Friday, February 28, 2014

Affordable Care Act and the Alliance

Between September 30, 2013 and February 23, 2014 the Health Promotion Advisers at the Alliance spoke to 15,862 consumers about what the Affordable Care Act means to them.  There were many important lessons but the top ten were:  
  1. All consumers know that insurance is important to have.
  2. The state you live in makes a huge difference.
  3. Consumers like to know what are all of their options.
  4. Technology is a great tool but it is not enough.
  5. Mobile platforms are essential.  
  6. If you have never had health insurance, or even if you did, the language of insurance is confusing.
  7. Comparisons based solely on monthly cost is the wrong way to make a selection.
  8. Co-pays should be more accurately described as "you pay"
  9. Coverage for mental health needs to be upfront.  
  10. Conversations with an informed and trusted source are key.

Wednesday, July 10, 2013

Devious Maids is an Insult to Everyone

Raul Reyes' commentary in USA Today is on the mark http://www.usatoday.com/story/opinion/2013/07/09/devious-maids-latinos-tv-show-column/2461193/.  The new show "Devious Maids" should go into television oblivion.  While it is an adaptation of a novela (Spanish soap opera) the producers overlooked that in the Spanish original all the characters were Hispanic. That makes for a very different story line. The producers even missed in the translation of the title which in English would be, "They are the Joys of the Home."  

Just as damaging are the defensive statements that the story of the maids should also be told. Huh? It is not their story that is being told and most important of all the story where Hispanics are maids has been told so many times.  This type of show only reinforces stereotypes. 

We need other stories about Hispanics and there are plenty of good ones still waiting to be told.

Thursday, April 25, 2013

Coca-Cola Joins BIO

I was reading today's POLITICO Influence that I receive by email when I was surprised to read: "COCA-COLA JOINS BIO: Coca-Cola Company has joined the Biotechnology Industry Organization. The trade group is expanding its multinational members. The group also added Scott Vitters, general manager of the PlantBottle Packaging Platform for Coca-Cola Company, to its Industrial and Environmental Section Governing Board."

Expanding its members?  When I looked at the webpage for BIO it indicated that it was the world's largest biotechnology organization http://www.bio.org/articles/about-bio.  Now that is what I call expansion.


Tuesday, March 26, 2013

Freedom is Not About the Size of a Sugar Sweetened Drink


Today, the Alliance was the lead signatory on an amicus (friend of the court) brief filed in the NY Appellate Division of the Supreme Court supporting the NYC Board of Health’s (BOH) public health rationale and authority to limit serving sizes of sugar sweetened beverages to 16 ounces in New York City food service establishments. The brief filing comes two weeks after a lower court ruled that the NYC BOH policy could not be implemented following a court challenge organized in part by the beverage industry.

While we were able to have many signatories to our Amicus Brief what was most interesting and challenging were all of those organizations that should have immediately signed on and who were silent.  If you are concerned about wellness and health promotion then you should be focused on those actions that support people be healthy.  

Instead what we found was that trigger words were thrown around to invoke a knee-jerk response but were often devoid of content.  The refrain that people's "freedoms" were being attacked seem not only misguided but made light of the very concept of freedom.  More than anything it is very sad to see the effect of financial pressure placed on organizations to make decisions that are contrary to their espoused mission.

It is a reminder that decisions based on integrity are priceless.

Friday, February 8, 2013

Forget about pay for performance (P4P)

The principles of behavior modification demonstrate the importance of incentives. What is also well documented is that extrinsic rewards, i.e., financial incentives, have limited impact on complex behaviors.  Moreover, extrinsic rewards are most effective with young children. 

Consequently, based on the science of human behavior P4P would result in the desired performance in very limited settings and situations. We should not be surprised by the outcomes that we have experienced by applying P4P to health care...more money is not the answer.  




http://content.healthaffairs.org/content/31/9/1932.abstract?sid=6eb2c26a-18b9-4a35-a1cc-5b44b41c8ca2

Thursday, February 7, 2013

When Setting Targets Misses the Mark

The solution to the problems we face in health care are frequently reduced to one sentence pronouncements.  National health care is put forth as the best answer and in the same breath the National Health Service, a la British model is lauded as the way to go. And while that model may have elements we may want to adopt (home visits for parents of newly born infants) we also need to be well aware of its failures.

Today's New York Times on Page 9 describes the recent report which looked at conditions at Stafford Hospital in England from 2005 to 2009 where care became so negligent that, "...patients left unbathed and lying in their own excrement and urine..patients left so thirsty that they drank water from vases..."  It seems that they were trying to meet health service targets and balance the books. While many of the senior managers were let go, the top regional person is now at the helm of the National Health Service in England and it seems that no one lost their license because of the way patients were treated.

There are many lessons to be learned from Stafford hospital.
http://www.nytimes.com/2013/02/07/world/europe/hospital-report-cites-appalling-suffering-in-staffordshire.html

Wednesday, September 5, 2012

Epilogue: Case Study Ellen—Good Policy is Not Enough

These last few months have been so intense.  I have seen health care providers who struggle as they try to care for patients while others acted as if caring for a patient was a burden.  It was at the point of patient care that I saw the greatest variability in how someone was treated.  

I remember the nurse in the step-down unit who had said that the IV should be changed every 72 to 96 hours and became annoyed that after 96 hours I asked how come the IV had not been changed.  Her response was that she was dealing with more pressing patients and she would get around to it.  It was clear that the needs of the individual had become either dominated or subservient to some benchmark or target. This is not the health care any of us want or deserve.

As all this occurred I contacted the leadership at Georgetown University Hospital and they were responsive to my many concerns.  They  made it clear that the policies they had developed had not been followed.  All were apologetic and all apologies were accepted but the bottom line is that the patient suffered and died.