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Appendix E: Health Care Presentations
Invited experts, stakeholders, and citizens have given presentations to the
Citizens’ Health Care Working Group on a wide array of health care subjects.
What follows is a list of those presentations, organized chronologically in
order of presentation to the Working Group.
Underlined text denotes a link to an electronic document on our website that
contains the presentation, biographical information, or meeting summary.
Wednesday, May 11, 2005; Crystal City, VA
Overview of the American Health Care System
Thinning Social Contract”, John
Iglehart, Project Hope. (See summary for 5/11/2005).
Provides description of American health care system and health expenditures.
Asserts that the United States provides a lower rate of health care coverage
than other industrialized countries. Many of the uninsured are employed full
time. Health care expenditure growth has been outstripping the rates of increase
in wages and non-health expenditures. Among 30 countries belonging to the
Organization for Economic Development and Cooperation, tax receipts are lowest
in the United States, but our expenditures for health care are highest.
Public Insurance Programs: Medicare, Medicaid and SCHIP
Thursday, May 12, 2005; Crystal City, VA
Private Health Insurance: Employer-Based Insurance and the Individual Market
- “Employment-Based Health
Benefits Among Mid-Sized and Large Employers”, Paul
Fronstin, Employee Benefit Research Institute. (See summary for 5/12/2005).
Describes the status of employer-sponsored health insurance and changes taking
place that are weakening this form of coverage.
- “Small-Group and Individual
Coverage”, Deborah Chollet,
Mathematica Policy Research. (See summary for 5/12/2005).
Describes features of the small group and individual insurance markets
Public Sector Initiatives to Expand Coverage
- “State Strategies To
Expand Or Maintain Health Care Coverage”, Linda
Bilheimer, Robert Wood Johnson Foundation. (See summary for 5/12/2005).
Identifies numerous state initiatives in process or under consideration tailored
to expand or maintain coverage and to constrain costs in State Medicaid programs.
- National Governors’ Association (NGA) Reform Proposal, Matt
Salo, NGA (See summary for 5/12/2005).
Describes challenges facing State Medicaid programs from the perspective of
the States and offers some suggestions for change, such as updating federal
cost sharing rules, which have not been changed since 1982.
- “Communities in Charge:
Financing and Delivering Health Care to the Uninsured: Lessons from Community-Based
Initiatives to Expand Coverage and Improve Care Delivery”, Terry
Stoller, Medimetrix. (See summary for 5/12/2005).
Describes a four-year Robert Wood Johnson Foundation-funded effort to develop
comprehensive community-based health care services for the uninsured and the
Private Sector Initiatives to Expand Coverage
- “National Health Access”,
Ken Sperling, CIGNA. (See
summary for 5/12/2005). Describes
an initiative promoted by the Human Resources Policy Association to address
the health care coverage needs of the working uninsured; an effort scheduled
to be implemented in 2005 at many U.S. corporations,.
- “Private Initiatives
to Expand Coverage”, Anthony
Tersigni, Ascension Health. (See summary for 5/12/2005).
Describes Ascension Health’s efforts to improve health care for underserved
members of their communities, including underlying principles and a model
for change at the community level. Includes description of some efforts in
communities where Ascension Health facilities are located.
Friday, May 13, 2005; Crystal City, VA
Health Care Costs
Public Sector Initiatives to Control Costs
- “Controlling Costs in
Medicare”, Jack Hoadley,
Georgetown University. (See summary for 5/13/2005).
Describes ways in which Medicare currently constrains costs and additional
options for the future, which include adjustments to the payment system, innovative
approaches to purchasing services in the fee-for-service market, and increased
enrollment in managed care.
- “Public Sector Initiatives
To Control Costs: Medicaid”, Jim
Verdier, Mathematica Policy Research. (See summary for 5/13/2005).
