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.

Reform's secret weapons: quality measures and the nurses who act on them

Valerie Overton, a nurse practitioner at the Fairview Rosemount Clinic in Rosemount, MN, writes about how nurses are helping clinics improve their quality scores and saving lives along the way.

Measuring and publicizing the quality of health care in communities is crucial to reforming our dysfunctional health care system because it forces doctors and hospitals to improve the care they deliver. A recent Wall Street Journal article showed how this is happening in my state, Minnesota, thanks to the efforts of an organization called MN Community Measurement (MNCM).

Nurses are key players in the reforms unfolding here. As the article rightly noted, doctors “started letting nurses call patients back in if the physicians forgot to order tests during a visit.”  But at Minnesota’s Fairview Rosemount Clinic, where I work, we don’t wait for Twin City-area women to come to us. We write them urgent reminders to get Pap, breast and colon check-ups as well as talk face-to-face about screening. 

Those calls can save lives. Just ask Jean Shanley and Amanda Franco.

Shortage of frontline health-care workers poses challenge to reform

Maria Flynn, director of Jobs to Careers, writes that the millions of health care workers on the front lines are key to the success of health reform - but they have been mostly absent from lawmakers' discussions.

As representatives on both sides of the aisle battle over the fine points of health care reform, the debate focuses primarily on the scope and cost of proposed changes.  Few on the Hill seem aware that one of the greatest challenges to achieving affordable, accessible health care is the persistent and severe shortage of frontline health-care workers.

There’s no doubt that increasing the number of primary-care physicians and nurses is needed to improve care. But the five million health aides, medical assistants, laboratory technicians and other workers who make it possible for the nation’s hospitals and clinics to operate nearly round the clock are also in increasingly short supply and in need of opportunities to increase their skills and education.

Public health nurses help make prevention actually happen

By Susan Hassmiller

In this year’s run at major health reform, I find it encouraging that the debate has widened, rather than narrowed.  Meaning, policymakers are not just discussing how to reform our health care system—they are also discussing how policies that affect people’s lives inside and outside the care system can help make us healthier.  Therefore, the concepts of “prevention” and “public health” are finally becoming more familiar—even to the public, as a recent poll showed that voters ranked prevention as the top health reform priority.

But if health reform legislation truly ends up shifting the paradigm of how we think about health and health care—if we start seeing policies that emphasize prevention as much as the disease—then we will also need to figure out who will be doing what under the new paradigm.  In all of the discussions about the proposed ideas for paying for and delivering health care, there is very little discussion about how the health and health care workforces might need to adapt along with these changes.