Health Care Topics Candidates Ought to Discuss

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Dr. Robert Pearl, MD, Chairman and CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group, was recently interviewed by Bloomberg BNA’s Alex Ruoff about a primer on health care issues produced by the Council of Accountable Physician Practices (CAPP), which Dr. Pearl chairs. The primer was written for political candidates at all levels of elected office, and encouraged candidates to think beyond the success or failure of the Affordable Care Act (ACA) when considering health care policy.

The primer identified three issues that all elected officials should learn about to make the best policy decisions for their constituents. These include value-based reimbursement for doctors and hospitals, robust and coordinated use of health information technology, and improved quality measurement and reporting.

Dr. Pearl said in the article that neither Democratic candidate Hillary Clinton or Republican Donald Trump has spent much time discussing these topics during their speeches or in their official platforms.

“Both candidates have commented on the exchanges and the price of drugs, but there hasn’t been a discussion about the big changes needed in health care,” he said.

According to the article, although Medicare is already moving doctors into value-based payment systems, CAPP wants the candidates to commit to accelerating the pace of change and push for global capitation in which doctors are paid a flat rate based on the size and health of their patient population instead of for each service they provide.

The article goes on to assert that this shift could help to reduce the annual growth in Medicare spending, which according to the 2016 Medicare Trustees Report, is expected to increase as a portion of overall gross domestic product from its current level of 3.6 percent to 5.6 percent by 2040.

“When you look at what we’re spending on health care, it’s unclear why we’re not talking about changing payments,” Pearl said.

 

Source: Ruoff, Alex. Why Hasn’t Clinton or Trump Talked About Health IT? Bloomberg BNA, 31 August 2016.

Mayor, What Will You Do To Improve My Health?

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On July 19,  Smart Growth America (@SmartGrowthUSA) hosted its annual Local Leaders Council (@SGALocalLeaders),meeting at the Center for Total Health.  Attendees included influential leaders from various communities around the nation including mayors, city council members, county officials, city managers and agency heads. The event allowed these influential leaders to incorporate total health into their community and the content at the center provided a perfect backdrop.

Geoffrey Anderson, president of Smart Growth America, started off the event with a warm welcome. Parris Glendening, former governor of Maryland, and Rick Danner, mayor of Greer, South Carolina, both spoke about the excellent solutions Smart Growth America has developed.  The keynote speaker, Amy Liu (@amy_liuw), the vice president and director of Metropolitan Policy Program at Brookings, touched on growth and planning during her talk, titled  “Economic Development for All”.  Through her work in urban and social planning in challenged economic communities in Philadelphia, she has learned numerous solutions to improving residents overall quality of life by improving the economy in a neighborhood.  As Amy Liu stated, “Better jobs, access to grocery stores and community programs for youth will improve the health of disadvantaged residents.”  It was a pleasure hearing Amy Liu’s solutions and ideas for creating healthier neighborhoods, mainly in metropolitan areas such as Washington, DC, and its surroundings.

Throughout the day, Smart Growth America rotated through different breakout sessions and seminars for guests to discuss and brainstorm solutions.  One such seminar was Creative Placemaking Strategies, giving community leaders tools for success. Another was Revitalization without Displacement, which encouraged leaders to  brainstorm strategies to improve the economy in their community.  Guests also networked with one another over a catered lunch and were invited on a 20 minute guided walking tour with Ted Eytan, MD, (@tedeytan). The event ended with a closing plenary discussion by Peg Moertl, the senior vice president of Community Development Banking of PNC Bank, Sarah Goldfarb, director of Policy and Research of Jersey City Redevelopment Agency, Ken Bowers, planning director in Raleigh, North Carolina, and Dean Gordon, director of Business Growth in Birmingham, Alabama.

Once again, the center is glad Smart Growth America held this inspirational annual event at the Kaiser Permanente Center for Total Health.  If you would like to host an event at our center, please visit our website.

Paving the Way to Active, Sensored Streets: Part 1

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Our guest blogger this week is Sam Piper, Senior Planner, Alta Planning + Design (@altaplanning). Alta Planning + Design designs and implements bicycle and pedestrian infrastructure for cities and institutions. This is Part 1 of 2 blogs by Mr. Piper.

A new study from Imperial College London published in April 2016 had startling findings: “There are now more adults in the world classified as obese than underweight.”

