William N. Werner, MD, MPH
Updated President’s Message – August 2012
“Where Do We Go From Here”
I was recently asked by a church group to talk about the impact of health care reform on the average person and “where do we go from here.” In light of the recent Supreme Court decision on the constitutionality of PPACA, I launched into a discussion of Medicaid expansion, Health Insurance Exchanges and Accountable Care Organizations along with the preliminary timeline for their implementation. I could sense that I had lost the audience somewhere around value based purchasing. Finally, a nurse asked if I knew anyone who had read the entire 2000-plus pages of the legislation. Guess what – I don’t.
There are many aspects of health care reform legislation and implementation that remain ill-defined and unknown. But the nurse’s question got me thinking about how we will be able to measure the success of healthcare reform. Will it be in the number of newly covered lives, improved access to care, better health outcomes or reduced costs? Are the metrics in place to measure such change? What happens if the current gridlock in Washington, DC continues and the current reforms are stalled or even repealed? If so, what will be replaced? One certainty is that the November 2012 election is promising to be a national referendum on health care reform.
Another person spoke up during my presentation, wanting to know “how do I get health insurance right now?” It has become apparent to me that there is a general lack of knowledge about the actual components of the PPACA, the timeline for its implementation and how people will access coverage. If health care reform is to be successful, I believe there needs to be an educational outreach to the American public, including health care professionals. Who will provide the factual information for the average citizen, unfiltered by political bias and in understandable terms? Nationally this is being done by major national health care foundations, like the Kaiser Health Care Foundation, Commonwealth Foundation and Robert Woods Johnson Foundation, as well as national foundation associations, such as Grantmakers in Health. The links to all these organizations can be found on our website at www.wshf.org.
What can the Chicago area foundation community anticipate as health care reform evolves over the next several years? As additional people have health insurance coverage, will there be an adequate supply of the health care work force and facilities? I think it is safe to assume that there will be a need to fund pilot program models dealing with the best way to provide for the expansion of community based health care. Clinics will need to be staffed and outfitted with equipment and supplies. Pilot programs will test innovative and novel methods of delivering health care. Imagine how many different “flavors” of medical home models could exist. The infrastructure to connect community clinics needs further refinement, especially if electronic medical records are to be the “glue” holding networks of providers together.
There is a clear need to develop pilot programs to find additional resources and new methods of training the health care providers, from clinical care technicians to nurses to primary care doctors. We are already seeing shortages, along with the perennial misdistribution of the health care work force. Will health care professionals be encouraged or required to practice “at the top of their license?”
However, one thing may be certain in regard to these health reform challenges. Local foundations, like Washington Square, can help to fund the pilot programs to test potential solutions; however, they cannot fund the actual provision of health care based on any new models of care. There simply is not enough money to do that in the entire philanthropic world . Funding of the actual care under PPACA remains a contentious issue.
Finally, the solutions to these questions and concerns will get played out over the next several years, depending on the public’s acceptance of the PPACA, its affordability and effectiveness in achieving the goals of substantive health care reform. The real answer to the question “where do we go from here” may be “how do we know when we get there?” Well-designed pilot programs should have measurable goals based on the objectives of PPACA.
William N. Werner, M.D., M.P.H., F.A.C.P
President
The Gathering Storm – January 2012
Sir Winston Churchill’s first volume on The Second World War is titled The Gathering Storm. That seems to me to be an apt description of the current atmosphere in health care.
Scanning the horizon we see:
- the historic and controversial Patient Protection and Affordable Care Act of 2010 which now is in the hands of the US Supreme Court,
- a slow recovery from a deep recession,
- threats to cut funding for the Medicare and Medicaid entitlement programs while, at the same time, expanding the number of individuals covered by Medicaid,
- shortages of essential pharmaceuticals,
- lack of primary care practitioners; and
- inadequate support for the education of health care professionals.
Are we witnessing the collapse of the American health care system or a call to arms to defend what is working and reform what is not? And while we may not be facing the cataclysm of a world war, it is clear that the current health care system of delivery and payment is not sustainable.
A recent study by The Commonwealth Fund highlights some of the challenges that local communities face in providing effective and efficient health care services. A “scorecard” with comparative data for various regions in the United States tracked 43 indicators across four dimensions of access, prevention and treatment, costs and potentially avoidable hospital use, and health outcomes. It is not surprising that wide variations exist and that location matters when assessing access and care experiences.
What I found disturbing was how poorly Chicago performed on a variety of health indicators. Chicago and Blue Island are in the bottom half of areas overall and in the bottom quartile for avoidable hospital cost and use. In contrast, the Evanston and Melrose Park communities score in the top half of all regions of the country and are in the top quartile for prevention and treatment and health lives. The study also reports that deaths from potentially preventable causes with timely and effective health care ranged from 77 per 100,000 in Melrose Park to 117 per 100,000 in Chicago. Less than 40% of older adults in Chicago receive recommended preventive care.
The report concludes that, regardless of a population’s income level, variations in how local health care systems are organized and care is delivered make a difference, especially in terms of cost of care and potentially avoidable use of expensive resources. There are opportunities to improve care coordination and strengthen primary care access, improve quality and reduce costs. And socioeconomic factors such as high poverty rates are associated with some but not all areas of health system performance. It is recommended that resources need to be targeted to impoverished communities through community health initiatives.
What is abundantly clear is that the health care “safety net” for the Chicago area’s uninsured and underinsured citizens is in danger of collapsing. Because of governmental funding cuts and increasing utilization of emergency room services due to lack of access to primary care, WSHF has seen an increase in the number of safety net hospitals, clinics, agencies and services seeking operational funding through grant requests.
The Foundation’s Board has devoted the last several years concentrating on the need to keep these essential institutions and services intact. I know WSHF is not alone among non-profit service organizations and foundations in this concern. But how can one foundation adequately address the needs identified in the Commonwealth Fund report? Factor in the uncertain future of federally sponsored health care reform and shrinking resources, and it is clear that one organization cannot address all the needs. However, there are considerable community assets, that if organized and applied based on models of best practice that exist in the high performing communities identified by the report, can improve our health outcomes.
To this end, WSHF recently helped to organize a meeting of the Donors’ Forum that started a conversation on the potential collaborative efforts of area foundations. WSHF is also undertaking a renewed concentration to support area food pantries that address the basic health issues of nutrition and healthy eating among our neediest populations. Hopefully, these efforts offer some signs of hope amidst the gathering storm clouds over health care in the 21st century.
