Beliefs and Myths About U.S. Health Care – Week 1
Far too often in the world of health policy, we accept half-truths as indisputable facts. But what happens when we take a deeper dive and really scrutinize the data? Dr. Arthur “Tim” Garson, Jr., director of the TMC Health Policy Institute and author of the book Health Care Half Truths, will challenge panelists and audience members to reconsider what they think they know about health care.
For example, many of us think the U.S. has the best health care system in the world. But what do the numbers tell us? We’ve all heard over and over again that preventive care saves money. But do the dollars really add up? Garson will discuss those myths and misconceptions, and others, with experts from across Texas Medical Center in what’s sure to be a fun and informative discussion.
Discussion: 5:30 p.m. to 7 p.m.
Drinks and hors d’oeuvres: 7 p.m. to 8 p.m.
Follow the conversation using #HealthPolicyMyths
Arthur “Tim” Garson, Jr., MD, MPH
Director, Texas Medical Center Health Policy Institute
Former Dean, Baylor College of Medicine
Former University Provost, University of Virginia
Anita G. Hufft, PhD, RN
Professor and Dean, Texas Woman’s University College of Nursing
Stephen Linder, PhD
Associate Director, Texas Medical Center Health Policy Institute
Director, Institute for Health Policy, University of Texas Health Science Center at Houston School of Public Health
Lamar Pritchard, PhD
Professor and Dean, University of Houston College of Pharmacy
Jean Raphael, MD, MPH
Founding Director of the Center for Child Health Policy and Advocacy at Texas Children’s Hospital
Associate Professor of Pediatrics, Baylor College of Medicine
Jessica L. Roberts, JD
Director, Health Law & Policy Institute, University of Houston Law Center
Health Policy Scholar, Center for Medical Ethics & Health Policy, Baylor College of Medicine
Michael E. Speer, MD
Professor of Pediatrics, Baylor College of Medicine
Past President, Texas Medical Association
State and Local Health Policy Objectives and Methods – Week 2
Slides 1 | Slides 2
- Role and responsibility of state and local health policy
- Institutions and processes (who’s in charge, who decides)
- Texas legislature
- Health and human service agencies
- Local public health and healthcare organizations
- Hot topics in state and local role, responsibilities, organization, processes
Professor, UT School of Public Health
Director of Public Policy and Government Affairs, Mental Health America of Greater Houston
Vice President, Government Affairs, Memorial Hermann Health System
Vice President, Public Policy and Government Relations, Harris Health System
Senior Vice President, Cornerstone Government Affairs
- What is the role of state and local health policy?
- How does it relate to federal health policy?
- What is the basis for distribution of responsibilities?
- How does a bill get created? Become law?
- What are the state and local agencies
- that implement policy? How are they organized and funded?
- What are the hot topics in state and local health policymaking relationships, authority, responsibility?
- PJ Egler, C Dykes, February 17, 2012. University of Houston Law Center, Texas Legislative History Research.
- Sunset Advisory Commission, Staff Report with Commission Decisions, December 2014. System and Agency at a Glance, pp. 13-17.
- Harris Health System, Who We Are
- Harris County Public Health, Services and Programs
- City of Houston, Houston Health Department
How Health Policy is Made - Week 3
- Institutions and processes
- Interest groups and lobbyists
- Sources of influence
Aisha Morris Moultry, Pharm.D., M.S.
Professor and Associate Dean of Academic Affairs, Texas Southern University College of Pharmacy and Health Sciences
Managing Associate, Texas Legislative Associates and Public Policy Consultant
America’s 5 Minute Advocate
Edward Stemley, Pharm.D., M.S.
Director of Pharmacy, UTMB, Professional Organization
- Explain the various stages of health policy development.
- What are the roles of various interest groups in healthcare public policy?
- What is the difference between presidential, congressional, and state roles in health care public policy debate, establishment, and implementation?