The study, which pooled data from 183 countries, found thatthe number of obese people worldwide had risen from 105 million in 1975 to 641 million in 2014”. While the World Health Organization previously set a goal to have no rise in obesity above 2010 levels by 2025, the new research predicts that the probability of reaching this goal is “close to zero.”1

Negative health outcomes and obesity trends have coincided with other major trends. Consider the correlation between the growth in American obesity during a period over which Vehicle Miles Traveled (VMT) have persistently increased nationwide. In recent years, this trend has halted, with VMT actually decreasing.

 

alta1This dip has been attributed to a variety of factors, including the Great Recession, the recent growth in urban populations (which for the first time since the 1920s exceeded the growth of suburban areas), a diversification of transportation options (think car share, uber, lyft, and real time transit information) among other factors.

More recent data indicates that VMT growth rates could be shifting to pre-recession rates, and it is yet to be seen if the reduction in driving will last.

Regardless, the growth in obesity levels has steadily increased during this period: “Over the past 35 years, obesity rates have more than doubled. The average American is more than 24 pounds heavier today than in 1960.”

What has attributed to this incessant rise in obesity?

One factor is the fundamental change to the American built environment that has occurred over the past 100 years, which encourages sedentary lifestyles.  At the turn of the 20th century, most people lived in farming communities (60 percent) and worked labor intensive jobs, while 28 percent lived in dense, walkable cities. Relatively few people at this time, about 12 percent, lived in “suburban” areas.2

By 2000, the landscape of America had drastically altered, with the majority of Americans (52 percent) living in sprawling suburban communities designed to move vehicles.

Although correlation is not causation, that our culture is so dependent on the automobile for daily life has impacted, to some degree, our health and our well-being. Most Americans now live in places where it is uncomfortable to walk or bike for most trips, making driving the most viable option for transportation. Multiple data sources indicate that a majority of people, 76 percent (according to 2013 data) drive alone to work.

Cities and states across the country are well aware of the obesity epidemic. As a result, they are working to prioritize bicycling and walking infrastructure development to provide more healthy travel options. Doing so represents an attempt to halt the growth of obesity through transformative tools such as complete streets programs and safe routes to school programs.

Transportation planners and engineers rely on data to develop better infrastructure and to prioritize investments. Longitudinal data on vehicular travel is robust, but equivalent data for walking and bicycling is almost non-existent. The ability to access more robust data helps communities:

  • Determine where investments in walking and biking infrastructure are most needed
  • Assess changes over time, draw conclusions about the impact of new facilities, and improve the design of future facilities
  • Understand crashes involving people walking or bicycling more than is typically possible with crash data alone
  • Quantify the benefits of walking and biking, which ultimately makes active transportation projects more competitive for funding

Fortunately, there are a number of current and emerging technologies that can capture and process non-motorized data efficiently and economically. After researching several of these technologies, Alta Planning + Design, a company that designs and implements bicycle and pedestrian infrastructure for cities and institutions, is excited to announce the publication of the Innovation in Bicycle and Pedestrian Counts white paper.

Learn more about Alta Planning and Design’s findings tomorrow in Part 2.

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[1] http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30054-X/abstract

[1] https://www.wvdhhr.org/bph/oehp/obesity/section1.htm

[1] http://www.healthdata.org/news-release/vast-majority-american-adults-are-overweight-or-obese-and-weight-growing-problem-among

[1] https://www.wvdhhr.org/bph/oehp/obesity/section1.htm

[1] 2014 State Indicator Report on Physical Activity. National Center for Chronic Disease Prevention and Health Promotion. Division of Nutrition, Physical Activity, and Obesity.

Serving the needs of children and adolescents who have experienced sexual violence

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Guest blog post by Marcy Levy, Senior Technical Advisor, JSI Research and Training Institute, Inc

aidsfreephoto

Responding to the comprehensive needs of children and adolescents who have experienced sexual violence can be daunting. Survey data from eight countries show that approximately one in four girls and one in seven boys experience sexual violence as children.

There is growing consensus on the need for integrated services – clinical, social, and community— and for clear referral pathways between these services to meet the complete needs of the child/adolescent beyond the clinical exam. These linkages are critical to meet the short and long-term medical, psychosocial, safety/protection, legal/justice, and other social needs of children and adolescents who have experienced sexual violence.

However, there is limited global guidance on how a referral system for children and adolescents who have experienced sexual violence should function, and/or what follow-up such a system should include.

How do we respond to something so sensitive that requires multi-sectoral support and funding, in environments that have few resources?

