Health Affairs

As my work week draws to a close, I have put together a quick listing of some foundation-related posts that I think you might want to check out. If your foundation has a blog about health care and it is not listed on GrantWatch Blog’s Blogroll, let me know about it!

Disparities in Health:

“Poll Finds Disparities in How Californians View Their Health,” Daniel Weintraub, Feb. 9, on California Health Report. The poll described was funded by the California Endowment.

Environmental Health:

“Green and Healthy Homes Initiative Means Healthy Kids, Quality Jobs, Stable Neighborhoods,” Ruth Ann Norton of the Coalition to End Childhood Lead Poisoning and the Green and Healthy Homes Initiative, Feb. 1, on the Council on Foundations RE: Philanthropy blog. Read about this initiative funded by the Open Society Foundations.

Global Health:

“Uncommon Rewards,” Orin Levine of Johns Hopkins University, Feb. 11, on the Bill and Melinda Gates Foundation’s Foundation Blog. Levine discusses some good news: “This year marks the first time ever that children in the world’s poorest countries will have access to the same pneumonia vaccines as children in the USA, and on the same timeline.” The GAVI Alliance—The Global Alliance for Vaccines and Immunisation, which receives support from the Gates Foundation, and other donors are helping to make this happen. (This post was originally published on the Huffington Post.)

Health Care Delivery/Specialty Care to Underserved/Telehealth:

“Despite Political Uncertainties, An Emerging Model Shows Health Care Transformation Is Possible,” John Lumpkin of the Robert Wood Johnson Foundation (RWJF), Jan. 3 on the RWJF’s Pioneering Ideas blog. This post focuses on Project ECHO (Extension for Community Healthcare Outcomes), an RWJF grantee, located in Albuquerque. Lumpkin notes that Project ECHO “offers not only a new way of providing health care services and education but a new way of addressing a host of problems that have plagued our health care system for many years.” Susan Promislo at the RWJF told me today that this week the foundation posted a new video on Project ECHO; check it out here.

Health Care for the Elderly:

“A Growing Repository of Knowledge,” Rita Jablonski of Pennsylvania State University, Jan. 27, on the John A. Hartford Foundation’s health AGEnda blog. Jablonski discusses POGOe (Portal of Online Geriatric Education). In 2004 the Donald W. Reynolds Foundation, based in Las Vegas, funded creation of what is now “a free public repository of a growing collection of over 400 geriatric educational materials.” POGOe is now integrating materials from the Hartford Geriatric Nursing Initiative. The funding guidelines for the Reynolds Foundation’s national program on Aging and Quality of Life say that “this initiative is driven by invitation only.” Read more here.

Health Information Technology (IT):

“President Obama Points to Personal Health Information Downloads,” Markle Foundation’s Connected World Blog, Jan. 27. This post concerns Obama’s remarks in his State of the Union address.

Health Reform:

“State’s Health Reform Implementation Plan a Must Read for Legislators,” Matt Sundeen, senior program officer for health policy at the Colorado Trust, Jan. 26, on that funder’s Community Connections blog.

“Student Health Plan Enrollees to Gain New Protections under Affordable Care Act,” Sara R. Collins of the Commonwealth Fund, Feb. 11, on the Commonwealth Fund Blog. Read about new regulations for these plans offered by colleges and universities.

Obesity Prevention:

“Obesity Epidemic Threatens Colorado’s Health, Economy,” Kelly Dunkin of the Colorado Health Foundation, Feb. 10, on the foundation’s Health Relay blog.

Philanthropy News:

“Catalytic Philanthropy: Investing in Policy Advocacy,” Ashley Allen of the Endeavor Group, a consulting firm, Feb. 11, on the Foundation Center’s PhilanTopic blog. Allen discusses how foundations can “maximize and leverage their investments. . .to drive social change.” She provides three examples of “effective advocacy campaigns”—all having something to do with global health.

“Health Is About People, Not Patients,” Chuck Reyman of the Colorado Health Foundation, Jan. 18, on the foundation’s Health Relay blog. Reyman discusses a change in vocabulary at this Denver-based funder.