- What changes have you seen in the policymaking process as a result of changes in presidential administration?
- What are some strategies/tactics used by interest groups to influence public policy?
- How can interest groups and political parties influence government policy in modern day America?
- Please explain the “Iron Triangle” model of policy-making involving Congress, the bureaucracy, and interest groups.
- Rice T, Unruh LY, Rosenau P, Barnes AJ, Saltman RB, van Ginneken E. Challenges facing the United States of America in implementing universal coverage. Bulletin of the World Health Organization. [Internet]. 2014 Dec 1 [cited 2018 Jan 25];92(12):894–902. Available from: http://www.who.int/entity/bulletin/volumes/92/12/14-141762.pdf
Access to Care and Health Insurance Coverage - Week 4
- Objectives of coverage
- Insurance coverage policies/provisions
- Characteristics of the uninsured/underinsured
- Gaps in coverage
- Access barriers
- Insurance reform
Ben Raimer, MD
Senior Vice President, Health Policy & Legislative Affairs, UTMB
John David Prochaska, Dr.P.H., M.P.H.
Assistant Professor, Department of Preventive Medicine & Community Health, School of Medicine, UTMB
Cara L. Pennel, Dr.P.H., M.P.H.
Assistant Professor and Director of Public Health Practice, Department of Preventive Medicine & Community Health, UTMB
Third-year PhD student, UTMB
- Characteristics of Uninsured/Underinsured by Dr. Prochaska
- DSRIP Medicaid Waiver and Implications for Texas by Dr. Pennel
- Young Adult’s Health Status and Access to Care by Dr. Kaul, presented by Jacqueline Avila
Financing, Payment, and Cost - Week 5
- National Healthcare expenditure: Overview and comparisons
- How the money flows
- Why we pay more for healthcare
- Cost-containment measures
- Managing the revenue cycle
Director, Health Care Initiative, Jones Graduate School of Business, Rice University
Senior Vice President and Chief Operating Officer, Baylor St. Luke’s Medical Center
Vice President, Revenue Cycle and Treasurer, MD Anderson Cancer Center
Executive Director, Finance, Revenue Cycle Analytics, MD Anderson Cancer Center
Executive Director, Financial Planning & Analysis, MD Anderson Cancer Center
George Perkins, MD
Chief Medical Officer and Medical Director
Physicians Referral Service, Faculty Group Practice, The University of Texas MD Anderson Cancer Center
Professor of Radiation Oncology
Breast Service, Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center
- Anderson, Gerard F. Reinhardt, Uwe E. Hussey, Peter S. and Petrosyan, Varduhi. It’s the Prices, Stupid: Why The United States Is So Different From Other Countries. Health Affairs. 2003;22(3): 89-105.
- Centers for Medicaid and Medicare Services. National Health Expenditures 2015 Highlights. (https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html).
- Cooper, Zack. Craig, Stuart. Gaynor, Martin, and Van Reenen, John. “The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured.” Health Care Pricing Project. (www.healthcarepricingproject.org). December, 2015. Read the Executive Summary
- Findlay, Steve. “Health Policy Brief: Implementing MACRA.” Health Affairs. March 27, 2017.
- Schneider, Eric C. Sarnak, Dana O. Squires, David. Shah, Arnav. and Michelle M. Doty. “Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care.” The Commonwealth Fund. July 2017.
- The Quality Payment Program Overview Fact Sheet. Centers for Medicaid and Medicare Services. The Department of Health and Human Services.
Optional Reading Assignments:
- Cutler, David M. “Where are the Health Care Entrepreneurs? The Failure of Organizational Innovation in Health Care. National Bureau of Economic Research. May 2010.
- MACRA Quality Payment Program Year 2, Final Rule Fact Sheet. Centers for Medicaid and Medicare Services. The Department of Health and Human Services.
- National Chartbook of Health Care Prices-2015. Health Care Cost Institute. May 2016.