The AIDSFree project developed a new toolkit, Strengthening Linkages between Clinical and Social/Community Services for Children and Adolescents who Have Experienced Sexual Violence: A Companion Guide, which provides inspiration for even the small “next steps” that a program can take to better serve the needs of children, adolescents, and their families.

The full version of the companion guide can be found here. Here are some of the highlights:

The Companion Guide

The companion guide provides a basic framework, examples, resources, and contact information for health providers and managers to:

  • Better understand and facilitate linkages with critical social and community services for comprehensive care of children and adolescents who have experienced sexual violence and exploitation beyond the clinical exam
  • Take additional steps to help children and adolescents receive the information and support they need
  • Contribute to changes in sociocultural norms that perpetuate a culture of violence and silence that can also increase HIV risk and vulnerability.

Among other topics, the Guide:

  • Includes an overview of the minimum services children and adolescents who have experienced sexual violence and exploitation need
  • Describes the major service providers for children and adolescents who have experienced sexual violence and their coordinating roles; offers detailed guidance on setting up a referral pathway and facilitating coordination between communities and facilities
  • Presents program highlights from around the world on efforts to address sexual violence.

Children and adolescents who experience and seek services for care, treatment, and support for sexual violence may enter the system at any number of points: a lower-level health facility, a hospital, a nongovernmental organization office, a police station, a school, a church or mosque, another community point or by reporting a violation to a community leader or traditional court mechanisms.

To ensure that children and adolescents receive the services they need, all stakeholders in this system must coordinate their service provision and should be aware of what resources are available in their communities.

About the author:

Marcy Levy is a senior technical advisor for JSI and the AIDSFree Project. The Strengthening High Impact Interventions for an AIDS-free Generation project is managed by a consortium of partners including JSI Research & Training Institute, Inc., Abt Associates Inc., EGPAF, EnCompass, LLC, IMA World Health, the International HIV/AIDS Alliance, Jhpiego Corporation, and PATH.

Diabetes

Make Today a Little Sweeter

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November is American Diabetes Month. According to the American Diabetes Association, nearly 30 million Americans have diabetes, while 86 million have pre-diabetes and are at risk for developing type 2 diabetes. While there are some risk factors for diabetes that you can’t change, knowing your risks lets you decide what’s best for your health. This fall, take time to make and celebrate healthy changes. Some ideas:

Play detective: Find out what you don’t know about your family history, especially when it comes to chronic conditions.

Stay in check: Low blood sugar levels can cause sudden mood swings in some people, so don’t go too long between eating meals.

Indulge smart: When you want to satisfy your sweet tooth, be mindful of your choices. A serving of berries is almost always better than a pastry or chocolate.

Form more information, visit kp.org/diabetes.

Walking, Talking, Ward 8 Visualizing at the Walking Summit

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Walking Summit Ward 8 Walk and Talk Washington DC USA00281

Walking Summit Ward 8 Walk and Talk Washington DC USA00281 Left to Right: Rosemary Agostini, MD, Kim Holland, MD, Group Health Cooperative, Jojo Cambronero, Seattle Police Department (View on Flickr.com)

Sometimes you can’t take people passionate about walking anywhere — that is, unless you are interested in changing everything, then you should go with them everywhere 🙂 .

Thanks to community colleague Khadijah Tribble (@TribbleME) and fellow organizers, a group of nurses, doctors, law enforcement professionals, and other civic leaders walked in Washington, DC’s Ward 8.

If you don’t know what is meant about Ward 8, not to worry, the blog way-back machine will bring you back to my very first meeting with Khadijah, where she walked us through her community (see: The People of Washington, DC’s Anacostia are Building a Culture of Health ).

What I love about yesterday, though, is that Khadijah instructed us to not focus on what wasn’t right with the community as we walked it. Instead, she asked us to focus on its beauty. And there’s a lot of beauty.

We were joined by a team from Seattle, including my physician colleagues Rosemary Agostini, MD, and Kim Holland, MD, who are community health evangelists as part of the magical health system of the future, Group Health Cooperative (@GroupHealth). They’ve been doing a ton of work to engage people around walking in their city, and have engaged collaborators in the Seattle Police Department, who also joined us.

And that’s when our learning experience went to the next level…

In true Rosemary Agostini fashion, she engaged a group of Washington’s Metropolitan Police Department officers in Congress Heights to talk about community and engagement and safety. As you can tell from the photographs, it was a meaningful, authentic conversation.