Substance Abuse/Global Health:

“Methadone as a Human Right,” Kathleen Kingsbury, Feb. 16, on Open Society Foundations Blog. Kingsbury, who is a program officer in the Open Society Public Health Program, discusses “opiate substitution therapies,” such as methadone, which can treat addiction to heroin and also can help to prevent HIV infection. Such therapies are forbidden by law in Russia, which has many heroin addicts and “one of the world’s fastest-growing HIV/AIDS epidemics,” she states.

Lagniappe (a little something extra, as they say in Louisiana):

Health Professions Workforce:

“Primary Care: Addressing Workforce Attrition,” Vanessa Hurley of New America Foundation (a public policy institute, not a philanthropic foundation), Jan. 26, on New America’s The New Health Dialogue blog.

Medicare and other entitlement programs are back in the news in the coverage of President Barack Obama’s Fiscal Year 2012 budget, which was released this week.

In this post, I mention a selected sampling of recent foundation-funded efforts on Medicare.

Recent Publications:

DataBrief:

The SCAN Foundation and Avalere Health say that low-income Americans who qualify for both Medicare and Medicaid (“dual eligibles”) are more than twice as likely to use the emergency department of a hospital than Medicare-only beneficiaries. According to a new DataBrief from the two organizations (which, for this point, cites Henry J. Kaiser Family Foundation [KFF] research), duals also are more than twice as likely to have a mental illness than the Medicare-only crowd. Dual eligibles, who are “among the sickest and costliest patients” in the U.S. health care system, the brief says, are twice as likely to use a skilled nursing facility or a hospice as people with Medicare only. The brief, which uses 2008 Medicare claims data, suggests that higher service use by dual eligibles than by Medicare-only beneficiaries could be caused in part by lack of care coordination between the Medicare and Medicaid programs. Read more in this one-pager about duals’ use of services and how the Affordable Care Act of 2010 addresses the challenges of paying for the care of this population. The brief, “Dual Eligibles—Health Services Utilization”, was released Feb. 3.

Primer:

People often talk about the effects of the baby boomers getting on Medicare. However, the authors of a new primer published by the KFF note, “The contribution of increased enrollment and an aging population” to increasing Medicare spending “is modest” compared with the “effects of rising health care costs.”

As Congress and the Obama administration focus on the federal budget deficit, many policy experts and several bipartisan deficit-reduction panels have proposed major changes to Medicare to decrease federal spending and address increasing health care costs, the KFF commented in a Feb. 15 e-alert. Thus, this operating foundation’s new online publication, Medicare Spending and Financing: A Primer, February 2011, is timely indeed. The foundation cites research from a number of sources and pulls it together in a clear and informative way. Here are some nuggets from this primer by Lisa Potetz of Health Policy Alternatives and Juliette Cubanski and Tricia Neuman of the KFF.

• Ever since Medicare was enacted (in 1965), spending on this large federal program “has grown steadily, as measured in absolute dollars, as a share of the federal budget, and as a share of the gross domestic product (GDP), and these trends are expected to continue.”

• However, the authors say, Medicare spending is projected to grow more slowly (about 6 percent a year) during the decade ahead, compared with the average annual rate of growth between 1985 and 2009.

• Costs of administering Medicare have stayed low over the years—less than 2 percent of program expenses, the authors note.

• Ever wondered just how Medicare is financed? See the authors’ explanation on pages 7–8 of the primer.

• Medicare financing projections are “always uncertain,” the authors caution, because the U.S. economy and the U.S. health care system are complex.

• The authors of this well-written report say in conclusion that policy on Medicare will be shaped as much by concerns about the size of the federal budget deficit and national debt as by worries about Medicare’s financial sustainability.

Policymakers have their work cut out for them: They need to find “cost-reducing strategies that sustain or improve quality of care, and possibly new sources of revenue as well, while balancing the needs of beneficiaries, taxpayers, and health care providers,” the authors say in summary. A Herculean task, I would say!

