Class Photo on Capitol Hill © Laura Sikes Photography

The 21st Washington Health Policy Institute

Registration is now open! 

If you want a true insiders’ view of what health care policy is about, how it is made, and who makes it, you should not miss the Washington Health Policy Institute (WHPI).

Students have the unique experience to learn from top Health Policy professionals, visit Capitol Hill and their representatives, and gain graduate credits or continuing education credits at the 21st Washington Health Policy Institute.

Registration is open today

WHPI student network at the reception © Laura Sikes Photography

The 20th Washington Health Policy Institute was such a success last year. Students from all over the country collaborated, building both their personal and professional networks.

HAP 605 students watch Len M. Nichols' powerpoint while listening to the course lecture © Laura Sikes Photography

Click here for further information about the 21st Washington Health Policy Institute  About the Institute .

For common questions about the event click our FAQ page.

Dr. PJ Maddox of GMU and Dr. Veronica Feeg of Molloy College (our first WHPI cohort) take a moment to pose by the WHPI poster © Laura Sikes Photography

Please feel free to reach out to any of our event planners with other questions, comments, or inquiries at chpre@gmu.edu

Courtesy of Common Images

Mason Selected to Evaluate CareFirst Medical Home Program

Posted: March 10, 2013 at 5:00 am, Last Updated: March 12, 2013 at 12:03 pm

George Mason University is part of an elite group to evaluate CareFirst BlueCross BlueShield’s Patient-Centered Medical Home (PCMH) program, one of the largest in the nation, CareFirst announced on March 11.

George Mason, along with a joint team from Harvard University, Brandeis University and the Massachusetts Institute of Technology, as well as a team from Westat Research Corp., will study the PCMH program. Mason has a five-year, $5.4 million contract, says Len Nichols, principal investigator for the Mason team and director of Mason’s Center for Health Policy Research and Ethics in the College of Health and Human Services (CHHS).

How well a patient’s health improves while under a physician’s care, not how many services are given, is a benchmark for patient-centered programs, Nichols says. “The patient’s health is at the center of the focus as opposed to just services and tests for the patient,” he says.

Patient-centered care also means the patients themselves play an active part in their own health care, Nichols says. That’s critical because many patients with chronic conditions typically have two or more. For example, someone with heart disease may also be diabetic.

“You have to manage care for chronic patients very carefully,” Nichols says.

In addition, the patient-centered programs are a response to cost pressures and an effort to re-examine how care is delivered to patients, Nichols says. “I think it is a game-changer for our national conversation about how to contain costs,” he says.

CareFirst has more than 3,600 participating primary care physicians and nurse practitioners covering about one million CareFirst members in Maryland, Northern Virginia and the District of Columbia. CareFirst showed total health care costs for PCMH members in 2011 were 1.5 percent lower than expected. Nearly 60 percent of physician groups participating in 2011 earned incentives based on the attainment of savings and quality performance, according to CareFirst information. 

“The approach has great promise since it links physician incentives to higher quality care, better outcomes and lower costs,” Nichols says.

Mason’s evaluation is expected to show how well that promise is fulfilled. 

“Our PCMH program is a critical component of our efforts to reduce health care costs while improving health care quality,” said CareFirst President and CEO Chet Burrell in a statement announcing Mason’s selection as a PCMH evaluator. “The program has grown tremendously, and we are pleased with the early results that we have seen. In selecting these leading institutions and organizations to evaluate the program, we will get a thorough, independent look at every aspect of the program. We want to know what works well, what could work better, whether the program is truly changing the behavior of physicians and patients and much more.” 

Mason’s team includes three health economists, a professor of nursing, a physician and a consumer engagement expert who can detail what can help bring patients into the program.

A multidisciplinary team is essential to give the program a thorough examination, Nichols says. “You need multiple perspectives,” he says. “You need all hands on deck.”

In addition to Nichols, the Mason team members are:

• Gilbert Gimm, co-principal investigator, economist and associate professor in Mason’s Department of Health Administration and Policy (HAP) in CHHS.
• Alison Cuellar, economist and associate professor, HAP.
• Lorens Helmchen, economist and associate professor, HAP.
• Margaret Rodan, associate professor in Mason’s School of Nursing, CHHS.
• Jay Want, a physician and CEO of Colorado-based Physician Health Partners LLC and board chair of the Center for Improving Value in Health Care.
• Kalahn Taylor-Clark, a consumer engagement expert and director of health policy for the National Partnership for Women and Families.
• Alan Newman Research, Richmond-based health survey experts.

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.

Courtesy of Wiki - Images

States take practical path on exchanges

When the Affordable Care Act was debated in Congress, the House of Representatives wanted one federal exchange and as much federal control of state insurance markets as possible. The Senate wanted state insurance exchanges and state flexibility to tailor market rules to local market conditions.