Describes major direct cost control mechanisms including: limiting eligibility
or benefits covered, increasing copayments and deductibles, implementing disease
management programs, instituting mechanisms for controlling pharmacy costs,
and limiting possibility of fraud.
- “Public Sector Initiatives
to Control Costs: The State Children’s Health Insurance Program”, Genevieve
Kenney, Urban Institute. (See summary for 5/13/2005).
Describes some methods that states have used to constrain costs under the
program, including enrollment caps and eligibility cutbacks, premium increases,
and reduced outreach efforts.
Private Sector Initiatives to Control Costs
- “Private Sector Initiatives
to Control Costs Presentation to Citizens’ Health Care Working Group”,
Alice Rosenblatt, WellPoint.
(See summary for 5/13/2005).
Describes WellPoint’s initiatives to control costs and provide better information
to its health care consumers. Also describes WellPoint’s Pay for Performance,
pharmacy management, and behavioral health initiatives.
- “Private Sector Initiatives:
Controlling Costs and Empowering Consumers”, Helen
Darling, Washington Business Group on Health. (See summary for 5/13/2005).
Describes employers’ efforts to address the growing unsustainability of health
care costs, including the introduction and implementation of decision support
systems, chronic care management, quality and patient safety efforts, and
Health Savings Accounts.
Wednesday, June 8, 2005; Jackson, MS
Access, Safety Net, Health Disparities
- Rural Health Disparities, Dr.
Dan Jones, Dean and Vice Chancellor, University of Mississippi Medical
Center. (See summary for 6/8/2005).
Describes the problem of health disparities in the United States, especially
for the poor, and how limited access to care is a major cause of this problem.
Describes impact of uninsured on his facility and the financial challenges
institutions like his face.
- Mississippi Health Shortages, Roy
Mitchell, Executive Director, Mississippi Health Advocacy Program (See
summary for 6/8/2005). Describes
widespread uninsured and under-served rural public health conditions, the
significant adverse impact any reductions in Medicaid or SCHIP would have
on the poor, and the importance of improving the health care safety net in
- Prevention and Insurance Needed, Dr. Herman Taylor, Director of
the Jackson Heart Study, University of Mississippi Medical Center. (See summary
for 6/8/2005). Illustrates
racial/ethnic health care disparities for cardiovascular disease and other
health conditions. He argues for access to preventive care for the nation’s
46 million uninsured to lessen “downstream” adverse impacts.
The Reality of Being Uninsured
- Employer Exclusions and Health Care Needs, Georgia Rucker. (See
summary for 6/8/2005). Narrates
personal story of struggling with health care problems and an employer who
enforced a restrictive employment clause to deny health care insurance coverage.
Ms. Rucker is currently dependent on her family and church for support.
- Experiencing Uninsured Status, Richard Dye. (See summary for 6/8/2005).
Describes his personal experience of being uninsured and how the help of family
and friends sustained him.
Local Access Initiatives
- Coverage Plans for Small Employers, Bill Croswell, Chamber Plus,
Metro Jackson Chamber of Commerce. (See summary for 6/8/2005).
Describes activities of Chamber Plus, a subsidiary of the Chamber of Commerce
formed in 1996 in response to the need for a health insurance product for
employees of small businesses. Chamber Plus now provides group health insurance
coverage for 20,000 employees of small firms in the greater Jackson area.
Many other Chambers of Commerce in Mississippi have also adopted this product.
at the Community Health Center Level” (PDF
version), Dr. Janice Bacon, G.A. Carmichael Community Health Center. (See
summary for 6/8/2005). Briefly
summarizes her work at a local community health center and the center's efforts
to address chronic conditions such as asthma and diabetes.
- “The Jackson Medical
Mall Foundation”, Primus Wheeler, Executive Director, Jackson Medical
Mall Foundation. (See summary for 6/8/2005).
Focuses on the key elements that allowed the establishment of a central health
care facility to work in Jackson, MS. A key factor was the collaboration and
cooperation of many individuals who were held together by the shared vision
and active leadership of Dr. Aaron Shirley, an early advocate for and promoter
of community health centers.
