2019 Health Policy Course

The 2019 TMC Health Policy Course is a first-of-its-kind collaboration between the Texas Medical Center’s academic institutions. The course, now in its second year, teaches students the fundamentals of U.S. health policy and provides them with the background and context they need to analyze the most pressing health policy challenges facing the country today.

 

The course includes 13 sessions organized by the TMC Health Policy Institute and led by experts from across the Texas Medical Center. The sessions complement students’ studies at their home institutions, from which they may earn course credit.

For more information on the course, contact Stephen.H.Linder@uth.www.tmc.edu.

Video

Course Schedule

Click on each session for details including moderators, panelists, topics to be discussed and assigned readings. Please note that instructors continue to update this information on a regular basis. All sessions are held Tuesdays from 5:30 p.m. to 7:00 p.m. at 6550 Bertner Avenue in Houston.

1. Debunking the Health Policy Myths – Jan. 15

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.

Moderator:

Arthur “Tim” Garson Jr., MD, MPH
Director, Texas Medical Center Health Policy Institute
Former Dean, Baylor College of Medicine
Former Provost, University of Virginia

Panelists:

  • 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
  • Ken Janda, JD
    President and CEO, Community Health Choice, Inc.

2. State and Local Health Policy Objectives and Methods – Jan. 22

Video

Topics:

  • Policymaking
    • Texas Legislative Process
    • State Health and Human Service Agencies
    • State Budget Process
    • City/County Public Health and Healthcare Agencies
  • Policy Role
    • Medicaid/CHIP
    • Mental Health/IDD
    • Long Term/Post Acute Care
    • Health Workforce
  • Current Issues
    • Medicaid/CHIP
    • Mental Health
    • Delivery System/Coverage Reform
    • Social Determinants of Health
    • Other

Moderator:

Panelists:

  • Annalee Gulley
    Director of Public Policy and Government Affairs, Mental Health America of Greater Houston
  • Freddy Warner
    Vice President, Government Affairs, Memorial Hermann Health System
  • Tim Schauer
    Senior Vice President, Cornerstone Government Affairs

Questions:

  • What are the major responsibilities/objectives of state and local health policy?
  • How does a bill become law?
  • How does the Texas budget work and how does that process impact policy?
  • What are the major responsibilities of state and local health agencies?
  • How does state/local health policy relate to federal health policy?
  • What are the hot topics in state and local health policy?

Readings:

3. How Health Policy is Made – Jan. 29

Video

Topics:

  • Institutions and processes
  • Interest groups and lobbyists
  • Sources of influence

Moderator:

Aisha Morris Moultry, Pharm.D., MS
Professor and Associate Dean of Academic Affairs, Texas Southern University College of Pharmacy and Health Sciences

Panelists:

  • Willie Capers, II, Pharm.D., MBA
    Assistant Professor and Vice Chair of Clinical and Administrative Services, Texas Southern University
  • Cedric Dark, MD, MPH, FACEP, FAAEM
    Assistant Professor and Emergency Medicine Physician, Baylor College of Medicine and Executive Editor of Policy Prescriptions
  • Rodney Cox, M.S., RPh
    Director of Pharmacy Services, Memorial Hermann Memorial City Medical Center
  • Edward Stemley, Pharm.D., M.S.
    Director of Pharmacy, UTMB

Panel Questions:

  • 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.

Reading:

  • 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: https://www.who.int/entity/bulletin/volumes/92/12/14-141762.pdf

4. Access to Care and Health Insurance Coverage – Feb. 5

Video

Topics:

  • Objectives of coverage
  • Insurance coverage policies/provisions
  • Characteristics of the uninsured/underinsured
  • Gaps in coverage
  • Access barriers
  • Insurance reform

Moderator:

Ben Raimer
Senior Vice President, Health Policy & Legislative Affairs, UTMB

 

Panelists:

  • Laura Rudkin, PhD
    Chair & Professor, Preventive Medicine and Community Health, University of Texas Medical Branch
  • Sapna Kaul, PhD
    Assistant Professor, Department of Preventive Medicine and Community Health, University of Texas Medical Branch
  • Cara L. Pennel, DrPH, MPH
    Assistant Professor and Director of Public Health Practice, Department of Preventive Medicine & Community Health, University of Texas Medical Branch