- “Health Care Costs 101: Spending Rose with More Coverage and Care.” California Health Care Almanac. September, 2017.
- Cooper, Zack. Craig, Stuart. Gaynor, Martin, and Van Reenen, John. “The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured.” Health Care Pricing Project. (www.healthcarepricingproject.org). December, 2015.
Quality of Care - Week 6
- Defining and Measuring
- Improving Outcomes and Safety
- Paying for Value-based Performance
Lee Revere, PhD, MHA
Director, Fleming Center for Healthcare Management, UTHealth School of Public Health
Ryan Walsh, MD
Chief Medical Information Officer, The University of Texas Health Science Center at Houston and UT Physicians.
Bela Patel, MD, FCCP
Vice Dean, Healthcare Quality and Professor, Division Director, Critical Care Medicine, McGovern Medical School, The University of Texas Health Science Center in Houston
John Bingham, MHA
Vice President, Performance Improvement and Chief Quality Officer, The University of Texas MD Anderson Cancer Center
Laura A. Petersen, MD, MPH, FACP
Director, Center for Innovations in Quality, Effectiveness and Safety, Associate Chief of Staff for Research (ACOS/R), Michael E. DeBakey VA Medical Center
Eric Williams, MD
Chief Quality Officer-Medicine, Texas Children’s Hospital
Vice President, Quality Management, Community Health Choice
Berwick DM, Nolan TW, and Whittington J. (2008) The Triple Aim: Care, Health, And Cost: The remaining barriers to integrated care are not technical; they are political. Health Affairs, 27 (3): 759-769.
Institute of Medicine. (2001) Crossing the Quality Chasm: a New Health System for the 21st Century.
Institute of Medicine. (1999). To Err is Human: Building a Safer Health System.
Das A, Norton EC, Miller DC, Ryan AM, Birkmeyer JD, and Chen LM. (2016). The Effects of Adding a Spending Measure to the Hospital Value-Based Purchasing Program. Health Affairs (Millwood). 2016 May 1; 35(5): 898–906.
Porter ME and Lee, TH. (2013). The Strategy That Will Fix Health Care. Harvard Business Review. 2013 October.
Safety Net Programs - Week 7
- Veteran’s Administration and other federal
- Local public/private providers and uncompensated care
- Describe a brief history and key features of safety net programs in the U.S.
- Identify types of providers of safety net programs and services.
- Identify the target population for safety net programs and population served per year.
- Discuss how safety net programs are funded; annual expenditures and the financial challenges.
Associate Professor, College of Nursing, Prairie View A&M University
Senior Director of Communications, Legacy Community Health Clinics
Nurse, El Centro de Corazon Clinic
Director of Pharmacy Services, San Jose Clinic
Director, Health Care for the Homeless, Harris Health System & Baylor College of Medicine
COO, Community Health Choice
Saramma M. Russell
Family Nurse Practitioner, Harris Health Systems, Health Care for the Homeless
- What are the key features of safety net programs in the U.S.?
- Who are the target population for these safety net programs?
- Who are the providers of services in these safety net programs?
- What are the funding sources for safety net programs?
- What are the annual expenditures and number of people served?
- What are the challenges in safety net programs?
The Public Health System - Week 8
- Define public health, its scope, and contrast/compare with healthcare
- Describe the public health system and the role of healthcare, non-profits, businesses, government agencies and others within that system
- Explain the various bodies/entities that are involved with public health and how they interact
- Discuss the challenges of public health
- Given the challenges, with the emerging and ongoing community issues, describe innovative approaches
- Utilize vaccinations as a case study vehicle to demonstrate how public health operates among the various entities.