On the way back to Ward 6, I got to learn about how community engagement and crime fighting work together to support a healthy community.

As it was said to me, “you don’t get information from people when you arrest them, you learn by engaging them.”

As usual, I see a lot of similarities to medicine and health care – disease fighting (or disease pre-emption) + member, patient, community involvement go a long way to understanding what creates health, and what prevents it.

I was really impressed by what I saw, by all the people involved. I obviously love learning, and I love learning how similar our perspectives are when it comes to ensuring that every person and community achieves their full potential. What is health care here for, and law enforcement, and civic leaders, and …. 🙂

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Celebrating Summer

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Looking to trim down this summer?  Take advantage of the warm weather, skip the gym, and get active outside!

  • Explore your city or town.  Play games at the park, go for a bike ride around town, or do laps at the local pool.
  • Pack your snacks.  Plan ahead for your day and bring along fruit, nuts, and other healthy treats.
  • Bring water.  Avoid the temptation of sugary drinks by staying hydrated from the start.
  • Wear your sunscreen.  And remember to reapply it regularly if you’re outside all day.

If you live in a place that gets really hot, think about hitting the streets early in the morning or later in the evening, when the sun isn’t a factor. Or save these ideas for the cooler fall weather that will be here before you know it.

Want to learn more about a healthy weight? Click here.

 

 

Three Ways to Improve Digital Health for the Underserved

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“Nothing is more important than your health.  Not money, not anything.  Without your health you can’t do anything.  Emotionally, socially, at work; everything goes with health.…”   – Focus group participant.

“Nothing is more important than your health.  Not money, not anything.  Without your health you can’t do anything.  Emotionally, socially, at work; everything goes with health.…” – Focus group participant.

A new report from Oakland-based non-profit ZeroDivide reveals three ways in which low income women of color use digital technology to access health care for themselves and their families, as well as how they would like to use it in the future.

To determine the current use and usability of consumer-facing electronic health tools (“eHealth”) by low-income communities and communities of color, and to identify opportunities to improve the use of eHealth to address persistent health disparities in these target communities, ZeroDivide held six focus groups with over 60 diverse women in four American cities during June 2014.

In spite of a revolution in new health technologies, advancements that economically and socially privileged populations enjoy, however, have in many instances eluded underserved populations and underserved women in particular.

Through these discussions, participants shared their perceived value of eHealth tools, as well as challenges they face to eHealth adoption.

“The translation of health on the websites are atrocious, they are terrible,” one participant said. Another remarked, “You have to go through so many phases just to get to where you’re trying to go, and it’s like, I have to remember this too? My Mom ends up being more confused.”

The report offers three policy recommendations.

  1. Improve the digital and eHealth literacy of underserved consumers and safety net providers and outreach to these populations;
  2. Support eHealth tools for underserved populations that feature user-centered design and design that enhances communication with providers; and
  3. Support technology capacity building for safety net providers to strengthen the eHealth equity infrastructure.

Read the full report here.

Total Health, Thriving Economies, Community Health: The Connection

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In cased you haven’t noticed, “total health” is a term we like to use a lot around here. It’s meant to encompass all the aspects of living that impact a person’s mental, physical and social well-being.

We link total health to a lot of seemingly disparate subjects that one might not immediately think of when thinking about health – e.g. transportation technology, zip codes, mindfulness.

So you might suggest we’re really stretching things a bit when we link total health to…the economy. But there is, in fact, a very important connection here.

Community health and an individual’s health and well-being are very intricately connected. Communities that support health and prosperity – communities with safe places to walk and ride your bike; easy access to fresh, locally grown produce; affordable housing and strong schools – these communities create the conditions that support healthy people. They are also the signifiers of a healthy and vibrant local economy.

Thriving local economies help “create conditions in communities that give rise to health,” explains Tyler Norris, vice president for Total Health Partnerships at Kaiser Permanente.

Norris sat down with Michelle Long, executive director of the Business Alliance for Local Living Economies (BALLE) to explore the connections between total health, thriving economies and community health. BALLE builds its mission on thriving local economies. Advancing what it calls a “localist agenda,” BALLE seeks to lift up the value of local community in driving a fair and equitable society. From BALLE’s website:

Localism is about building communities that are more healthy and sustainable – backed by local economies that are stronger and more resilient. It means we use regional resources to meet our needs – reconnecting eaters with farmers, investors with entrepreneurs, and business owners with the communities and natural places on which they depend. It recognizes that not one of us can do it alone and that we’re all better off, when we’re all better off.

