Access

Healthbeat’s Maggie Mahar uses the data in MedPac’s June Medicare spending report to debunk some of health care’s seemingly unshakable myths. Specifically, she addresses Medicare beneficiaries’ access to physicians; the concentration of our health care dollars; changes, trends and levels of reimbursement; cost-shifting; and the quality-spending-conundrum. She uses the graphs and charts to perform some of her own due diligence -- and some of the results are surprising. Check it out!

We've been posting this week on our New America colleague Phil Longman's new edition of "Best Care Anywhere," which tracks the remarkable transformation of VA care. The VA has its flaws -- but it also has considerable strengths that the rest of the health care system would do well to pay attention to. It uses electronic medical records to closely and effectively track and coordinate patient care. It uses evidence-based medicine. It has team-based care where doctors cooperate and communicate, instead of fragment and confuse. And it has long -- often life-long -- relationships with its patients, meaning investments in wellness and prevention and coordination can pay off. And it measures quality. Longman has been studying and writing about the VA for several years and he has been thinking about how the rest of the health care system can absorb or apply its lessons. Here is one idea he puts forth on how large nonprofit urban community or teaching hospitals -- the "St. Elsewheres" -- can turn themselves into VA-inspired systems.

For years, the debate over health care has rested on the assumption that the uninsured should be brought into the health-care system the rest of us use. But what if something like the opposite is true? What if the best way to help the uninsured is to make the health-care delivery system they already use -- the St. Elsewhere model -- better, more efficient, and more affordable -- in short, more like the VA? And what if, eventually, the rest of us could join that system?

Health information technology, as we’ve said before, is about more than switching medical records from paper to digital. Investing in and implementing health IT is an important part of modernizing and improving care delivery. The Wall Street Journal Health Blog’s Katherine Hobson reports on an innovative example in Colorado.

Aiming to help patients with hypertension keep their blood pressure under control, Kaiser Permanente Colorado turned to a home-based health monitoring system. The system was simple -- a blood pressure cuff with a USB port attached. Patients plug the cuff into a home computer and transmit readings via web to the American Heart Association’s Heart 360 website and a Microsoft HealthVault account. Kaiser pharmacists and doctors upload and review the data immediately to make sure  patients are staying on track. When necessary,  pharmacists adjust the patients’ medication. The early results look promising. The blood pressure of patients in the study declined by an average of 21 mm Hg. Patients in the control group saw a decline of only  9 mm Hg.

How to get the best value out of health care? A recent New America Foundation in California event explored how to answer that question for the people of California (and beyond). Making Reform Affordable focused on actions that the citizens and leaders of California could take to ensure that health care reform promotes affordable high quality care. The event coincided with the release of the California Task Force on Affordable Care report, which includes input from the state's health care leaders to outline how Californians can save $300 billion on health care during the next decade.

Kim Belshè, Secretary of the California Department of Health and Human Services, emphasized that health reform means more than expanding coverage. It must also account for affordability and quality improvement. “This task force is well positioned and well suited to bring an important voice to many of the important implementation matters that will come before our state elected leaders and our policy administrators,” she said.

HHS Secretary Kathleen Sebelius jokes that she’s tired of the letter “H.” H1N1. Haiti. Health Reform. Good thing that the next letter is “I.” As in “implementation.”

Speaking to the Association of Health Care Journalists conference in Chicago, Sebelius outlined some of the first steps HHS, along with Treasury and the Department of Labor, are taking to get health reform up and running. The initial focus includes new regulations for insurers (coverage of sick kids, end of rescissions etc.) and starting the state-based high risk pools. HHS is also reaching out to educate the still-confused public about how health reform can help American families.

(Reposting -- the Take Care Clinics are run by Walgreens)

CVS Caremark a few days ago announced plans to double its in-store Minute Clinics -- and also try to move beyond flu shots and strep tests and do more chronic disease management (diabetes, high blood pressure, asthma etc). Walgreens is eying partnership with a hospital or hospitals regarding future growth of its Take Care Clinics. (For more details on the business end of this, see this Business Week/Bloomberg story or this WSJ blog item.)

Coincidentally -- both I and my colleague Julie Barnes just a few days earlier had our first Minute Clinic experiences, for flu shots and strep throat. Both of us lived to tell the tale. Julie had a bad sore throat on a weekday morning when her regular doctor wasn’t in. She went to the CVS, and yep -- it was strep. She walked right over to the pharmacy counter, picked up her antibiotics, went home. The only minor flaw, she pointed out later, was that although the clinic had the capacity to communicate electronically with her doctor, and her doctor does have electronic medical records, Julie didn’t have the necessary information on her to have the clinic send the information. It will be up to Julie to fill the doctor in on what drug she took, and other relevant information, next time she sees her. And we hope providers soon figure out how to communicate by secure e-mail, but in the meantime Julie knows that she needs to keep the necessary info in her wallet for the future.

Being a woman just got a little bit less expensive.

No, the President didn’t mandate permanent clothing and accessory sales (we wish), but he did sign a bill that would forbid long-standing sex-discrimination practices in the health insurance industry. House Speaker Nancy Pelosi and other women’s health advocates have trumpeted provisions in the legislation that make certain being a woman is no-longer a pre-existing condition.

It isn't just politicians who share hard luck health care anecdotes. I got this one sent to my home e-mail this week, via my youngest child's school. And I'm not even running for office. I have changed the names and biographical details, because being on a neighborhood list serve isn't the same thing as being on a public blog, and I don't know this family. But as you read it, keep in mind this is about a sick five year old, a family WITH insurance, in a middle-class to upper-middle class community where even in a recession, people can afford to help. Think about how much worse it could be. Think of how much worse it is for countless families.

The bipartisan health care summit may be so last week, but before we move on (to reconciliation and House vote counting?) we wanted to just pull out three pieces of the transcript which made an impression on us. Here's President Obama explaining why he came around to believe in the individual mandate. It's important partly because it gets to the essential point of why we have to do comprehensive reform -- piecemeal just doesn't have the answers.

Here's Obama (and no, we haven't seen any comment from Secretary of State Clinton...):

Now, on the mandate, though -- because the mandate issue is connected, and so I'm just going to mention this real quickly, and then I will move on. When I ran in the Democratic primary I was opposed to the mandate.

Guess what's going up again? And not just for Anthem customers in California.

HHS Secretary Kathleen Sebelius released a new report, aptly called, Insurance Companies Prosper, Families Suffer: Our Broken Health Insurance System. (You can watch the press conference video, here). The report describes health insurance premium spikes in states across the country, specifically Michigan, Connecticut, Main, Oregon and Rhode Island.

The report was released shortly after Anthem Blue Cross of California, an insurance company owned by the for-profit company WellPoint, Inc., stated its individual market premiums would increase by 39 percent over the next few months despite WellPoint’s $2.7 billion profit in the last quarter. (After bad press and government inquiries, the scheduled increase was postoned until May 1, 2010.)