TAG: "Health care reform"

Charges for ER visits often based on wrong assumptions

Study shows flaws in use of discharge diagnoses to determine validity of ER visits.

Visits to the emergency room are not always for true medical emergencies – and some policymakers have been fighting the problem by denying or limiting payments if the patient’s diagnosis upon discharge is for “nonemergency” conditions.

A new UC San Francisco study challenges that framework by showing that criteria used as a basis to determine the appropriateness of an ER visit and to deny payment is inherently flawed. The study analyzed nearly 35,000 visits to hospital emergency departments around the country.

The research is published online Wednesday in JAMA, The Journal of the American Medical Association.

Overuse of the ER for nonemergency visits is often touted as a costly problem in the United States. The new study highlights the complexity of the issue by showing that using discharge diagnoses to determine the validity of an ER visit could have serious implications, including dissuading patients from using the ER when they really need it.

While many patients are given a diagnosis upon discharge that their condition was treatable through primary care, other similar patients actually required immediate emergency care or to be admitted to the hospital, the researchers found.

The authors conclude that strategies aimed at narrowly reducing use of the emergency room are unlikely to improve a community’s general health or to lower health system costs.

“This study highlights the flaws of a system that fails to distinguish between information available at arrival in the emergency department and information available at discharge,” said lead author Maria C. Raven, M.D., M.P.H., a UCSF assistant clinical professor of emergency medicine. “Attempting to discourage patients from using the ER based on the likelihood that they would have nonemergency diagnoses risks sending away patients who require emergency care. The majority of Medicaid patients, who stand to be disproportionately affected by such policies, visit the ER for urgent or more serious problems.”

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A roadmap for California’s health care system

Policy experts offer vision for better care at lower cost.

Berkeley Forum Roadmap for CA Health CareAn unprecedented, yearlong collaborative effort involving policy experts from the University of California, Berkeley, CEOs of major health insurers and health care delivery systems, and leaders from California’s public sector has produced a detailed roadmap that would transform the state’s health care system and improve care and outcomes while saving billions of dollars in the process.

The members of the Berkeley Forum for Improving California’s Healthcare Delivery System have agreed to support a risk-adjusted global budget model of paying for coordinated care, and today (Feb. 26), will issue a detailed report on specific actions that would save the state of California $110 billion – about $800 per household annually – over the next decade.

Global budgets, whereby physicians and hospitals optimize care under pre-determined expenditure targets, are a major shift from today’s predominantly fee-for-service environment. The current system, in which providers are paid for each treatment or procedure rendered, leads to the provision of more and duplicative services rather than efficient care that promotes good health, the report authors said.

Stephen Shortell, UC Berkeley

“For the first time, the key actors who deliver and pay for our health care have come together to support a roadmap for fundamental change in how we buy and provide health care services,” said forum chair Stephen Shortell, the Blue Cross of California Distinguished Professor of Health Policy and Management at UC Berkeley and dean of the School of Public Health. “They agreed that fee-for-service must be put to bed and that they support actions to move towards global budgets that will facilitate major innovations in delivering better, more coordinated care.”

The report comes as the state prepares to implement the Affordable Care Act, which will add millions of additional people to the health insurance roster. (A copy of the forum’s full report, “A New Vision for California’s Healthcare System,” and its executive summary are available online here.)

Convened by experts from UC Berkeley’s School of Public Health, forum members include presidents and CEOs of Anthem Blue Cross, Blue Shield of California, Cedars-Sinai Health System, Dignity Health, Health Net, HealthCare Partners, Kaiser Permanente, MemorialCare Health System, Monarch HealthCare, Sharp HealthCare and Sutter Health. The heads of these hospital systems, medical groups and health insurers joined state and federal health care officials in a series of meetings held throughout the past year.