Readings:

  • The Kaiser Family Foundation Fact Sheet: Key Facts about the Uninsured Population, Accessed Jan. 16, 2019. https://files.kff.org/attachment//fact-sheet-key-facts-about-the-uninsured-population
  • How Well Does Insurance Coverage Protect Consumers from Health Care Costs? Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016. Issue Brief, Oct. 2017. Accessed Jan. 16, 2019. https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_issue_brief_2017_oct_collins_underinsured_biennial_ib.pdf
  • P. Mulye, M.J. Park, C.D. Nelson, S.H. Adams, C.E. Irwin and C.D. Brindis. 2009. Trends in Adolescent and Young Adult Health in the United States. Journal of Adolescent Health, 45 (1): 8-24.
  • Sommers et al. 2013. The Affordable Care Act Has Led To Significant Gains in Health Insurance and Access to Care for Young Adults. Health Affairs, 32(1): 165-174.
  • Herring, D. Gaskin, H. Zare and G. Anderson. 2018. Comparing the Value of Nonprofit Hospitals’ Tax Exemption to their Community Benefits. Journal of Health Care Organization, Provision and Financing, 55 1-11.
  • Young, S. Flaherty, E.D. Zepeda, S.R. Singh and G.R. Cramer. 2018. Community Benefit Spending by Tax-Exempt Hospitals Changed Little After ACA. Health Affairs 37 (1): 121-124.

5. Quality of Care – Feb. 12

Video

Topics:

  • Quality landscape and the triple aim
  • Transparency in healthcare data
  • Improving quality
  • Providers role
  • Culture
  • Defining quality vs. cost
  • Value based care

Moderator:

Katie H. Basta, BSN, RN
Asst Director, Quality & Patient Safety, Texas Children’s Hospital

Panelists:

  • Miguel Lozano, PhD
    Manager, Healthcare Systems Engineering, MD Anderson Cancer Center
  • 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
  • Ryan Walsh, MD
    Chief Medical Information Officer, The University of Texas Health Science Center at Houston, UT Physicians
  • Eric Williams, MD, MS, MMM, FAAP, FCCM
    System Chief Quality Officer, Information, Innovation & Improvement, Texas Children’s Hospital; and Associate Professor, Sections of Critical Care and Cardiology, Baylor College of Medicine
  • Pamela Hellstrom
    Chief Compliance and Quality Officer, Community Health Choice

Required Pre-Reading

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.

Optional Pre-Reading

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.

6. Financing, Payment, and Cost – Feb. 19

Video

Topics:

  • Public and private health expenditures
  • Sources of financing
  • Provider payment and payment reform
  • Cost containment policies
  • Performance

Moderator:

Osama Mikhail
Professor of management, policy and community health at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health

Panelists:

  • Arthur “Tim” Garson Jr., MD, MPH
    Director, Texas Medical Center Health Policy Institute; Former Dean, Baylor College of Medicine; Former Provost, University of Virginia
  • John W. Adams, Jr.
    CEO Emeritus, Cedar Gate Technologies
  • Julie Nickell
    Chief Financial Officer, Baylor College of Medicine

Questions:

  1. Why does healthcare cost so much in the U.S.?
  2. Do the charges for various services in healthcare have anything to do with what is paid/reimbursed to providers?
  3. Do the charges have anything to do with the cost?
  4. Is access the same as coverage?
  5. What does any possible replacement for the ACA (also referred to as Obamacare) have in it? What is the problem, if any, with the the ACA?
  6. What is “value-based” purchasing?

7. Safety Net Programs – Feb. 26

Video

Moderator:

  • Abida Solomon
    Associate Professor, College of Nursing, Prairie View A&M University

Panelists:

  • Charles Begley
    Professor, UT School of Public Health
  • Kevin Nix
    Senior Director of Communications, Legacy Community Health
  • Saramma Russell
    Nurse Practitioner, Health Care for the Homeless, Harris Health System

Discussion Questions:

  • What are the major safety net systems in the US? Describe the history, objectives, and key features.
  • Who are the target populations, how are the systems financed and administered?
  • What are the current trends, changes, and challenges of safety net programs?