You can read the complete Op-Ed article through this link States Take Practical Path on Exchanges.

http://www.c-span.org/Events/Physicians-and-Experts-Discuss-Medicare-Reform/10737437659/

On Tuesday January 29, 2013, Len M. Nichols spoke as part of a panel for the Policy Summit, hosted by the National Journal Live and held at the Newseum.

The purpose of the policy summit was to bring together “ leading thinkers in the healthcare space—including physicians, healthcare executives, congressional staff experts, and other key voices—as we analyzed and weighed the policy options available in overhauling the Medicare payment system.”

The event was covered by C-SPAN including a full video of the entire panel. Members of the panel included:

Paul Ginsburg, president of the Center for Studying Health System Change; Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University; and Gail Wilensky, senior fellow at Project HOPE; participated in a panel, titled “Deep Thinkers.”

Dr. Thomas Claffey, president of InterMed; Dr. Edward G. Murphy, professor of medicine at the Virginia Tech Carilion School of Medicine; and Dr. Grace Terrell, CEO of Cornerstone Health Care;  joined the “Physicians Panel.”

Juliette Cubanski, associate director of the Program on Medicare Policy at the Kaiser Family Foundation; Jay Khosla, chief health counsel for the Senate Committee on Finance; Meghan McCarthy, policy analyst at McBee Strategic and former National Journal health writer; and Dana Safran, senior vice president of Performance Measurement and Improvement at Blue Cross Blue Shield of Massachusetts; particpated in the “Response Panel.”

Maggie Fox, senior health writer for NBCNews.com and Today.com, moderated.

Kaiser Health News reporter Ankita Rao was in attendance and published her piece “For Medicare Innovations – Think Locally” quoting CHPRE Director Len M. Nichols.

Beginning with an assessment of primary care shortages, taking the current ratio’s and blowing them up on a grander scale, concluding that primary care shortages may be a thing of the past due to nurse practitioners, physicians assistants, and electronic communications.

The issue continues, tackling “triple aim” care as well as innovations that help our health care industry work smarter rather than harder.

You can view this months Health Affairs issue through this link: It’s Past Time To Get Serious About Transforming Care .

Courtesy of JLME

Government Intervention in Health Care Markets Is Practical, Necessary, and Morally Sound

This essay makes the affirmative case for health reform by expounding on three fundamental points: (1) one moral case for expanding access to coverage and care to all is grounded in scriptural concepts of community and mutual obligation which continue to inform the American pursuit of justice; (2) the structure of PPACA springs from an appreciation of and approach to channeling market forces that was developed and proposed by a coalition of moderate and conservative Republican U.S. senators almost 20 years ago; (3) the most humane path to a better and more sustainable health system lies in implementing (and amending where appropriate) PPACA as fast and fully as we can. The purpose of this essay is to articulate why it is not possible to make our health system better, sustainable and serve us all without government playing specific and limited but absolutely crucial catalytic roles.

Click this link for the complete article: Government Intervention in Health Care Markets Is Practical, Necessary, and Morally Sound

Image from the Hastings Center Cover

Len M. Nichols among several other authors are featured in the Hastings Center Report, September – October issue, published by The Hastings Center this month.

Abstract: 

The issues before the Supreme Court, arising as they did out of multiple cases and divergent appellate court rulings, were quite complex, and its final decision will be parsed rather differently by lawyers, health policy wonks, and economists (or metaphysical philosophers, in Chief Justice John Roberts’s memorable phrase). This essay will focus on one singular element: did the final ruling enhance or detract from our collective power to exercise stewardship over our health care resources?

Clearly Americans diverge on key features of a desirable society and on the wisdom of using government to achieve even mutually desirable goals. But before politics settles the fate of the Affordable Care Act (and perhaps also the federal role in health policy for the foreseeable future), we should focus on what the Court has allowed us to consider: if we want it to, federal power may constitutionally be marshaled to compel insurers to end discrimination against the sick and to offer more transparent products so the marketplace will better serve consumers.

Dr. Nichols’ article titled “Justice Roberts’s Health Care Stewardship” can be read here: The Hastings Center Report September – October Issue

Affordable Safe Housing Means Healthy Citizens

By Caryn Sever

In a political landscape wrought with arguments over leadership (in most cases) rather than policy itself, it is difficult to connect the dots between seemingly unassociated initiatives and mandates.  Health Affairs  accomplishes this very task in their recent article “Health in All Policies: The Role of The US Department of Housing and Urban Development and Present and Future Challenges,”written by Raphael W. Bostic, Rachel L.J. Thornton, Elizabeth C. Rudd, and Michelle J. Sternthal.