UC Berkeley’s Richard Scheffler, Distinguished Professor of Health Economics and Public Policy and director of the Petris Center on HealthCare Markets and Consumer Welfare, and Liora Bowers, director of Health Policy and Practice at the Petris Center, are lead authors of the report. While designed in the context of California’s unique set of health care challenges, the initiatives endorsed by the forum offer relevant and realistic reforms for states across the country, they said.

“The report represents an innovative private sector approach to a problem that the federal and most state governments have failed at: improving quality and slowing the rate of health care spending,” said Scheffler.

At the core of the forum’s report are two interrelated proposals to fundamentally change how health care services are financed and delivered. The first entails a major shift toward the use of global budgets, which would be adjusted for the underlying health of patient populations. Payments would also be partly tied to quality of care and patient satisfaction measures to ensure that high standards of care are maintained.

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Registration opens for UC innovation center colloquium

Event will be May 3 in Oakland.

Mark Laret, UC San Francisco

>>Register online or download form
>>View draft agenda

Registration has opened for the University of California Center for Health Quality and Innovation’s second spring colloquium, 9 a.m. to 4 p.m. May 3 at the Oakland Marriott City Center, 1001 Broadway, Oakland (map). The registration form can be downloaded or filled online.

The colloquium will address the changing health care marketplace, increasing financial challenges, and clinical and operational approaches available to UC Health to compete as health care reform unfolds. Talks will include a keynote address by UC San Francisco Medical Center CEO Mark Laret and remarks by UC Health Senior Vice President John Stobo, UC Chief Risk Officer Grace Crickette, innovation center Executive Director Terry Leach and innovation center fellows. (View the draft agenda.)

The colloquium is open to anyone at UC’s medical centers and health professional schools who is working to improve health care delivery, population health and efficiency of care at UC Health.

The registration fee is $75. A limited number of registration fee waivers will be available for UC Health professionals, faculty and staff. Please contact claudia.schwarz@ucop.edu or (510) 987-9590 for more information.

Attendees interested in reserving a room at the Oakland Marriott City Center can take advantage of paying a group rate. Space is limited. For more information, visit the Marriott’s website or call (510) 451-4000 (reference “CHQI” for group rate).

The colloquium has been approved for AMA PRA Category 1 Credits™ continuing medical education, jointly sponsored by the UC Davis Health System Office of Continuing Medical Education and the UC Center for Health Quality and Innovation.

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the UC Davis Health System and the UC Center for Health Quality and Innovation. The UC Davis Health System is accredited by the ACCME to provide continuing medical education for physicians.

Credit designation
Physician credit: The UC Davis Health System designates this live activity for a maximum of 4.75 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMA PRA Category 1 credit acceptable for multidisciplinary team members
Nurse: For the purpose of recertification, the American Nurses Credentialing Center accepts AMA PRA Category 1 Credits™ issued by organizations accredited by the ACCME. For the purpose of relicensure, the California Board of Registered Nursing accepts AMA PRA Category 1 Credits™  (report 4.75 hours of credit and fill in “CME Category 1” for the provider number).

Physician assistant: The National Commission on Certification of Physician Assistants (NCCPA) states that AMA PRA Category 1 Credits™ are acceptable for continuing medical education requirements for recertification.

About the UC Center for Health Quality and Innovation
The UC Center for Health Quality and Innovation, launched in 2010, is charged with identifying best practices, convening key stakeholders to facilitate the exchange of knowledge and funding innovative projects that demonstrate improved value in the health care delivery system. The center is governed by a board composed of the six UC medical school deans, five UC medical center CEOs and chaired by the UC Health senior vice president. For more information, visit http://health.universityofcalifornia.edu/innovation-center or email chqi.info@ucop.edu.

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UC Davis nursing school dean appointed to statewide primary care committee

California Advanced Primary Care Institute launched this week.

Heather Young, UC Davis

Heather M. Young, associate vice chancellor for nursing at UC Davis and founding dean at the Betty Irene Moore School of Nursing, joined more than a dozen health care leaders in San Jose Jan. 15 to launch the California Advanced Primary Care Institute (CAPCI), a multipronged effort to improve the appeal of primary care as a career choice for health professionals and also elevate the performance of primary care teams.