Friday, July 22, 2005; Salt Lake City, UT
Health Care Challenges: The Federal Perspective
- “21st Century Health
Care Challenges: Unsustainable Trends Necessitate Reforms to Control Spending
and Improve Value” (as PDF
document), David M. Walker,
Comptroller General of the United States. (See summary for 7/22/2005).
Explains the unsustainability of current cost trends in Medicare and Medicaid,
which now represent the fastest growing components of the Federal budget,
the implications of these rising costs for the future of the federal budget,
and potential areas of inquiry to address interrelated problems of cost, access,
Health Care Quality
- Comments on “Crossing the Quality Chasm,” Donald
M. Berwick, MD, MPP (by telephone), President and CEO, Institute for Healthcare
Improvement. (See summary for 7/22/2005).
Describes the “quality chasm,” the gap between the health care quality we
have and what we could have, and its six dimensions: safety, effectiveness,
patient-centeredness, timeliness, efficiency, and equity. To get to better
quality, three areas must be addressed: emphasizing knowledge-based care,
establishing patient-centered care, and enhancing cooperation.
- “Unwarranted Variations in Health Care,” Part
1, Part 2”,
John E. Wennberg, M.D., M.P.H.,
Dartmouth Medical School (7/22/2005). (See summary for 7/22/2005).
Describes the existence of geographic and institutional variations in the
use of health care services that are unrelated to severity of illness or any
demographic variations and that do not result in improved outcomes. Addressing
these variations would have important consequences for health care costs and
Health Information Technology Panel
- “IT Session: Citizens' Health
Care Working Group”, Stanley M.
Huff, M.D. Senior Medical Informaticist, Intermountain Healthcare. (See
summary for 7/22/2005). Describes
the clinical information system in use at Intermountain, an integrated health
care system in Utah, lessons learned from use of this system and potential
directions for future work in health information technology.
- Information Technology in Service of Health Care Providers, Eric
Pan, M.D., Internist, Center for Information Technology Leadership (See summary
for 7/22/2005). Presents
findings from a study "The Value of Health Care Information Exchange
and Interoperability," including estimates of annual potential cost savings
of $77 billion to the nation’s health care system from the standardization
of health care information exchange.
- “Health Information
Technology”, Scott Williams,
M.D., Vice President for Health Affairs, HealthInsight, the Quality Improvement
Organization (QIO) for Utah and Nevada (See summary for 7/22/2005).
Describes the key components of health information technology (electronic
medical records, health information exchange, and clinical support for decisions-making);
lays out many of the issues related to the provider level business case for
implementing different forms of health information technology and explores
potential Federal roles in health information technology.
- “Purchasers’ Path to Promoting
Higher Value in Health Care”, Peter
Lee, Pacific Business Group on Health (See summary for 7/22/2005).
Explains how cost increases and issues of quality can be addressed by purchasers
through better information, evaluation, and financial incentives for both
consumers and providers. Examples include consumer support for hospital choice
and provider pay for performance mechanisms.
- “Transforming the
Health Insurance Delivery Business Model – A Labor-Management Initiative to
Manage Care and Targeting Quality”, David
Blitzstein, United Food and Commercial Workers International Union. (See
summary for 7/22/2005). Describes
how improved information collection systems, analysis of costs and outcomes,
and making information and results of value analyses available to individuals
and organizations can support improved health care service selection.
- “Controlling Healthcare
Costs A New Approach”, Elizabeth
Gilbertson, Hotel Employees and Restaurant Employees International Union
Welfare Fund. (See summary for 7/22/2005).
Explains how her organization, working in the context of an extended health
care network (with 1,800 physicians), monitors physician cost and care patterns
and how such monitoring can lead to reduced costs, better quality of care,
maintaining benefit levels, and higher wages.
