.g. Second Life); wikis; social networking sites (Facebook; Twitter; etc.); content sharing sites (YouTube; etc.).  It would be reasonable to conclude based that the greatest influence of social media so far has been on collective thinking and on collective action.  This presentation will explore the impact of social media on healthcare and on health related activities.  We will consider some promising research avenues in this regard, particularly the potential impact on personal health behavior. We will also explore some of the differences between the earlier generation of social media (e.g. online communities) that has had considerable role in health care and the newer generation of social media (e.g. Facebook, Twitter) whose role in health care is yet to emerge.

Click  Social Media and Health Care by Dr. Priya Nambisan to view the flier.

Office GMU Picture of Dr. Alison Cuellar

Dr. Alison Cuellar will present her talk titled:  Implementing Health Care Reform, an outside view of the Office of the Assistant Secretary for Planning and Evaluation. Dr. Cuellar is currently an advisor in the Office of the Assistant Secretary for Planning and Evaluation within the federal Department of Health and Human Services. She will share her perspectives on the implementation of health care reform.

For further information about Dr. Alison Cuellar, please see the event flyer.

If you have any questions about the event, please contact Caryn Sever at 703.993.9490 or csever@gmu.edu.