Related resources:

“Are You Paying Your Fair Share for Medicare?” Gene Steuerle of the Urban Institute, in the “Government We Deserve” series of periodic commentaries, published by the Tax Policy Center of Urban and the Brookings Institution, Jan. 6. The center receives funding from numerous foundations including the Annie E. Casey, Ford, Bill and Melinda Gates, John D. and Catherine T. MacArthur, Nathan Cummings, Rockefeller, and Smith Richardson Foundations. Steuerle is a former vice president of the Peter G. Peterson Foundation.

“The Federal Budget: Fiscal Year 2012—Budget Overview,” White House, Office of Management and Budget (OMB), February 2011. President Obama’s budget released this week pays for the first two years of the so-called doc fix—which would prevent a big cut in Medicare physician-reimbursement rates. That fix will be paid for “with $62 billion in new, specific health care savings,” the document says.

The Kaiser Family Foundation website’s Medicare section is chock full of information. See, for example, a Dec. 2010 issue brief titled “Income-Relating Medicare Part B and Part D Premiums: How Many Medicare Beneficiaries Will Be Affected?” This short publication focuses on provisions in the Affordable Care Act that call for higher-income Medicare beneficiaries to be charged more for their monthly Parts B and D premiums. The authors, who are with either KFF or Actuarial Research Corporation, point out that the income thresholds ($85,000 for an individual and $170,000 for a couple) that trigger the higher premiums “are substantially lower than the thresholds often used to define higher-income individuals in other policy discussions,” and that could be a problem for some folks.

Also, see the KFF’s Medicare and Prescription Drug Plan Tracker. The tracker, which includes 2011 updates, lets site users monitor trends for Medicare Advantage plans since 1999 and for Medicare prescription drug plans since they began in 2006, according to a Jan. 26 e-alert. Confused about the difference between those types of plans? Just go to the Web page’s “Start with a Topic” and slide your computer mouse over either term. A handy explanation of both types of plans, which I will not repeat here, pops up!

Obama: Tax Cut Deal Not Perfect, but Worth Passage,” Ben Feller, Associated Press (AP), on WTOP.com, Feb. 15. Feller reports on Obama’s news conference where the president said directly that tougher decisions on the country’s biggest expenses (Medicare, Medicaid, and Social Security) will have to be grappled with by Republicans and Democrats together, not by directives from the White House.

“Obama’s Health Care Budget: ER Visit but No Cure,” Ricardo Alonso-Zaldivar, AP, on WTOP.com, Feb. 14. This article on how Obama’s FYI2 proposed budget will affect some federal health programs mentions staving off that Medicare doc fix (see above). However, the president’s budget is “largely silent” on big cuts to the major entitlement programs, such as Medicare and Medicaid, Alonso-Zaldivar says. Also, economist Alice Rivlin, a former vice chair of the Federal Reserve Board and a former member of Obama’s deficit reduction commission, comments in the article: “I believe that the president, probably as a tactical move, did not propose changes in the big entitlement programs.” She adds, “He wants to work that out on a bipartisan basis with the Congress.” One thing leading to Republicans’ taking back a majority in the U.S. House of Representatives was their “unrelenting criticism” of the Accountable Care Act’s cuts to Medicare, the article also notes. Many Republicans, though, want even more “sweeping changes” to Medicare, such as converting it to a voucher plan in which older Americans would receive a fixed payment for their health care, Alonso-Zaldivar states.

SCAN Foundation and Avalere Health, “New Resources to Improve the System of Care for Dual Eligibles,” Feb. 3 Webinar on improving care for low-income Americans eligible for, and enrolled in, two public programs—Medicare and Medicaid. View the event in its entirety.

Peter G. Peterson Foundation: Visit its website for information on fiscal challenges facing the United States, including those related to health care. This funder seeks “long-term solutions that transcend age, party lines and ideological divides in order to achieve real results.”

“Health Policy Brief: Paying Physicians for Medicare Services,” Health Affairs, Updated Dec. 16. Funded by the Robert Wood Johnson Foundation. Consultant Mark Merlis is the author of this brief, which concerns the one-year “doc fix” that Congress enacted in late 2010. The fix prevented a reduction in Medicare physician-reimbursement rates.