A complete understanding of this topic begins, as most do, with a historical context. The U.S. Housing Act of 1937 also known as the Wagner-Steagall Housing Act, was enacted for the following reasons:

• to promote the general welfare of the Nation by employing the funds and credit of the Nation, as provided in this chapter—
  • to assist States and political subdivisions of States to remedy the unsafe housing conditions and the acute shortage of decent and safe dwellings for low-income families;
  • to assist States and political subdivisions of States to address the shortage of housing affordable to low-income families; and
  • consistent with the objectives of this subchapter, to vest in public housing agencies that perform well, the maximum amount of responsibility and flexibility in program administration, with appropriate accountability to public housing residents, localities, and the general public;[1]

The need was clear in a Depression riddled America, more people on the streets or in compromised housing meant unsafe and unsanitary conditions for all, including big business owners, tax payers, and voters. “Slums were thought to breed immorality, disease, and death, and it was believed that better housing would eliminate those ills.”[2] It is true that this act was flawed creating several issues including class and racial segregation; however it was the first solid action in a line of progress that continued to the present day.

1965 marked the creation of the Department of Housing and Urban Development (HUD) as part of Lyndon B. Johnson’s “Great Society” program which fought to end poverty in America.  His initiative linked and targeted the health implications between poor housing conditions and poor health in the United States given the vulnerable populations involved; a notion which continued into the 90’s. An example used in the Health Affairs article is the Healthy Homes and Lead Hazard Control, established in 1991 to target indoor environmental health hazards including lead, mold, and unsafe structure/design features.[3] The action contributed to a “70 percent reduction in childhood lead poisoning since the early 1990’s.”[4]  In the following years, HUD worked with localities and community organizations to create safe public housing and health care programs.

Today, the Obama Administration has launched a “place-based budgeting” initiative that requires the federal government to consider the geography both physically and culturally, when setting “fiscal priorities.”[5]  The goal was to promote funding to help vulnerable communities address inadequate housing, education, public transportation, and poor health. Further efforts include the Neighborhood Revitalization Initiative, which is aimed to “support local communities in developing and obtaining the tools they need to revitalize neighborhoods of concentrated poverty into neighborhoods of opportunity.” [6] The interagency program the Partnership for Sustainable Communities, a collaboration between HUD, DOT (Department of Transportation), and the EPA (Environmental Protection Agency) outlines six principles of livability:[7]

(1)   to Provide more transportation choices

1. developing safe and affordable transportation
2. reduce dependence on foreign oil by using green technology

i.      reducing greenhouse gas emissions

ii.      promoting public health

(2)   to promote equitable, affordable housing

1. expanding location
2. using energy efficient choices
3. increasing mobility and lowering combined cost of housing and transportation

(3)   Enhance economic competitiveness

1. employment centers
2. educational opportunities
3. other services and tools needed by workers or potential workers

(4)   Support existing communities

1. Targeted federal funding towards existing communities

i.      Transit oriented, mixed use development and land recycling

1. Community revitalization and public works efficiency investments
2. Safeguarding rural landscapes

(5)   Coordinate and leverage federal policies and investment

1. Aligning federal policy and funding to remove barriers

i.      Increase accountability and effectiveness

ii.      Smart energy choices

1. Locally generated renewable energy

(6)   Value communities and neighborhoods

1. Enhancing unique characteristics
2. Investing in health, safety, and walkable neighborhoods

i.      Rural, urban, and suburban

The Strong Cities, Strong Communities Initiative, was developed to “strengthen neighborhoods, towns, cities and regions around the country by strengthening the capacity of local governments to develop and execute their economic vision and strategies.” [8]  The idea is to assist local government by providing access to federal agency expertise and foster public and private sector partnerships. These partnerships will, in conjunction with the local government, “develop comprehensive plans for their communities and invest in economic growth and job creation.”[9]

Programs and initiatives such as these provide the infrastructure, funding, and support needed to create effective, efficient community health programs. The Healthy Food Financing Initiative, developed by the Obama Administration for example, lends aid to support the increase of access to healthy, affordable food while encouraging expansion and development of grocery stores in areas that are virtually “food deserts” (little or no access to grocery stores or fresh food in the area). [10]  This effort would be a difficult reality without the development of community programs and revitalization.

HUD has been keeping a close eye on the connection between health and housing, in an interview with the Robert Wood Johnson Foundation blog New Public Health, Raphaeal Bostic, a Professor at USC and former Assistant Secretary for Policy Development and Research at the U.S. Department of Housing and Urban Development, explained that HUD has been interested in the “intersection between housing and a whole host of other areas – health care, school performance, job attachment”[11]   because they seem closely linked in his assessment. HUD’s project “Moving to Opportunity” tracked health benefits as the one of the biggest benefits of affordable, safe housing. This analysis opened the dialogue for HUD. Now they could bring this information to their stakeholders and grantees to aid them in development of programs that included building healthier communities.