CAPCI emerged from a statewide consensus meeting in April 2012 led by the California Association of Physician Groups. The nonprofit foundation convened its first Steering Council meeting Jan. 15. Young was appointed to the steering council.

“I am pleased to be part of this group. In order to meet the increasing demand for primary care in California, it is essential we prepare a variety of health care professionals,” Young said. “We need nurses, physicians, physician assistants and other team members with advanced skills in understanding complex problems and generating solutions, understanding how health systems and health care works and how to improve quality, lead teams and deal with the business aspects of care.”

“Primary care is the cornerstone for all of California’s health care delivery systems and sets the foundation for every goal of health care reform,” said Wells Shoemaker, the medical director for the California Association of Physician Groups. “Sadly, California faces a serious erosion of primary care workforce at the same time that our state braces for a daunting bulge in chronic illnesses and the long awaited opportunity through health reform to serve millions of previously uninsured individuals and families.”

California’s primary care workforce is expected to shrink by 30 percent in the next five to eight years as a consequence of retiring professionals and fewer new clinicians choosing to work in primary care.

“If we are going to transform primary care to provide superb, patient-centered care to every Californian, we will need to fundamentally change our approach to training the people who work in primary care,” said physician Kevin Grumbach, a professor at the UCSF Department of Family and Community Medicine, and member of the CAPCI executive management committee. “This new coalition represents an unprecedented partnership between practice organizations and training institutions to equip the workforce for the innovative care models that will drive excellence in primary care throughout California.”

CAPCI received startup funding from the California HealthCare Foundation, The California Endowment, CAPG group contributions, and the California Academy of Family Practice.

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UC Health & Anthem Blue Cross form alliance

New public-private partnership launched between university and health insurer.

John Stobo

Anthem Blue Cross and University of California Health — UC’s medical centers and health professional schools — announced today the launch of a groundbreaking alliance aimed at addressing some of the most critical issues facing the state’s health care delivery system.

Under this new agreement, Anthem and UC Health will focus on care innovation and California health policy development with the purpose of improving access to affordable, quality health care for California residents. The parties have named this joint venture the California Health Alliance. Both expect an enduring and productive association that will benefit the people of California.

With all five of the world-class UC academic health centers in Anthem’s network, both organizations have a long-standing history of serving residents throughout the state and are uniquely positioned to understand the health care needs of Californians. And, as the state prepares to expand health care through the Affordable Care Act (ACA), both organizations believe that today, more than ever, a collaboration of this type can effectively address the impact expected on the state’s health delivery system as more residents prepare to access medical services.

Among some of the initial areas of focus of this alliance will be the development of accountable care models to better manage costly chronic conditions and the expansion of alternate delivery systems, such as telemedicine to encourage wellness and prevention and to provide access to health care for residents in rural areas. In addition, this new alliance is expected to provide opportunities for research, analysis, literature development and policy recommendations.

“We know that residents of the state look to a future that includes access to quality health care that is affordable,” said Pam Kehaly, president of Anthem Blue Cross. “By teaming with the University of California Health, we are bringing together some of the most innovative minds to help us achieve a common goal: to improve the health and wellness of California residents.”

“As two of the state’s leading organizations, this new affiliation has the ability to revolutionize California’s health care delivery system,” said Dr. John Stobo, senior vice president for UC Health. “By coming together, we know we can develop meaningful research, policy and best practices that can be leveraged on a broader scale to help improve the state’s health care system and the health of the population at large.”

Media contacts:
Leslie Porras, Anthem Blue Cross
(818) 234-3368

University of California Media Office
(510) 987-9200

About Anthem Blue Cross:
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Additional information about Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company is available at www.anthem.com. Also, follow us on Twitter at www.twitter.com/healthjoinin, on Facebook at www.facebook.com/HealthJoinIn, or visit our YouTube channel at www.youtube.com/healthjoinin.

