Nominee for HHS Secretary Has Had High-Level Jobs at Two Foundations

April 15th, 2014
by Lee-Lee Prina

On Friday, following President Obama’s announcement of health and human services (HHS) secretary Kathleen Sebelius’s resignation, he nominated Sylvia Mathews Burwell as her replacement.

Now director of the Office of Management and Budget (OMB) for the Obama administration, Burwell is no stranger to philanthropy as the New York Times and the Chronicle of Philanthropy’s Philanthropy Today blog reported this past week.

President Obama mentioned Burwell’s work at the Bill and Melinda Gates Foundation, where she was chief operating officer and later president for global development. She then was head of the Walmart Foundation, he added.

Read more about Burwell and her background in my April 1, 2013, GrantWatch Blog “People Post” at the time she was nominated for the OMB post—about a year ago!


Adding Their Voices: What Older Adults Are Saying about Team Care and the Medical Home

April 14th, 2014
by Marcus Escobedo

Foundations, government, and the health care sector are making large investments to reengineer and revitalize primary care, hoping this will improve the cost and quality of health care overall. Primary care practices that use expanded teams to deliver well-coordinated care designed around the needs of patients and families—widely known as patient-centered medical homes—have become the base of this movement.

For these investments to be successful, we at the John A. Hartford Foundation think it is important to target our efforts where these care innovations can reap benefits large enough to make a meaningful difference. The older adult population, with complex needs and higher costs than younger people have, represents the biggest orchard of low-hanging fruit out there. That is why we continue to invest in testing and spreading models of primary care for older adults that incorporate geriatrics expertise. However, we also think we can do as much as we want to and for this (or any) population, but without their input and involvement, we will fail.

To begin incorporating the input of older adults into the current debate about medical homes, we recently released our latest public opinion poll, “On Your Team.” We asked adults age sixty-five and over about their experiences with the expanded team and enhanced services offered through this type of primary care. This survey of 1,107 older adults was conducted January 30 through February 3, 2014, by PerryUndem Research/Communication using Knowledge Network’s nationally representative online panel.

Given the mixed results of medical home studies thus far (supported by many of our colleagues in philanthropy such as the Commonwealth Fund), we think this survey adds to our understanding of this evolving model’s potential benefits and points to the areas of greatest importance to the older patients we are trying to serve.

Through this poll, we heard an important message. Contrary to stereotypes that older adults distrust and resist changes to their health care and don’t trust anyone but their own physician, older adults value team care and other medical home services. Older adults want access to care when they need it (for example, same-day appointments, twenty-four-hour telephone access), coordination between their primary and specialty care providers, and a primary care team (including nurses, social workers, mental health providers, and others) all working off of a plan of care based on the individual patient’s own health goals.

While relatively few older adults receive this type of team care (just 27 percent), an overwhelming majority (83 percent) of those who do receive it report that it has made a difference in improving their health. Even among the many respondents who don’t receive team care now, a substantial majority (73 percent) say they would like to. Also, 61 percent say they believe this type of care would improve their health. About half (48 percent) of respondents who do not currently receive team care say they would change providers if it meant they could get such care. And as the number of medical home services that people received increased, so did their reported level of satisfaction with their care. Read the rest of this entry »

Health Care and Domestic Violence: A Prescription for Prevention

April 8th, 2014
by Bess Bendet

Have you ever filled out a questionnaire at the doctor’s office that asks if you’re a smoker, how many drinks you have per week, or if there’s a history of high cholesterol in your family? Chances are good that you have. What you may not have seen is a question that asks if you feel safe in your relationship.

The way that we screen for smoking, alcohol abuse, and obesity is part of our health care system’s standard model for prevention and intervention. Thanks to early-twentieth-century efforts to halt the spread of disease rather than simply treat it, we’ve made significant strides in reducing illness and eliminating epidemics that used to plague our society. Unfortunately, one epidemic remains: domestic violence.

Currently, domestic violence affects one in every four women in the United States. That’s two times higher than the incidence of breast cancer. Of those affected women, three are murdered every single day in a domestic violence homicide. In addition to the immediate trauma caused by abuse, domestic violence can contribute to a number of chronic health problems, including hypertension, arthritis, high cholesterol, heart attack, and stroke.

The good news is that, like tuberculosis and pneumonia, domestic violence is preventable. And like other scourges on public health, we all have a responsibility to take action.

New national guidelines created under the Affordable Care Act provide an opportunity to integrate domestic violence into our health care system. The law now requires all health plans to fully cover screening and counseling for domestic violence as a standard element of women’s preventive services. So, what’s next? Read the rest of this entry »

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