Tuesday, July 26, 2005; Houston, TX
Hispanic Health Issues
- “Health Disparities”,
Adela S. Valdez, MD, Valley
Baptist Health System. (See summary for 7/26/2005).
Describes high levels of uninsurance among Hispanics in Texas and the need
for more investment in tobacco cessation, nutrition, and encouraging physical
activity. The last two health behaviors are especially relevant to reducing
the negative consequences of diabetes and obesity. Hispanics have disproportionately
high rates of diabetes. In 2004 five of the nation’s “fattest” cities were
in Texas. She advocated for increased investments in education as the single
most important thing to do to reduce health disparities.
- “Hispanic Health and
Health Care Issues in Texas and the United States”, Karl
Eschbach, University of Texas Medical Branch at Galveston. (See summary
for 7/26/2005). Describes
Hispanic population trends in the United States and Texas and presents the
“Hispanic paradox,” a finding of low age-specific mortality rates for the
Hispanic population of the United States compared to the non-Hispanic white
population, despite the socioeconomic disadvantages of Hispanics. Hispanics
have lower heart disease and cancer mortality; and birth outcomes are similar
to whites. The Hispanic “advantage” is larger for immigrants than it is for
natives and may be attributed to better health habits and selective migration.
- “Rural and Community
Health in Texas”, Patti Patterson,
Vice President for Rural and Community Health, Texas Tech University Health
Sciences Center, Lubbock. (See summary for 7/26/2005).
Describes the realities of large distances in rural Texas and the added difficulties
that this introduces when trying to assure that individuals have the health
care services they need,or that their health doesn’t suffer directly from
their isolation. She also describes strategies for recruiting and retaining
health care providers in rural areas.
- “Fast Facts
About Rural Texas” (PDF
document), Ernest R. Parisi,
Administrator and Chief Executive Officer, East Texas Medical Center, Quitman.
(See summary for 7/26/2005).
Describes the challenges of operating a small hospital and local community
health network in rural Texas, their dependence upon major public health financing
programs such as Medicare and Medicaid, and the impact of the uninsured on
- Federally Qualified Health Centers, Rachel
Gonzales-Hanson, Chief Executive Officer, Community Health Development,
Inc., Uvalde (See summary for 7/26/2005).
Describes the critical role that community health centers play in the health
safety net, the need for continued funding, and the increasing challenges
they must address, especially in rural areas.
Long-Term Care, Home and Community Options
- “Long Term Care: Care
for Elders”, Nancy Wilson, Huffington Center on Aging, Baylor College
of Medicine. (See summary for 7/26/2005).
Describes key issues in long-term care, including lifetime risk, costs, the
benefits of community versus institutional care, and other issues of concern.
She also gave examples of community-based approaches to long term care and
noted that addressing long-term care needs will involve collaboration, strategic
planning, and involvement of consumers, providers, and health agencies.
- “Long Term Care: A Community
Based Approach”, Lanette Gonzales, Sheltering Arms, Houston. (See summary
for 7/26/2005). Describes
a community-based initiative in Houston, efforts they have made to recruit
and retain staff, and the impact of demographic and other trends and their
implications for the future.
Retiree Health Care
- “Addressing the Growing
Gap in Retiree Health Coverage”, Paul
Dennett, American Benefits Council. (See summary for 7/26/2005).
Describes the growing number of retirees without employer-sponsored health
insurance and the growing percent of health care costs that retirees have
to pay themselves. Recommends several actions, including improving care quality
and lowering health care costs.
- “Health Coverage in Retirement”,
Gerry Smolka, AARP. (See summary
for 7/26/2005). Describes
trends in retirement and retirement health insurance coverage as well as the
special problems faced by early retirees (i.e., those younger than 65) in
finding and affording health insurance coverage.
- “US Family Health Plan:
Providing High Quality, Cost Effective Healthcare to Military Beneficiaries”,
Marshall Bolyard, U.S. Family Health Plan. (See summary for 7/26/2005).
