Ohio Health Policy Review

Survey finds health care opinion leaders see need for fundamental change to health care system

The Commonwealth Fund and Modren Health Care magazine released their 14th annual survey of health care opinion leaders (Source: "Health Care Opinion Leaders' Views on Health Care Delivery System Reform," The Commonwealth Fund, April 2008).  This year's survey includes responses from 211 individuals.

One survey question asked about the amount of change needed to achieve signficant gains in quality and efficiency care.  Among the respondents, 89 percent called for fundamental change and 8 percent for modest reform, while no one responded that no changes are needed.

Another question asked about how important five different policy options are to improving health care delivery.  Strengthening the primary care system and encouraging care coordination were both rated as important or very important by 90 percent of the respondents.  The rating of the other three policy options as important or very important was 88 percent for promoting care mangement for high cost/complex patients, 82 percent for integration of providers and organizatinos, and 67 percent for promoting health information exchange.  Eighty (80) percent of the responded agreed that government funding support for health information technology infrastructure development is a high or very high priority.

The survey also found strong support for payment reform.  For instance, 84 percent of respondents gave strong or very strong rating for providing supplemental payments to primary care providers and for incentives to avoid uncessary hospitalizations and rehospitalizations.  In addition, 71 percent favored giving additional payments to certified medical homes.

School Health Employees Board proposes first rules

The School Health Employees Board, which the Ohio General Assembly created to establish best practices around health care coverage for school employees throughout Ohio, had extensive deliberations on its first four rules at its April 17th board meeting (Source, "First four rules proposed by state board", This Week Community Newspapers, April 24, 2008).  These rules focus on employee wellness programs, disease management programs, access to specialty networks, and dependent eligibility audits.  One major point of discussion revolved around whether these rules would be specific and mandatory across all school districts or general and open to flexiblity in adoption.  The Board expects to approve rules in these four areas at its May meeting.

New report explores roles states are playing to create high performance health systems

The National Academy for State Health Policy released a report from its State Health Policies Aimed at Promoting Excellent Systems project.  This report examines if and how states are using different policy tools to create high perofrmance health systems (Source: "States' roles in shaping high performance health systems," The Commonwealth Fund, April 10, 2008).

Key findings of the report include:

States' multiple roles in the health care system create opportunities for promoting performance; many states avail themselves of these opportunities.

Every state reported some activity that promotes achievement of a high performance health system.

States continue to focus strongly on securing insurance coverage and access to health care services for vulnerable populations.

States are moving beyond historic roles to exert influence with the private insurance market, leverage purchasing power, and collaborate more with the private sector.

Few states are actively pursuing system performance in areas such as efficiency and patient safety.

In every area examined, there is room for states to do more in pursuit of a high performing health system.

Ongoing mechanisms to monitor, study, and report state activities could help diffuse and speed adoption of promising policies and practices.

More in-depth exploration of specific areas of state activity could yield richer information that would aid state and national efforts to improve system performance.

Opportunities for state-to-state exchange could help transfer knowledge and experience and spark new and innovative approaches through joint state problem-solving.

New online information resources on health care spending, quality, and innovation available from AHRQ

The Agency for Healthcare Research and Quality (AHRQ) announced in its latest electronic newsletter (issue #255) two new or updated online resources that have information related to health spending, health care quality, and health care innovations.

The first resource is the web-based Health Care Innovations Exchange. This resource, which is updated every two week, is a repository for successful health care innovations.  It also includes a lesson learned component, which entails descriptions of unsuccessful innovation attempts.  The purpose of this resource is to all "health professionals to learn, share, and adopt innovations in the delivery of health services."  AHRQ is holding a web conference to learn more about this resource, entitled Using AHRQ’s Health Care Innovations Exchange to Take on the Challenges of Care Delivery.  The web conference will be on May 12 at 2pm, E.D.T. 

The second resource is the 2006 update to the Healthcare Cost and Utilization Project (HCUP).  HCUP is a federal-state-industry partnership that brings together the data collection efforts of State data organizations, hospital associations, private data organizations, and the Federal government to create a national information resource of encounter-level health care data.  The most recent database release includes the State Inpatient Databases (SID), State Amublatory Surgery Databases (SASD), and State Emergency Department Databases (SEDD) of selected States, including Ohio.

A contrary view on the physician shortage question

David Goodman, M.D., and Elliot Fisher, M.D. disagree with the claims that there is a significant current and looming physician shortage (Source: "Physician Workforce Crisis? Wrong Diagnosis, Wrong Prescription," New England Journal of Medicine, April 17, 2008).  In this free online access article, Goodman and Fisher, who are involved with the Dartmouth Atlas project, note that the distribution of physicians varies greatly across the country.  This variation, they argue, makes invalid any universal claim for a physician shortage.

Goodman and Fisher next note that evidence suggests that the presence of more physicians does not translate into better care, better access to care, or better continuity of care.  They claim that having more physicians in an area most strongly correlates with more health care spending.