About UC Health:
University of California Health includes five academic health centers — UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco — with 10 hospitals and 18 health professional schools and programs on seven UC campuses. For more information, visit http://health.universityofcalifornia.edu.

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First-ever partners in primary care summit shares lessons from field

Participants discuss successes, frustrations.

The first-ever UC San Francisco and Partners Primary Care Summit brought key players to the table to discuss how to improve patient-focused care in San Francisco as part of national health reform.

“Instead of being in our parallel universes, can we recognize our common aspirations in primary care and learn from each other?” asked Kevin Grumbach, M.D., kicking off a recent gathering at the UCSF Laurel Heights campus.

Grumbach, chair and professor in UCSF Family and Community Medicine, addressed the 160 or so people in the audience who work at three major health delivery systems in San Francisco in which UCSF is involved: the San Francisco Department of Public Health, UCSF Medical Center and the San Francisco Veterans Affairs Medical Center. UCSF residents, medical students, and nursing students also attended the summit.

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Filling the gap

UC medical centers provide vital support to health professional schools. (View chart).

John Stobo, UC Health

By John D. Stobo

At University of California Health, patient care, health professional education and biomedical research go hand in hand. The connection has become only more important during these difficult budget times.

UC’s medical centers provide vital aid to UC’s medical and other health professional schools: $522 million this year in professional services and support of research and educational programs. UC medical centers have nearly doubled their contribution over five years, helping fill in the gap from shrinking state support. Indeed, UC medical center support for UC’s health professional schools now exceeds state general fund support.

The growing support from UC medical centers has been a lifeline for UC’s aspiring doctors, dentists, nurses, optometrists, pharmacists, public health professionals and veterinarians, bolstering the nation’s largest health sciences education system. But this lifeline is under threat.

UC’s self-supporting medical centers, which receive no state general funds, operate in extremely competitive environments. Their ability to sustain support for medical education – and provide a significant amount of care to low-income people – faces key fiscal challenges:

Capital requirements: UC medical centers’ capital needs are approximately $5 billion over the next five years. To best serve patients and meet government requirements, UC medical centers have major capital commitments from electronic medical records to state-mandated seismic-safety upgrades. UC San Diego and UC San Francisco have new hospital projects under construction. UCLA’s Santa Monica medical center completed a major rebuilding project this year. UC Davis opened a new surgery and emergency services pavilion in 2010. UC Irvine opened a new hospital in 2009.

Pension costs: UC medical centers face a growing obligation to pay pension costs. Those employer costs are projected to total nearly $3 billion over the next seven years. UC medical centers receive no state support to offset these costs.

Labor costs: UC medical centers have significant labor costs. They offer competitive compensation, which is necessary to attract and retain the nurses, doctors and other health care professionals who make UC medical centers such renowned institutions.

Health care reform: Under health care reform, reimbursement for clinical services by government and private insurers could be reduced substantially, including reimbursement rates for service and payments for graduate medical education.

The combined impact of these challenges could erase medical center margins. UC Health is working hard to address these issues. As UC Health moves into the throes of health care reform, the mutually beneficial relationship that exists between our medical centers and health professional schools must be preserved.

John D. Stobo, M.D., is senior vice president for UC Health.


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Large gaps ID’d in lifetime earnings of specialist, primary care physicians

Wage disparities could limit the success of health care reform.

J. Paul Leigh, UC Davis

A national study has found that earnings over the course of the careers of primary care physicians averaged as much as $2.8 million less than the earnings of their specialist colleagues, potentially making primary care a less attractive choice for medical school graduates and exacerbating the already significant shortage of medical generalists.

The results, published online in the journal Medical Care, lead the study’s authors to recommend reducing disparities in physician pay to ensure adequate access to primary care, which has been shown to improve health and reduce health-care costs.