The dynamic conversation on localism, economies, and health is captured in this recent article and podcast on Kaiser Permanente’s Share website.

A Perfect Storm Brings Health Care, Government and Business Together for a More Sustainable DC

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There was a “perfect storm” of activity in the nation’s capital last week, and if you weren’t tuned in closely, you might have missed it.

The Sustainable DC pledge awaits formal signatures from health care representatives signifying their commitment.

The Sustainable DC pledge awaits formal signatures from health care representatives signifying their commitment.

This perfect storm was not another Superstorm Sandy. In fact, one might argue that one of the aims of this perfect storm was to build resilience to any such storms in the future. This perfect storm brought together representatives from 21 different health care organizations and local government officials at Kaiser Permanente’s Center for Total Health pledging to make the District of Columbia “the most sustainable city in the United States.

So what makes this newsworthy? The health care sector is certainly no stranger to coming together under the umbrella of sustainability. Over the past 20 years, the sector has been leading its very own “green revolution,” with hospitals and health care systems of all sizes looking hard at their contributions to environmental waste and pollution and what they must do to flip the equation and support more environmentally sustainable health care approaches.

What makes the Sustainable DC effort special is its focus on a single urban community, on bringing together leaders from health care, government and business sectors in a particular place, concentrating their efforts across governance, jobs and the economy, equity and diversity with the goal that, “By 2032, the District will be the healthiest, greenest, most livable city in the nation by using sustainability solutions to address core challenges.” The Sustainable DC plan outlines specific goals, targets and actions to get there. And the plan makes it clear that health care organizations to be at the table to bring the mighty vision to fruition.

Hospitals in America contribute an estimated 8 percent of greenhouse gas emissions, generate more than 2 million tons of waste each year and draw upon natural resources like water in ways that often counteract efforts to support the health of individuals and communities. Recognizing this paradox, many health care leaders have joined efforts like the Healthier Hospitals Initiative, Practice Greenhealth and Health Care Without Harm to green their own health care systems.

Kathy Gerwig, chief environmental stewardship officer for Kaiser Permanente, chronicles this green movement in her recent book, Greening Health Care: How Hospitals Can Heal the Planet. In the book, she notes the reasoning behind why health care organizations would move to join forces with each other and government to move the needle on environmental health:

“In the final analysis, most health systems engage with their communities not because they are incented to do so by federal and state tax law, but because they are mission-driven organizations that care deeply about the health of their communities. They know that individuals’ health depends on the health of the communities in which they live, work, learn, and play, and that the health of those communities depends on a healthy environment—health-sustaining air, water, soil, and all natural resources. They strongly believe, on the basis of compelling evidence, that when they invest their dollars and their expertise in promoting healthy social and physical environments, they are benefiting their communities and contributing to the health of everyone.”

That mission-driven energy was palpable on October 23, 2014. The energy in the room was exciting, collegial and activated. There was much talk of the sustainability progress that is already converging in DC – from an extensive array of green roofs and LEED-certified buildings across DC to the build out of the Metropolitan Trail to provide safe, physical activity and active transportation options. And there was a clear conviction expressed by health care leaders who were gathered, as well as the Mayor’s office, that this coming together for a more sustainable DC was just setting the stage for a convergence of efforts that would echo progress even beyond DC limits.

We can only hope that, as DC leads the way in sustainability, so goes the rest of the country.

Representatives from DC area health care organizations gather with Mayor Vincent Gray at the Center for Total Health after the signing of the Sustainable DC pledge.

Representatives from DC area health care organizations gather with Mayor Vincent Gray at the Center for Total Health after the signing of the Sustainable DC pledge.

Kaiser Permanente applauds the Sustainable DC plan, and we are pleased to be among the pledge-signers and the hosts for this momentous step forward. We have pledged our support and look forward to working with fellow health care system leaders to advance the goals outlined in the plan.

Kaiser Permanente physician director for the Center for Total Health, Ted Eytan, along with Keith Montgomery, executive director for the Center, nicely set the stage for the day’s event in their welcome remarks. Ted offered his follow-up reflections in a blog post that summarized the vision for total health that everyone in the room intuitively if not concretely echoed that morning. He writes, the Sustainable DC plan is “not just about the environment, it’s about everything that goes into creating an ‘equitable, prosperous, society.’”

You can watch the full signing ceremony in this video.