Describes a plan available to, and well received by, military beneficiaries,
including military retirees.
Wednesday, August 17, 2005; Boston, MA
- “Department of Mental Health:
Commonwealth of Massachusetts”, Elizabeth
Childs, M.D., Commissioner, Massachusetts Department of Mental Health.
(See summary for 8/17/2005).
Describes the work of the Massachusetts Department of Mental Health, giving
key statistics about the department and its beneficiaries. She also describes
three current initiatives and the department's efforts to address stigma as
the chief barrier to individuals receiving mental health treatment.
- “Beacon Health Strategies,
LLC”, Deborah Nelson, Ph.D.,
Beacon Health Strategies. (See summary for 8/17/2005).
Describes this managed behavioral health plan and the challenges it faces
in providing mental health services.
- “The State of Mental Health
Services in Massachusetts: The Impact of Inadequate Funding”, Toby Fisher,
Executive Director, National Alliance for the Mentally Ill. (See summary for
8/17/2005). Describes some
of the difficulties that result from inadequate funding, which include long
waits for services, especially troubling when children must wait, and inadequate
pharmaceutical benefits. He also described the successful integration of federal,
state, and local policy and initiatives from the perspective of a grass roots,
State, County, and Local Initiatives
- “Cost, Quality And Access:
A System Approach”, Trish Riley,
Director, Governor's Office of Health Policy and Finance, Maine. (See summary
for 8/17/2005). Describes
efforts in Maine to address cost, quality, and access with a special focus
on Dirigo Health Care, an effort to expand health insurance coverage to low-income
people in Maine.
- “Access Health: Closing
the Gap Between Public and Private Insurance Coverage”, Vondie
Woodbury, Director, Muskegon Community Health, MI. (See summary for 8/17/2005).
Describes a local county program designed to provide health care coverage
to those who would otherwise not have it. The program is targeted at small
businesses in particular. The premium costs are shared by the employee (30
percent), employer (30 percent) and the community (40 percent).
End of Life
- “Dying in America: A Generation’s
Crisis and Opportunity”, Ira Byock, M.D., Director of Palliative Medicine,
Dartmouth Hitchcock Center, NH. (See summary for 8/17/2005).
Describes trends in aging in America, the shrinking pool of caregivers, and
the need to shift services for those approaching death away from institutions
and towards care in the home. Most people want to live and die at home, not
in institutions. For this to happen, there needs to be an emphasis on palliative,
rather than on life-extending, but not enhancing, aggressive medical intervention.
Hospices can help in reaching this objective and more caretakers will be needed.
- Research Findings About End of Life, Nicholas
Christakis, M.D., Harvard Medical School. (See summary for 8/17/2005).
Describes the components of a “good” death: individuals want to know what
to expect, as well as freedom from pain, not being a burden to their families,
having a doctor who listens, and the ability to choose to die at home.
- “Defining and Reforming ‘End
of Life’ Care”, Joanne Lynn,
M.D., Rand, Washington DC. (See summary for 8/17/2005).
Proposes a model of care for the ill that gradually decreases “curative” care
while increasing “palliative” care proportionately. The timing of these changes
should be based on the predicted life duration, even though it is difficult
to forecast exactly when a person will die. More support for family caregivers
Employer Initiatives: Leapfrog and Bridges to Excellence
- “Bridges to Excellence” (Part
1) and “The Leapfrog Group (Part
2) Jeffrey R. Hanson, Regional
Healthcare Manager, Verizon Communications. (See summary for 8/17/2005).
Describes two employer-based initiatives for improving health care quality.
Bridges to Excellence is a system of rewarding high quality performance of
providers and encouraging consumers to purchase high quality care. The initial
efforts have focused on diabetes and cardiovascular disease. Leapfrog is an
initiative of over 150 purchasers that has focused on identifying specific
actions that can result in improved care delivery and on setting up a system
of rewards for top performers.