Executive Director, Harris County Public Health
Director, Office of Policy and Planning, Harris County Public Health
Peter Hotez, MD, PhD
Dean, National School of Tropical Medicine and Professor of Pediatrics and Molecular Virology & Microbiology at Baylor College of Medicine
Doug Schuler, PhD
Associate Professor of Business and Public Policy, Jones School of Business, Rice University
Umair Shah, MD, MPH
Executive Director, Harris County Public Health
Allison Winnike, JD
President & CEO, The Immunization Partnership
- What is public health and how does it compare to healthcare? What is their relationship?
- What is health equity and how is addressed in the public health system?
- What institutions at the federal, state, and local level as well as in the academic and private sector should people be aware of that have PH roles? Describe their interaction with each other.
- With responsibilities related to ebola, vector control, chronic diseases, vaccinations, environmental health, tobacco, climate change, substance abuse, mental health, and so on, how are national, state or local priorities set, and to what extent do they encourage (or discourage ) interaction across players in the public health system?
- How does funding affect the public health system? What are some of the other primary challenges?
- How does the legal environment affect the public health system? Describe some of the authorities and mandates, and how well they ensure the public is protected from public health threats.
- What are the challenges in implementing laws and policies at the State and local levels given disinterest or conflicting ideologies/worldviews?
- What are some of the challenging and emerging legal issues in public health?
- What does public health innovation look like across the various actors in the system (e.g. law/policy, government, academia, business, nonprofits)?
- How well is the public health system understood by the public or elected officials? What can be done to help build awareness about the importance of public health?
- What tensions exist between public and private institutions (e.g. legal, political, ethical) when there are competing public and private interests (e.g. oil & gas, drug development, etc)
- Extremely poor populations are often overlooked, but certain businesses are leveraging this very population for business entrepreneurship. Please give examples.
For the case study on the issue of vaccines, several of the questions above would be repeated in that context. Additional questions:
- What’s been the domestic and global public health impact of vaccines?
- Where have we made public health gains on vaccines? Where are we failing?
- With sustainability and funding a challenges (and other challenges), what are some ongoing and emerging innovations that institutions should be aware of and try to tap into?
- Scientific hurdles aside, what are the economic and geopolitical barriers to developing new vaccines?
- What’s been the impact of the antivaxxer movement, in Harris County, Texas, US, globally?
- What local, state, national, global public policies need to be implemented to counter the antivaxxer movement?
U.S. Health Policy Methods - Week 9
- Policymaking Tools
- Case Study: Medicaid
Co-Director, Health Law & Policy Institute, University of Houston Law Center
Seth J. Chandler
Law Foundation Professor of Law, University of Houston Law Center
President and CEO, Community Health Choice
President and CEO of the Episcopal Health Foundation
Senior Vice President, Cornerstone Government Affairs
- Bovberg identifies various factors that guide the analysis of which level of government — state or federal — is better suited to address a particular policy issue. These factors can be grouped into three categories: political philosophy, political and economic competition among the states, and pragmatic considerations. Which political philosophical considerations favor federal action and which favor state action? When might competition among states for residents/businesses promote “better” policies, and when might competition among states prove detrimental to public concerns? What pragmatic considerations favor federal action over state action, and vice versa?
- What factors does Lester Salamon identify for evaluating the advantages and disadvantages of different regulatory approaches?
- Congress is currently debating Medicaid’s future. Presently the federal government gives funding to state Medicaid programs and establishes eligibility, coverage, and other parameters that all states must abide by, with states retaining flexibility within those parameters. Republicans have proposed a smaller role for the federal government, with less federal funding for Medicaid and states having greater flexibility as to how they structure and operate their state Medicaid programs. In contrast to Republican proposals, some scholars have proposed removing states from the Medicaid picture and operating the Medicaid program as a federal-only program (similar to Medicare). Which approach do you favor?
