The Users' Guide to the Health Reform Galaxy

Teaming Up to Improve Care of Diabetes Patients in Minnesota

As Congress and the president figure out their next steps on national health care reform, we want to continue shining a light on local laboratories of reform. Here, Bruce Siegel, director of the Robert Wood Johnson Foundation’s Aligning Forces for Quality initiative and the RWJF legacy program, Expecting Success: Excellence in Cardiac Care, writes about the effort to encourage high-performing health care providers in the Land of 10,000 Lakes.

Quality reformers have a mantra: You can’t improve what you don’t measure. But in Minnesota, the local team that the Robert Wood Johnson Foundation tapped to manage its Aligning Forces for Quality initiative, also knows you can’t lose weight by just standing on the scale. You have to act on what you learn.

The Foundation’s grantee, Minnesota Community Measurement, operates the scale. Its HealthScores project gathers performance data from Minnesota health plans as well as 300 medical clinics statewide. But it is part of a multi-pronged action team that is driving change in Minnesota by helping providers improve on their performance and then rewarding them when they do.

'Bending the Cost Curve' by Tackling Overuse of Diagnostic Imaging

Bruce Siegel, director of the Robert Wood Johnson Foundation’s Aligning Forces for Quality initiative and the RWJF legacy program, Expecting Success: Excellence in Cardiac Care, examines how some communities are using evidence-based  guidelines to rein in a conspicuous source of health care overspending. This post is part of our continuing effort to shine a light on local laboratories of health care reform.

If you look closely in Aligning Forces for Quality communities, you can see how local laboratories are grappling with some of the most vexing delivery issues in health care. And there is probably no more vexing issue than overuse of health services—an issue that has figured prominently in the health care debate as Congress and the president wrestled with the question of how best to control costs.

Dartmouth researchers have estimated that as much as 30 percent of health care spending is for care that doesn’t improve people’s health—and don’t just take their word for it. Thompson Reuters came out with a new study last October attesting to the reasonableness of this estimate.

Diagnostic imaging, especially when it involves lower-back pain, is one case drawing the attention of overuse detectives. Lower-back pain is the fifth-most-common reason Americans see a doctor, and the common use of expensive imaging technology to diagnose it has become controversial. For more than a decade, guidelines for treating lower-back pain have recommend delaying imaging use for most patients because their backs typically get better, and their pain often subsides, within a month. A recent study published in Health Affairs took a look at the relationship between the supply of MRI machines, and their use for lower-back pain. Surprise, surprise: The researchers found “a clear relationship between MRI availability and MRI use for low back pain patients.”

Hat Tip to Emergiblog, the Life and Times of an ER Nurse

Head over to Emergiblog for this week’s Grand Rounds – the LOL Edition, a collection of medblog posts complete with accompanying “Lolcats” and “kittehs." This week's overview includes a post from our very own Susan Hassmiller about the importance of recognizing nurses as health reform leaders.

The Wisdom of Crowds?

David Colby, vice president of research and evaluation, writes about what you, our readers, selected as the most influential articles funded by the Robert Wood Johnson Foundation last year.

In December, we asked the public to vote on the most influential articles funded by the Robert Wood Foundation in 2009.  It was our second effort to draw outside feedback into our Year in Research process. What do you think about the wisdom of the crowd?  Did the crowd miss important articles or themes?  Did the Foundation miss funding some important articles?  Please join the discussions by posting your thoughts and comments below.

The articles receiving the most votes in 2009 are:

• Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons with Severe Alcohol Problems;
• What Newly Licensed Registered Nurses Have to Say About Their First Experiences;
• A Closer Look at the Economic Argument for Disease Prevention;
• Association Between School Food Environment and Practices and Body Mass Index of U.S. Public School Children;
• Geographic Variation in Public Health Spending.

The wisdom of which crowds?  Last year, my picks and the picks of our readers were different. Last year, the picks of the nation and those from inside the Beltway were different. This year, the picks of single article voters and those who voted for more than three articles were different. Those who voted for more than three articles chose:

• A Closer Look at the Economic Argument for Disease Prevention;
• Association Between School Food Environment and Practices and Body Mass Index of U.S. Public School Children;
• Geographic Variation in Public Health Spending;
• Slowing the Growth of Health Care Costs - Lessons from Regional Variation;
• What Does It Cost Physician Practices To Interact With Health Insurance Plans?

Now you’ve seen the full results of the poll, I would love to hear from you about the crowd’s choices and our process. 

Prevention - An Impetus for Moving Health Reform Forward

Jeffrey Levi, executive director of Trust for America's Health, writes about how strong public support for expanded disease prevention programs could help jumpstart the legislative process. This column first appeared in Huffington Post.

As we turn the page to the next stage of debates around health reform, we should remember there is a whole lot in the current Senate and House bills that is popular, already in close agreement, and could be the impetus for moving forward.

The prevention and wellness sections of the bills could help do just that.

A public opinion survey released in November 2009 by Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) found that disease prevention is one of the most popular parts of health reform. In fact, 71 percent of Americans favor an increased investment in disease prevention.

Investing in disease prevention receives majority support from across the political spectrum (85 percent of Democrats, 59 percent of Republicans, and 68 percent of Independents) and across the country (72 percent in the Northeast, 73 percent in the South, 71 percent in the West, and 69 percent in the Midwest), according to the poll, conducted by Greenberg Quinlan Rosner Research and Public Opinion Strategies.

Call to Action: Tapping Nurses' Leadership and Expertise

Susan Hassmiller, senior adviser for nursing at the Robert Wood Johnson Foundation, writes about the need for nurses to be full partners in reforming the health care system and improving patient care.

There’s image and there’s reality, and the two are not the same where nurses are concerned.  Nurses are seen as trusted, caring, compassionate, skilled health care providers. But that image doesn’t fully capture the reality of the roles nurses play in our health care system, which are much more extensive, substantive, pivotal and robust. 

Today, the Robert Wood Johnson Foundation and Gallup are releasing an unprecedented survey of 1,500 opinion leaders that provides insight into what we need to do to ensure nurses’ place at the decision-making table—and to give health reform every chance to succeed. In many ways, the  two objectives are inextricably connected.

For years, nurses have come out on top of Gallup’s annual poll of most trusted professionals. It’s a truism that the public trusts nurses. But this survey goes deeper. It finds that diverse opinion leaders—including those in insurance, health services, government, industry and academia—say that nurses should have more influence on health systems and services. 

Addressing the primary care workforce shortage to come

Deanna Okrent, senior health policy associate with the Alliance for Health Reform, writes here about a predicted shortage of primary care providers to treat a larger pool of insured Americans.

With the prospect that an additional 31 million Americans may gain insurance coverage under national health reform, many warn there may be too few primary care providers to treat them. 

Following enactment of reform in Massachusetts -- a state often studied to help inform the current debate -- increased demand for primary care led to longer waits for medical appointments and unmet needs for some types of care.  This may have been the result of pent-up demand from previously uninsured individuals. In a May 2009 paper on health reform in Massachusetts, Sharon Long notes that this demand is expected to stabilize as people have coverage for a full year and longer.

Many predict a similar phenomenon after national reform is implemented.  A contributing factor is the declining interest in primary care as a professional goal. Far fewer medical graduates entered residencies in family medicine and internal medicine in 2009 than they did in 1999. Among the reasons graduating physicians choose specialties and subspecialties over general practice are: 1) their large educational debts and  2) the relatively low compensation of primary care physicians, which means it takes longer to pay back that debt.