The correlation between affordable, safe housing and the health of citizens is not new. It’s not a mystery why a person living in a warm safe space will be healthier than one living on the street or in a slum. It is a quandary why this is not a priority in American politics. Bostic hopes that “the collaborations happening on the national level will eventually diffuse down” remarking “if we integrate health and housing policies at all levels, that will be very exciting.”[12]   The reality is that the health of the nation depends upon communities to take action; the action depends upon local representatives providing support, meanwhile, with many of these programs in place, we can only hope that revitalization and health in urban and rural areas increase.

Graphic Credit - Adam Cole - NPR http://kutnews.org/post/supreme-courts-medicaid-decision-could-reach-far-beyond-health-care

Medicaid Works: Citizens Lose when States Opt Out

By Caryn Sever

Beginning in 2014, every state will have the option to expand Medicaid coverage to any adult whose income is more than 133% below the poverty line (a little over $31,000 for a family of 4).  At least 5 states, including Florida, Louisiana, Mississippi, South Carolina, and Texas will choose not to participate. Five other states are leaning towards not participating, and 27 states, including Virginia are currently undecided. This means that the majority of the United States is either not going to participate or is currently undecided about the expansion.  On August 23^rd, The Commonwealth Fund released a blog post explaining why Medicaid works, and what it means for these states to opt out of expansion. “Medicaid Works: Public Program Continues to Provide Access to Care and Financial Protection for Society’s Most Vulnerable” written by Karen Davis, President of the Commonwealth Fund and Kristof Stremikis, a senior researcher for the Commonwealth Fund,  outlines the need and benefits of Medicaid expansion as dictated by the Affordable Care Act (ACA).

According to the new projections released by the Congressional Budget Office, about “30 million previously uninsured Americans will gain coverage by 2022, 3 million fewer than had been predicted after the law was passed but before the Supreme Court decision.”[1] Furthermore, as per the ACA, the primary reason for trimming the annual payments to hospitals under Medicare was to compensate hospitals for the unrecoverable debts of previously uninsured patients. [2] This means that these adjustments will generate billions of dollars to help finance the expansion of coverage. Davis and Stremikis fear that repealing the coverage provisions, while maintaining the reduced payments would render it quite difficult for the hospitals to take on the debt that comes from providing care to the uninsured. “Repealing the law would increase the federal deficit by $109 billion over the next decade.” [3]

All money aside, there is a reason that Medicaid and Medicare exist. In 1965, when President Lyndon B. Johnson signed the programs into law, it was done so in response to meet the health care needs of the elderly and poor. [4] In his introduction of LBJ, President Harry Truman remarked “I am glad to have lived this long and to witness today the signing of the Medicare bill which puts the Nation right where it needs to be to be right.” [5] Johnson himself explained “There are more than 18 million Americans over the age of 65. Most of the have low incomes, most of them are threatened by illness and medical expense that they cannot afford. And through this new law, Mr. President [Truman], every citizen will be able, in his productive years when he is earning, to insure himself against the ravages of illness in his old age.”[6] Now, 47 years later states are debating expansion over an ever growing populous.

States that chose to opt out of the expansion are doing their citizens a disservice in several ways. Not only would the health of their state suffer, but resisting the expansion places a heavy burden state hospitals as well as “keeping the medically underserved community from receiving an enormous economic infusion”. [7] All the evidence points to the fact that expansion will save both the state and federal government’s money so even if certain states choose not to expand, the residents of each state will still be paying federal taxes to cover the expansion of those states that chose to opt in.

The facts stand for themselves, Medicare and Medicaid saves lives. In a study on Medicaid enrollment in Oregon, it was found that participants who receive coverage through the program were able and more likely to visit the doctor than those without coverage. In another study conducted by Harvard’s School of Public Health, it was found that states with Medicaid expansion showed a 6.1 percent decrease in deaths, or roughly 2,840 per year for every 500,000 US adults. [8] The study compared New York, Maine, and Arizona five years before and after expansion while comparing them with four neighboring states that had no Medicaid expansion. The United States Census Bureau recorded the US population in 2012 at 314,226,708 judging by the results of this study that means that Medicaid expansion saved about 1,784,807.70 people per year. This public program is critical to vulnerable populations such as the poor and elderly, who require public programs to survive and thrive. When states opt out the citizens suffer, the burden falls to the population who lose out on building a strong health care system with the funds specifically allotted for this purpose.