Friday, September 23, 2005; Portland, OR
The Oregon Health Plan
- “White Paper distributed
at Citizens' Health Care Working Group hearing” (PDF
version), John Kitzhaber,
M.D., Center for Evidence Based Policy, Oregon Health & Science University,
Former Governor of Oregon. (See summary for 9/23/05).
Sets forth his belief in the need to change the health care system from one
that rations people to one that rations care. He asserts that major change
is needed, incremental change will not suffice.
- “Oregon Health Decisions:
Community Meetings Process”, Michael
J. Garland, D. Sc. Rel, Oregon Health & Science University. (See summary
for 9/23/05). Describes the
efforts by a variety of individuals in Oregon to conduct public discussions,
formulate a new system for organizing care, and pursue it through to partial
enactment and implementation within the state.
- [No title or slides], Ralph Crawshaw, Co-founder Oregon Health
Decisions (Co-presented with M. Garland - See summary for 9/23/05).
Describes the process they went through to hold community level meetings in
developing the Oregon Health Plan and the impact of these meetings on developing
the plan and on the meeting participants.
The Health Services Commission: Prioritizing Benefits
- “The Work of the Health
Services Commission – Prioritizing Benefits”, Alison
S. Little, M.D., Oregon Health Services Commission. (See summary for 9/23/05).
Describes the process the Commission used to develop a prioritized list of
benefits that formed the core of the Oregon health plan.
- “White paper distributed at
Citizens' Health Care Working Group hearing” (PDF
version), Ellen C. Lowe, Oregon Health Services Commission. (See summary
for 9/23/05). Offers a personal
perspective on Oregon’s outreach efforts to develop the Oregon Health Plan,
based on her experiences as the citizen member of the Oregon Health Services
- [No title or slides], Diane
Lovell, Oregon Public Employees Benefit Board and Oregon Health and Sciences
University Employee Benefits Council. (See summary for 9/23/05).
Describes the open, public, and transparent process employed in Oregon in
developing the Oregon Health Plan and emphasizes the importance of these characteristics.
- “Methods for Comparative
Evidence Reviews”, Dr. Marian McDonagh, Oregon Evidence-based Practice
Center for the Drug Effectiveness Review Project. (See summary for 9/23/05).
Describes the technical process of review and decision-making regarding selection
of pharmaceuticals that are covered by Medicaid. The methodology is intended
to be transparent, systematic, and unchallengeable. Participants in the process
make sure that the information is very readable. Oregon wants to make sure
that its researchers have high standards and are impartial in their evaluation
of what constituted equivalent drugs for treatments.
- “Lessons Learned from the Oregon Experience,” Bruce
Goldberg, M.D., Oregon Office for Health Policy and Research. (See summary
for 9/23/05). Summarizes
the lessons learned from the effort in Oregon to develop an alternative approach
to providing insurance coverage.
- “White paper distributed at
Citizens' Health Care Working Group hearing” (PDF
version), John Santa, M.D.,
M.P.H., Center for Evidence-based Policy, Oregon Health & Sciences University.
Attachment to paper - M. Gold article (PDF only); see also related article
online. (See summary for 9/23/05).
Describes the values and central priorities that continue to motivate those
seeking to further the purposes of the Oregon Health Plan, including equity,
transparency, value, explicit decision making, and local control.
- [No title or slides], Mark Ganz, President and CEO, the Regence Group (See
summary for 9/23/05). Describes
some of the activities his firm is undertaking, including efforts to develop
an electronic health record for the group's members.
Public Sector/Private Sector Perspectives
- “Lessons Learned from Health Care Reform”, Jean
I. Thorne, Oregon Public Employees’ Benefit Board. (See summary for 9/23/05).
Former Oregon Medicaid Director reviews the process that Oregon followed and
candidly describes the successes and failures of the state’s efforts.