“The need for primary care providers is greater than ever before and expected to grow as millions more Americans become insured under the Affordable Care Act,” said J. Paul Leigh, lead author of the study, professor of public health sciences and researcher with the UC Davis Center for Healthcare Policy and Research. “Without a better payment structure, there will be extraordinary demands on an already scarce resource.”

According to projections by the Association of American Medical Colleges, the nation is likely to face a shortage of more than 65,000 primary care physicians by 2025.

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How community health centers could offer better access to subspecialty care

Integrated system offers most comprehensive access to subspecialty care, study finds.

The Affordable Care Act will fund more community health centers, making primary care more accessible to the underserved. But this may not necessarily lead to better access to subspecialty care.

In a new study, researchers from the David Geffen School of Medicine at UCLA and colleagues investigated the ways in which community health centers access subspecialty care. They identified six major models and determined which of those six offered the best access:

Tin cup
Center providers rely on personal relationships with informal networks of subspecialists (the most prevalent model).
Hospital partnership
Center has a contract with a community hospital for subspecialty care.
Buy your own
Center hires subspecialists.
Telecommunications equipment is used to connect patients with subspecialists.
Teaching community
Centers train primary-care resident physicians and integrate subspecialists as faculty.
Integrated system
Centers are integrated with local government health systems or safety-net hospitals having subspecialist networks.Of the six, the researchers found that the “integrated system” model offered the most comprehensive access to subspecialty care.

Payment reform is needed to move community health centers toward becoming part of integrated systems. Two new initiatives of the Centers for Medicare and Medicaid Services (CMS) can help. First, the State Innovation Models initiative will provide $275 million for states to plan, design and test new payment and delivery system models that aim to involve all payers and providers in the state. Also, the CMS has issued guidance describing pathways for how states can design and implement integrated care models for Medicaid populations. The new research offers guidance for states in creating such models.

Katherine Neuhausen of the department of general internal medicine and health services research at the David Geffen School of Medicine at UCLA; Kevin Grumbach of UC San Francisco; and Andrew Bazemore and Robert L. Phillips of the Robert Graham Center for Policy Studies in Primary Care.

The research is published in the August issue of the journal Health Affairs.

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IOM committee to review GME

UCSF’s Kathy Dracup to serve on committee to address doctor shortage.

Kathy Dracup, UC San Francisco

Worsening physician shortages, an aging baby boomer population and expanding health insurance coverage as part of the Affordable Care Act have prompted the nation’s health policy experts to explore possible changes to the graduate medical education system.

The Institute of Medicine (IOM), the health arm of the National Academy of Sciences, is convening a new ad hoc committee to conduct an independent review of the system and make recommendations on how to better produce a medical workforce for the 21st century.

Kathy Dracup, R.N., Ph.D., dean emeritus of the UC San Francisco School of Nursing, is one of 21 IOM members appointed to the Committee on Governance and Financing of Graduate Medical Education, which will hold its first meeting on September 4 in Washington, D.C.

Dracup joins dozens of UCSF scientists and scholars who have served the nation by advising leaders on health policy and scientific research at national institutions. (See UCSF Goes to Washington)

At issue before the IOM committee is how federal funding, including more than $9 billion from Medicare last year, is spent on graduate medical education.

The review comes as the Association of American Medical Colleges projects a shortage of 45,000 primary care physicians and 46,000 surgeons and specialists by 2020. Medical schools have increased enrollments over the last six years, but the number of federally funded residency training positions has been frozen since 1997.

“We’re going to be looking at the data, at the health care needs of this country,” Dracup said. “If the federal government is going to support the education of medical professionals, where should that money be distributed and how should it be distributed?”

The IOM established the committee at the request of a bipartisan group of seven U.S. senators who were prompted by calls for review from influential health policy organizations, including the Medicare Payment Advisory Council (MedPAC), the Josiah Macy Jr. Foundation and the Association of Academic Health Centers. The institute then brought together a panel that included UCSF’s Associate Dean of Graduate Medical Education Robert Baron, M.D., M.S., to outline the issues that the committee would evaluate.