Readings:

8. The Public Health System – March 5

Video

Moderator:

  • Rocaille Roberts, MPH
    Director, Office of Policy & Planning, Harris County Public Health

Panelists:

  • Gail Bray, PhD
    Director, The Menninger Clinic
  • John Graham, M.D., D.Min.
    President and CEO, Institute for Spirituality and Health
  • Umair Shah, MD, MPH
    Executive Director, Harris County Public Health
  • Allison Winnike, JD
    President & CEO, The Immunization Partnership

Questions:

  • What is public health and how does it compare/differ to healthcare?
  • Aside from funding, what is the most looming obstacle to the implementation/ operationalizing for public health organizations?
  • How has public health advanced over the past decade … or has it? And in either case, where does public health need to go to and be innovative to maintain and increase its utility (including funding)?
  • Events such as Hurricane Harvey and mass shootings from Columbine through Parkland have put a large spotlight on mental health – one that was not that bright several years ago. Additionally, we have children and adults who are experiences high rates of depression, anxiety, and suicide. How have public health institutions evolved in their role in addressing mental health, and where are the opportunities for the public health system to integrate mental health?
  • With many public health related issues being included in political rhetoric, have you notice a shift from the public in trust or otherwise when discussing dealing with these issues (e.g. vaccines, water, immigration)?

Readings:

Required

Optional

9. U.S. Health Policy Methods – March 12

Video

Topics:

  • Evolving objectives
  • Mechanisms, forms, types and sources
  • Federalism
  • Comparison of US with other countries

Moderator:

Jessica Mantel
Co-Director, Health Law & Policy Institute, University of Houston Law Center

Panelists:

  • Seth J. Chandler
    Foundation Professor of Law at the University of Houston Law Center
  • Cedric Dark
    Assistant Professor in the Henry J.N. Taub Department of Emergency Medicine at the Baylor College of Medicine; Founder and Executive Editor of “Policy Prescriptions”
  • Rosie Valadez McStay
    Assistance Vice President of Government Relations, Texas Children’s Hospital
  • Ling Zhu
    Associate Professor in Political Science, University of Houston’s College of Liberal Arts and Social Sciences

Questions:

  • 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?

Reading Assignments

10. Social Determinants of Health – March 26

Topics:

  • Social factors that influence health
  • Food insecurity in Houston
  • Policy response to population health management
  • Clinical and community response to population health
  • Integrating health care and public health

Moderator:

Tanweer Kaleemullah
Public Health Policy Analyst – Health System Transformation, Harris County Public Health

Panelists:

  • Chris Greeley, MD
    Chief, Section of Public Health Pediatrics, Texas Children’s Hospital Vice Chair for Community Health, Baylor College of Medicine
  • Quianta Moore, MD, JD
    Fellow in Child Health Policy, Baker Institute for Public Policy
  • Carol Paret
    Senior Vice President/Chief Community Health Officer, Memorial Hermann Healthcare System
  • Umair Shah, MD, MPH
    Executive Director, Harris County Public Health

Questions:

  • What is social determinants of health? And related … as with “population health,” does the phrase SDH have a different meaning for healthcare vs. public health?
  • Though more needs to be done, a great deal of education on SDH has occurred across various sectors including health, education, faith-based, etc. Accepting that the education needs to continue, what do public health and healthcare need to do to take this SDH work to the next level?
  • At what point should hospitals/clinics/physicians take action with regards to evidence-based practices or lack thereof? What are some of the advantages and disadvantages of moving forward vs. waiting until a solid based of evidence exists?
  • What are the limitation of hospitals, physicians, nurses, and healthcare in general in their ability or responsibility to address SDH?
  • LHD/Public health is seen as one of the obvious partners in the ongoing SDH efforts, but with continued decreases in public health funding at all levels of govt, what do you see as public health’s role in SDH overall? Are there ways that healthcare can bolster/support public health’s ability to respond more effectively in the community?