Social Determinants of Health - Week 10
- Introduction of social determinants of health (SDH)
- Community and clinical interventions
- Practical application and realities of interventions
- Structural state for supporting SDH efforts (e.g. reimbursements, community resilience)
- Looking ahead
Angelo Giardino, MD, PhD
Senior Vice President/Chief Quality Office, Texas Children’s Hospital
Umair Shah, MD, MPH
Executive Director, Harris County Public Health
Chris Greeley, MD
Chief, Section of Public Health Pediatrics, Texas Children’s Hospital
Vice Chair for Community Health, Baylor College of Medicine
Judy McFarlane, PhD
Parry Chair in Health Promotion and Disease Prevention at Texas Woman’s University, College of Nursing
Linda Highfield, PhD
Associate Professor, Departments of Management, Policy, Community Health Practice and Epidemiology UTHealth School of Public Health
- What are the social determinants of health, and how do they fit into today’s approach to public health & healthcare?
- What are the pros (benefits, possibilities) and cons (limitations, barriers) of screening/intervening for SDHs and ACEs?
- How can the health community appropriately address sensitive situations (e.g. IPV, food insecurity) in an effective manner given the complexity of the situations and the limited time with community members and patients?
- How does this translate into something practical for providers and other clinicians in their everyday work and approach to caring for community members and patients? [e.g. clinical and community efforts to address SDHs including screening]
- What are the financial realities of screening, diagnosing, intervening on SDHs whether in a clinical setting or community efforts?
- Additional/replacement questions
- What can healthcare do for SDHs like housing and the built environment? (this could be the initial question to follow the introduction of what social determinants is)
- How does screening for SDHs affect liability concerns?
- How do you see – if at all – the evolving relationship of public health and healthcare with SDH emerging?
- What are the dangers/cautions of SDH migrating into healthcare? What are the limits of healthcare’s involvement?
- What are the opportunities with this migration of SDH into healthcare?
- Are there data that screening and referring for SDH/ACEs improves the targeted behaviors/outcomes for a population (i.e. does broad screening in a pediatric office for poverty, lower the poverty rate of the community it serves)
- Is there a different way to think about SDH than the conventional “screen-and-refer” model?
Ethical Dilemmas in Health Policy - Week 11
- State and national policies relevant to end of life care
- Cost of care and payment mechanisms in managing end of life care
- Access, cost, quality in managing end of life care
Courtenay Bruce, JD, MA
Houston Methodist Hospital
Joslyn Fisher, MD, MPH
Associate Professor of Medicine & Medical Ethics, Baylor College of Medicine
Chair, Ethics Committee, Harris Health System
- Savitri Fedson, MA, MD
Associate Professor in the Center for Medical Ethics and Health Policy
Associate Professor in Cardiology at the Michael E. DeBakey VA Medical Center
Baylor College of Medicine
- Ricardo Nuila, MD
Assistant Professor of Medicine, Medical Ethics, and Health Policy
Director, Program in Narrative Medicine
Baylor College of Medicine
- Arlo Welte, MD, MPH, FACEP
Clinical Professor of Emergency Medicine,
UT Health McGovern School of Medicine
- William J. Winslade, PhD, JD
James Wade Rockwell Professor of Philosophy in Medicine
Institute for the Medical Humanities
University of Texas Medical Branch
- Donna S. Zhukovsky, MD, FACP, FAAHPM”
Professor, Palliative Care & Rehabilitation Medicine
UT MD Anderson Cancer Center
- How can individual autonomy be balanced with the ethical and medical responsibilities of clinical teams?
- What are the duties of medical professionals in allocating scarce resources related to end of life care?
- What role do patients and their families have in determining their care plan/treatment options in end of life care?
- Who determines treatment options in patients with terminal or irreversible conditions?
- How can federal, state, and local healthcare systems develop policies which ethically address challenges in the provision of high quality end of life care?
- How does the Texas Advance Directive Act impact patients and the clinicians caring for them?
- How is rationing relevant in the provision of end of life care?
- Wolf S, Berlinger N, Jennings B. Forty Years of Work on End-of-Life Care — From Patients’ Rights to Systemic Reform. N Engl J Med. 2015; 372: 678-682.