“Why Are Medicare’s Innovations More Secret than the Joint Strike Fighter?” Chris Langston of the John A. Hartford Foundation on its Health AGEnda blog, Jan. 20. Langston describes the inordinate amount of time he spent trying to get information on a Medicare demonstration project being conducted at Massachusetts General Hospital. He comments that not only are we doing too few demonstration projects on innovations in Medicare, as compared with those in commercially insured programs and populations, “but we are making it really hard to find out about those few we have.” New leadership at the Centers for Medicare and Medicaid Services (CMS) seems to be interested in “being more transparent” and learning while improving care, he comments. In conclusion, Langston says that he hopes that CMS will try “to more fully share the knowledge that we as taxpayers have already purchased.” By the way, the joint strike fighter is some sort of “super secret” military aircraft, in case you don’t follow U.S. Department of Defense matters!

At the end of each year, Robert Wood Johnson Foundation (RWJF) staffers look at research published during the past twelve months and choose several peer-reviewed articles that the staff deems to have “had major impact on research or influenced the field,” according to the foundation’s web site. All articles on the list are written by RWJF grantees.

In late 2010 the foundation nominated twenty articles “based on their RWJF Web site popularity.” Next, the foundation asked its web site visitors to help select, via an informal poll, “the five articles representing RWJF’s Most Influential Research Articles of 2010.”

Well, we at Health Affairs journal are pleased to report that two of the top-five articles on this list, released last month, were published in our pages!

Coming in at number 2 was “Federal Food Policy and Childhood Obesity: A Solution or Part of the Problem?” by Rachel Tolbert Kimbro of Rice University and Elizabeth Rigby of the University of Houston. This article was published in Health Affairs’ March 2010 edition, a thematic issue on child obesity.

As you likely know, the RWJF has a big program area on childhood obesity prevention.

Number 5 on the list was “The Role of Nurse Practitioners in Reinventing Primary Care,” by Mary D. Naylor of the University of Pennsylvania and Ellen T. Kurtzman of George Washington University. Health Affairs published this article in its May 2010 edition, a thematic issue on “Reinventing Primary Care.”

Read here about the RWJF’s funding efforts related to nurses (and other health care professionals), under its Human Capital program area.

Read about the other three articles on the top-five list. Two of those articles appeared in Preventing Chronic Disease: Public Health Research, Practice, and Policy (a journal published by the Centers for Disease Control and Prevention), and one was in Pediatrics (online).

Comments about the winners or suggestions about how to improve next year’s competition? Contact David C. Colby, RWJF vice president, research and evaluation, via Twitter: @DavidCColby.

Below, we have listed the three most-read posts. Take a gander in case you missed one of them when the original tweet or e-alert was sent out. Make sure to read the comments on two of the posts, and add your own, if you are inclined to do so!

1. “The Robert Wood Johnson Foundation and Its Mastery of Social Media,” by Hope Leman (Jan. 25, 2011).

Heading the list is a post by Hope Leman, a Web administrator at Samaritan Health, out in Oregon, and a GrantWatch reader. She is online much of her work-day and writes about the innovative work that the Robert Wood Johnson Foundation is doing. It is funding health technology projects, and its staff is using social media in their daily work. We would guess that is the most popular GrantWatch Blog post thus far (since the blog began in March 2010)! We learned that social media is a popular topic!

2. “Mental Health Care: What Have Foundations Been Funding in this Area?” by Lee-Lee Prina ( Jan. 13, 2011).

Next on the list is a post on what foundations around the United States have been funding in the area of mental health care. I wrote it shortly after the shootings in Tucson, Arizona, at a time when mental illness was on the minds of many. There are descriptions of grant results, publications, and a new initiative on mental health. I also list some interesting resources to read that I came across.

3. “Patient-Centered Care: A Grantmaker Relates an “Eye-Opening” Personal Experience,” by Lee-Lee Prina (Jan. 18, 2011).

The third most-popular post focused on another post that I saw on a foundation’s blog. A foundation staffer whom some of you know, I am sure, wrote a post (which I link to) about her experiences in the health care system after being diagnosed with Stage 4 cancer. Read about this beautifully written and courageous post in which the author says that, in her opinion, “patient-centered care” (a phrase we hear so often) was lacking. I also have a list of links to some Health Affairs articles on patient-centered care.