Reading Assignments:

Required:

Optional:

  • Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults [authors: Vincent J Felitti, Robert Anda, Dale Nordenberg, etc.] – 247-250

 

11. Ethical Dilemmas in Health Policy – April 2

What’s justice got to do with it? Ethical Implications of Social Policies on Health

Topics:

  • Ethical aspects of social determinants of health such as housing, environment, substance use, violence, food insecurity
  • Health equity
  • “Fairness” in distribution of public health
  • Obligations versus Rights in determining allocation of scarce resources

Moderators:

  • Joslyn Fisher, MD, MPH, FACP
    Associate Professor of Medicine & Medical Ethics, Baylor College of Medicine
    Vice Chair, Faculty & Staff Development, Department of Medicine, Baylor College of Medicine
    Chair, Institutional Policy Committee, Baylor College of Medicine
    Chair, Ethics Committee, Harris Health System 
  • Rebecca Lunstroth, JD, MA
    Associate Director, McGovern Center for Humanities & Ethics
    Assistant Professor, McGovern Center for Humanities & Ethics

Panelists:

  • Courtenay R. Bruce, JD, MA
    System Quality & Patient Safety, Houston Methodist System
    Associate Professor, Institute of Academic Medicine
    Adjunct Associate Professor, Texas A&M Health Science Center, College of Medicine
  • Ann Smith Barnes, MD, MPH
    Chief Medical Officer, Legacy Community Health
  • William B. Perkison, MD, MPH, FACOEM
    Assistant Professor, UT School of Public Health, McGovern Medical School
    Member of Council on Policy Affairs, American College of Occupational and Environmental Medicine
    Former Chair, American College of Occupational and Environmental Medicine, Climate Change Task Force
  • Karen Tseng, JD
    Senior Vice President for Population Health Transformation, Harris Health System

Questions:

  • How can individual autonomy be balanced with the ethical and medical responsibilities of clinical teams as it relates to policies surrounding social determinants of health?
  • What are the duties of medical professionals in allocating scarce resources in the context of social factors?
  • What role do health professionals, community members and policy makers have in developing and operationalizing policies that impact the social determinants of health?
  • How should we decide when health inequalities between different social groups should be considered unfair or fair?
  • How do we determine when a health inequality should also be considered a health inequity?
  • How can federal, state, and local healthcare systems develop policies which ethically address social determinants of health?

Reading Assignments:

Daniel H, Bornstein S, Kane G et al. Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper. Ann Intern Med. 2018;168:577-578.  http://annals.org/aim/fullarticle/2678505/addressing-social-determinants-improve-patient-care-promote-health-equity-american

Daniels N. Why We Should Care About the Social Determinants of Health, The American Journal of Bioethics, 2015; 15:3, 37-38, DOI: 0.1080/15265161.2015.1000062

Marmot M. Social justice, epidemiology and health inequalities. Eur J Epidemiol. 2017; 32(7): 537–546. Published online 2017 Aug 3. doi: 10.1007/s10654-017-0286-3

Preda A & Voigt K. The Social Determinants of Health: Why Should We Care?, The American Journal of Bioethics, 2015; 15:3, 25-36, DOI: 10.1080/15265161.2014.998374

Ruger J. Ethics of the Social Determinants of Health. Lancet, 2004; 364: 1092-1097.

12. Health Care Workforce – April 9

Topics:

  • Supply and demand of healthcare providers
  • Professional roles and responsibilities
  • Healthcare reform and scope of work
  • Change management in the healthcare workforce

Moderator:

Trevor Burt
Vice President, Education Administration, Methodist Hospital System

Panelists:

  • Carrie L. Byington, MD
    Vice Chancellor for Health Services, The Texas A&M University System; Senior Vice President, Texas A&M University Health Science Center; and The Jean and Thomas McMullin Professor and Dean, Texas A&M College of Medicine
  • Nana Coleman, MD, Ed.M.
    Assistant Dean for GME, Baylor College of Medicine
  • Robert Phillips, MD, PhD, FACC
    Executive Vice President, Chief Physician Executive & Specialty Physician Group CEO, Houston Methodist
  • Debra Sukin, PhD
    Regional Senior Vice President, Houston Methodist Willowbrook, West and Continuing Care Hospitals, and Chief Executive Officer, Houston Methodist The Woodlands Hospital

Questions:

  • 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?