Joyce Ann Viloria, a medical resident, is training in UCSF's primary care urban underserved track at San Francisco General Hospital and Trauma Center. (Click image for larger view)

Among the issues that the educational system must adapt to are a rapidly aging and increasingly diverse patient population, the growing prevalence of disability and chronic disease, and new health care innovations, the panel found. The committee will be tasked with reviewing the current number of residents and graduate medical education slots against the number needed to address those issues.

“First, are the hospitals getting paid the right amount of money and producing residents who have the right skills for practicing in the 21st century? And second, do we have the right workforce mix to meet the needs of the public?” are among the questions to be answered, Baron said.

Among the issues that the educational system must adapt to are a rapidly aging and increasingly diverse patient population, the growing prevalence of disability and chronic disease, and new health care innovations, the panel found. The committee will be tasked with reviewing the current number of residents and graduate medical education slots against the number needed to address those issues.

“First, are the hospitals getting paid the right amount of money and producing residents who have the right skills for practicing in the 21st century? And second, do we have the right workforce mix to meet the needs of the public?” are among the questions to be answered, Baron said.

The financial debate focuses on a large pot of federal funds – about $3 billion – dedicated to “patient care payments,” which go toward the higher costs taken on by teaching hospitals to train residents. Hospitals are facing proposed cuts to that funding, while some are calling for greater accountability for the existing funds.

“There’s been a growing concern about whether the money from Medicare, in particular, was being spent appropriately,” Baron explained. “Is there sufficient value for the Medicare money being spent?”

For Dracup – one of only two representatives of nursing on the diverse committee – a major question will be whether more federal funds should be put toward training nurse practitioners to help carry the burden from the projected doctor shortage. The pressure will be even greater with 32 million Americans becoming newly insured under the Affordable Care Act, she noted.

“Graduate medical education funding does go partially for nursing education, and increasingly nurse practitioners are providing care and being forecast to provide more care for the people who are uninsured,” said Dracup, who saw severe cuts to state funding of nursing education while leading the School of Nursing for a decade.

“Nurse practitioners can provide many of the same services that physicians provide, and they provide them just as safely and at lower cost,” she said.

The committee plans to hold five meetings over 18 months before issuing its recommendations.

A total of 89 UCSF faculty members have been elected to the IOM – one of the highest honors in the fields of health and medicine. Election by existing members is a recognition of outstanding professional achievement and commitment to service, and with it, members are appointed to serve on standing committees that range in topics including obesity, family planning and workplace safety, as well as special committees.

What is GME?
GME is the second phase of the formal educational process that prepares doctors for medical practice. It typically takes at least 11 years beyond high school to educate physicians before they will practice independently — four years for a bachelor’s degree, four years for medical school and three to seven years for residency (GME). Medical residents train at teaching hospitals such as UC academic medical centers, where they receive supervised, hands-on training in clinical specialties such as pediatrics or surgery. A residency can be followed by a fellowship, during which time a physician
receives subspecialty training.

UC Health: Graduate Medial Education

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How does U.S. health care compare with United Kingdom, China?

UC Riverside School of Medicine Dean G. Richard Olds will participate in Aug. 8 panel discussion.

G. Richard Olds, UC Riverside

Dr. G. Richard Olds, the founding dean of the School of Medicine at the University of California, Riverside, will be a member of a panel that will focus on health care in the United States, the United Kingdom and China.

Free and open to the public, the interactive panel discussion, titled “Healthcare in the United States, United Kingdom and China,” will take place at 5:30 p.m., Aug. 8, 2012, at the Riverside Medical Clinic, 7117 Brockton Ave., Riverside.  Light refreshments will be served.