- Alan Meisel, “End-of-Life Care,” in From Birth to Death and Bench to Clinic: The Hastings Center Bioethics Briefing Book for Journalists, Policymakers, and Campaigns, ed. Mary Crowley (Garrison, NY: The Hastings Center, 2008), 51-54.
- Daniel Callahan, “Health Care Costs and Medical Technology,” in From Birth to Death and Bench to Clinic: The Hastings Center Bioethics Briefing Book for Journalists, Policymakers, and Campaigns, ed. Mary Crowley (Garrison, NY: The Hastings Center, 2008), 79-82.
- American College of Healthcare Executives Policy Statement, November 2014 (rev).
- The Heritage Foundation – Center for Policy Innovation Ethics and Health Care: Rethinking End-of-Life Care. Daniel Callahan, PhD, and Peter Augustine Lawler, PhD July 2012.
- Gawande A. Quantity and quality of life: duties of care in life-limiting illness. JAMA. 2016 Jan 19;315(3):267-9. doi: 10.1001/jama.2015.19206.
Additional Suggested Readings:
- IOM (Institute of Medicine). 2015. Dying in America: Improving quality and honoring individual preferences near the end of life. Washington, DC: The National Academies Press.
- Melissa D. Aldridge, PhD, MBA, and Amy S. Kelley, MD, MSHS The Myth Regarding the High Cost of End-of-Life Care. Am J Public Health. 2015;105:2411–2415. doi:10.2105/AJPH.2015.302889
- Dzeng E, Colaianni A, et al. Influence of Institutional Culture and Policies on Do-Not-Resuscitate Decision Making at the End of Life. JAMA Intern Med. 2015;175(5):812-819. doi:10.1001/jamainternmed.2015.0295. Published online April 6, 2015. Corrected on May 6, 2015.
Health Care Workforce - Week 12
- Supply and demand of healthcare providers
- Professional roles and responsibilities
- Healthcare reform and scope of work
- Change management in the healthcare workforce
Vice President, Education Administration, Methodist Hospital System
- Steven D. Brown, MD
Chief Clinical Officer, Texas A&M Health Science Center
- Nana Coleman, MD, Ed.M.
Assistant Dean for GME, Baylor College of Medicine
- Robert Morgan, PhD
Professor and Chair, Department of Management, Policy, and Community Health – University of Texas Health Science Center School of Public Health
- Jessica Uriarte, DrPH
Manager, Office of Academic Development, Houston Methodist Hospital
- Supply and Demand: Are training institutions adequately training the quantity and type of healthcare providers needed to meet the healthcare workface needs in the US?
- How do we ensure each profession in the healthcare workforce is performing at the full capacity of their licensure and respective disciplines?
- What role does the current landscape of healthcare reform play in dictating the scope of work for each profession as a part of team-based approach to care?
- How do we manage the human response to culture change that is required for the future of team-based care?
National Health Reform - Week 13
Stephen Linder, PhD
— Associate Director, TMC Health Policy Institute
— Director, Institute for Health Policy at The University of Texas Health Science Center at Houston School of Public Health
Michael Ewer, MD, MPH, MBA, JD
— Visiting Professor, Health Law and Policy Institute at University of Houston Law Center
— Internist, Professor of Medicine , Special Assistant to the Vice President, The University of Texas M. D. Anderson Cancer Center
Arthur “Tim” Garson Jr., MD, MPH
— Director, TMC Health Policy Institute
— Former Dean, Baylor College of Medicine
— Former University Provost, University of Virginia
Anita Hufft, PhD
— Dean, Texas Woman’s University College of Nursing
George Masi, CHE, FACHE
— President & CEO, Harris Health System
Stephen Spann, MD, MBA
— Founding Dean, University of Houston College of Medicine
- Medicaid funding and coverage expansion
- Insurance regulation and mandates
- Taxes and tax subsidies
- Federal budget
- Impact on Texas