Reading Assignments:

13. National Health Reform – April 16

Moderator:

Stephen Linder
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

Topics:

  • Medicaid funding and coverage expansion
  • Insurance regulation and mandates
  • Taxes and tax subsidies
  • Federal budget
  • Impact on Texas

Health Policy Course Partners

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Course Details

Course Directors:

Arthur Garson, Jr., MD, MPH, Director, TMC Health Policy Institute

Stephen H. Linder, PhD, Co-Director, TMC Health Policy Institute

Course Goal: The TMC Health Policy Institute Health Policy course will train teach students (participants) about fundamental key concepts related to the development, implementation, and evaluation of (U.S.) health policy in an innovative format.

Course Objectives: By the end of the semester, students will be able to:

  • Describe the complex roles of the many participants in policymaking,
  • Summarize and discuss key components of healthcare policy, and
  • Assess competing positions on selected health policy controversies.

Course Overview: The TMC Health Policy Institute Health Policy course is an inter-institutional, inter-professional introductory health policy course for graduate students or advanced undergraduate students.

The Health Policy Institute will produce 13 seminar sessions (see topics below.) Each session will be led by an individual from a TMC member institution, and will select 3-4 others from TMC member institutions to participate in the seminar, to include diverse, inter-professional perspectives from local experts in the form of panel discussions, debates, and other interactive teaching modalities. Recommended pre-session readings will be provided ahead of time to course participants. The course is organized in three parts: (1) Policy Institutions and Processes (2) Policy Topics in US Health Systems issues (3) Emerging Topics & Controversies in Health Policy.

Course Leadership and Evaluation: Each participating institution will have a local course director who will be responsible for planning the course in terms of which TMC sessions to include (i.e. one institution may decide to include 10 TMC HPI course sessions and have 3 additional sessions of their own), and which additional readings, meetings, and other course work will be required. Assessment, evaluation, grading, and feedback will be entirely under the purview of the institution-specific course director and the institution’s curriculum committee.

Target Audience/Participants: This course is designed for students in all areas served by the TMC (such as nursing, pharmacy, medicine, PhD in research and advanced undergraduates); however, the TMC course will also be open to the public.

Time: Sessions meet once weekly (Tuesdays) for 13 weeks January 2019 – April 2019. Sessions run 5:30 p.m. to 7:00 p.m.

Location: Texas Medical Center headquarters at 6550 Bertner Ave., 6th Floor, Houston. Additional live broadcasts and recording will be posted on this website. Audience participation will be encouraged; for students taking the course for credit who are watching streaming video will be permitted to ask questions using distance technology.

Light refreshments will be served.

Cost: Free for participants

Steering Committee: Chuck Begley, Trevor Burt, Joslyn (Joey) Fisher, Tanweer Kaleemullah, Peggy Landrum, Jessica Mantel, Aisha Morris, Binata Mukherjee, Ben Raimer, Frances (Lee) Revere, Rocaille Roberts, Umair Shah, Abida Solomon, Sujit Sansgiry

Teaching Assistant: Adele Semaan

Communications Director: Ryan Holeywell

Course Directors

Students interested in obtaining course credit from their home institution for participation in the TMC Health Policy Course are encouraged to contact the appropriate faculty member listed below.

Course DirectorE-MailTMC Institution
Cecilia Ganduglia CazabanCecilia.M.GandugliaCazaban@uth.www.tmc.eduUTHealth School of Public Health
Gloria Rosegmrose@pvamu.eduPrairie View A&M University
Sharisse Hebertsahebert@pvamu.eduPrairie View A&M University
John Prochaskajoprocha@UTMB.EDUUTMB
Susan RuppertSusan.D.Ruppert@uth.www.tmc.eduUTHealth School of Nursing
Nina Fredlandnfredland@twu.eduTexas Woman’s University
Robin Tomsrtoms@twu.eduTexas Woman’s University
Peggy Landrumplandrum@twu.eduTexas Woman’s University
Terry Kirktdkirk2@Central.UH.EDUUniversity of Houston College of Nursing
Isabelle KustersKusters@UHCL.eduUniversity of Houston – Clear Lake
Aisha M. Moultrymorris_ma@TSU.EDUTexas Southern University College of Pharmacy and Health Sciences