Olds will talk about designing a medical school for Inland Southern California.  He will be joined on the panel by the following people:

Dr. H.S. Dhillon, chair of the Department of Surgery at Riverside Medical Clinic, who will talk about the United Kingdom National Health Service of yesteryear (25 years ago);

Pawanjit Hare, a medical student at the University of Leeds, the United Kingdom, who will talk about the United Kingdom National Health Service of today;

Charles Sands, the dean of the College of Allied Health at the California Baptist University, who will discuss allied health and its effect on the quality of health care in the Inland Empire;

Dr. Albert Ma, vice chair of the Department of Anesthesiology at Riverside County Regional Medical Center, who will shed light on health care reform in China; and

Dr. Steven Larson, chief executive officer and medical director at Riverside Medical Clinic, who will talk about the “future and now” of the Inland Empire.

For more information, please call (951) 782-5177.

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Women’s health marks milestone with new preventive care benefits

Changes have “potential rippling effect on not just women’s health but also family’s health.”

Claire Brindis, UC San Francisco

Women’s health is marking a significant milestone Wednesday, as a law requiring health insurance plans to provide new preventive care benefits officially takes effect.

The benefits, adopted last year by U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius, include allowing women access to annual preventive care doctor visits, support for breastfeeding equipment, domestic violence counseling, screening for human papillomavirus and contraception — all covered without a co-pay.

For UC San Francisco’s Claire Brindis, Dr.P.H., M.P.H., who served on the independent Institute of Medicine (IOM) that issued the report outlining eight key recommendations, the changes implemented Wednesday have a “potential rippling effect on not just women’s health but also family’s health.”

“It was an exciting opportunity to serve the nation and to really bring evidence to bear on women’s lives,” said Brindis, the director of the Philip R. Lee Institute for Health Policy Studies and a co-director of the Bixby Center for Global Reproductive Health. She was one of 16 health care experts on the IOM committee that wrote the 2011 report, titled “Clinical Preventive Services for Women: Closing the Gaps.”

“We really looked at where we failed to meet the needs of women and what acts as a barrier to getting access to health screenings,” she said.

“When we made the recommendations, we really did not know what was going to be the outcome, so it was extremely illuminating that all eight were adopted.”

According to an HHS report also released this week, approximately 47 million women are in health plans that must cover these preventive services at no charge. It’s being rolled out as part of the Patient Protection and Affordable Care Act (ACA) signed by President Barack Obama in 2010.

“President Obama is moving our country forward by giving women control over their health care,” Sebelius said in a statement. “This law puts women and their doctors, not insurance companies or the government, in charge of health care decisions.”

Despite cause for celebration, Brindis is cautious about challenges facing the new law, including a provision that allows some insurance providers to avoid implementing the changes for patients currently in plans. Only new and renewing plans must offer the new level of coverage, so it could take years before the benefits reach all women who are entitled to them.

Brindis also pointed to the ongoing opposition to the ACA in Congress as well as one of the most controversial provisions of the new law that requires health plans to provide free birth control to women. Courts are currently weighing lawsuits by the Catholic Church and religiously affiliated organizations, which are temporarily exempt from that provision.

“It’s this concern about government telling the church what they need to cover,” she said. “In fact, a very large proportion of Catholic women report that they use birth control, that they use contraception services.”

As the new benefits roll out, another challenge will be to educate women about these preventive services and measure its real-world impact, Brindis said. Medical and policy experts will be “keeping an eye on what’s the proof, that level of evidence, that incorporating these practices within the provision of health care actually contributes to health outcomes for women, as well as decreasing the cost,” she said.

And the work doesn’t stop there. The need to keep focusing on prevention, rather than after-the-fact treatment is more important than ever. For instance, Brindis cited studies showing that for every $1 spent on family planning, $10 are saved within 10 years.

“Health evidence is constantly being updated,” she said. “We need to have an infrastructure in place on an annual basis to look at whether there needs to be other preventive services that need to be incorporated into a health benefits package.”

Related link:
Focus on U.S. Supreme Court rules on health care law

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