The authors also disagree with the primary recommendations for addressing a physician shortage.  First, they note that physicians tend to practice where there are other physicians, not in areas with lower supply.  Therefore, producing more supply will not guarantee help for an area with a shortage of physicians.  Second, Goodman and Fisher contend that unrestricted expansion of graduate medical education, under current payment systems, would reinforce a fragmented, specialist-focused system of care.  Finally, they argue that expanding the supply of physicians will be expensive, an expense that will consume limited resources needed for other health reform tasks while not have any real evidence for its value.

Nation faces serious public health workforce shortage

A new study by the Center for Studying Health System Change (HSC) reports that local health departments across the country face a serious shortage of critical personnel with core skills and training specific to public health, a fact that threatens an agency's ability to provide basic public health services such as disease surveillance.  According to the research, factors contributing to the workforce shortage include inadequate funding, uncompetitive compensation, an exodus of retiring workers, an insufficient supply of trained workers, and a lack of enthusiasm for public health as a career choice.  Efforts to address the shortage through a focus on recruitment, retention, development and training have not adequately alleviated the problem.  The study, Public Health Workforce Shortages Imperil Nation's Health, is based on comprehensive interviews and site visits with state and local public health officials in six communities:  Cleveland; Greenville, S.C.; Indianapolis; Little Rock, Ark.; Orange County, Calif.; and Phoenix. 

Cardinal Health announces $1 million in grants for patient safety and quality of care improvement

On April 10th, Cardinal Health announced  grants totaling $1 million for new and innovative programs aimed to enhance patient safety and quality of care (Source, "Cardinal Health Awards $1 Million to Fund Patient Safety Initiatives," Cardinal Health, April 10, 2008).  This initiative, which is "the largest and first of its kind given by a health care company," provides grants between $5,000 and $50,000 to 34 hospitals.  Over 700 hospitals submitted applications for this grant opportunity.

Three Ohio hospitals are among the 34 grant recipients: Catholic Health Partners (Cincinnati); Cincinnati Children's Hospital; and Nationwide Children's Hospital (Columbus).  The focus of the Catholic Health Partners project is to configure a medication use system using Pyxis automation technologies.  The Cincinnati Children's Hospital's project involves partnering with families to improve patient safety, while the Nationwide Children's Hospital initiative focuses on fall prevention in hospitalized children.

Cardinal Health's CEO and Chairman, R. Kerry Clark, explained the importance of this work.  He stated that, “I believe the health care industry can use quality improvements as a strategy to achieve lower costs and provide safer care for our citizens. Fixing health care is not a simple task, but we have it within our control to take simple steps that can have a dramatic effect.”

New Institute of Medicine Report warns of impending health system crisis for older adults

The Institute of Medicine (IOM) released a new report that examines the health system capacity to serve the coming surge in older adults in the United States between now and 2030.  The report, "Retoooling For an Aging America: building the health care workforce," contends that the country is not prepared to meet the social and health care needs of this population.  It states that this growing older population will produce multiple challenges for the health care system, including:

- the majority of older adults suffer from at least one chronic condition;

- this population will become an increasingly larger user of total health care services, coming to use        more than 50 percent of all services, while rising to 20 percent of total population;

- the new generation of older adults will be more diverse than ever before creating different needs that previous generations;

- there is a dramatic shortage of health care workers to meet this growing service demand; and

- the existing health care workforce is not well trained to care for older adults

The IOM committee that produced this report calls for making improvements in three areas.  First, the report calls for enhancing the competence of the health care workforce to serve a geriatric population.  Second, it calls for increasing the recruitment and retention of geriatric specialists and caregivers.  Third, the report calls for improvement in the delivery of care to older adults.

According to John W. Rowe, former chairman and chief executive of health-insurance giant Aetna Inc. and chairman of the committee that wrote the report, "This could be seen as evidence that our society places little value on the expertise needed to care for vulnerable, frail, older Americans" (Source: "Report finds health work force Is unprepared for elderly boomers," The Wall Street Journal, April 14, 2008).

Consortium of competing interest seek to create uniform approach to rating doctors

An array of large emlpyers, insurers, consumer groups, and physician organizations are working to create the first nationwide initiative to create uniformity among doctor-rating programs (Source: "Uniform doctor rating system sought," The Wall Street Journal, April 2, 2008).  This effort seeks to overcome the frustration of having insurers and others use different rating methods and approaches.  It encourages insurers to employ national standards, such as those developed by the National Quality Forum.

Among the features being agreed to by participating insurers are: using an independent reviewer to review individual insurer rating systems; having an appeals system for doctors; and using both quality and cost indicators to rate doctors.

Ohio's Attorney General solicits help related to community benefits and Ohio's nonprofit hospitals

Ohio Attorney General Marc Dann has requested competitive responses to an RFP to assist the Attorney General in the creation of regulatory standards for Ohio's nonprofit health care entities.  According to the solicitation materials, "qualified professionals, attorneys, law firms, or consultants selected through this process will be appointed to serve as Outside Counsel or a Consultant to the Attorney General and will be assigned to the specific project of examining the total amount of community benefits provided by each of Ohio’s nonprofit healthcare entities, and evaluating whether this level of community benefits is adequate to provide meaningful access to healthcare for the citizens of the State of Ohio." 

Anyone interested in responding to this opportunity must submit their response by April 30, 2008.