Innovation Online

by Roland Stephen

Americans with major diseases receive only about half of the recommended medical care, according to research published in the New England Journal of Medicine. This information serves to underline the persistent and significant gaps that exist in healthcare quality in the United States.

These persistent gaps in quality are indicative of real problems in our health care system. Given the pace of innovation, there is an inherent difficulty in translating proven medical knowledge into greater health care quality across income, racial and geographic classifications in a culturally competent manner.

Physicians and other clinicians are inundated with practice guidelines, pharmaceutical marketing materials and clinical innovations. Keeping up with new medical innovations can be exhausting. As a result, even well intentioned, highly trained and skilled providers may fail to provide optimal care to their patients.

This is a particular challenge for health care providers serving a disproportionate share of rural, minority or low-income patients. These patients certainly receive quality care in their communities, but medical practices and clinics often provide services without support staff or financial resources found in other, richer communities.

Providers in these communities may also be at a digital disadvantage, working with less access to electronic databases and other important information technologies. Adding to the problem, patients often suffer because they lack information about needed treatments and don’t have adequate financial resources to obtain them. This lack of capacity leads to poorly developed expectations concerning the quality and management of their care. The end result is a failure to even try to obtain medical interventions or a sense of frustration that leads to dangerous disengagement.

This gap between medical care based on the best and latest scientific evidence, and care actually delivered to patients requires significant and continuous attention by policy-makers. Fortunately, North Carolina is home to outstanding physicians, renowned health care institutions and visionary health care leaders. As a result, many efforts are already underway to address challenges to health care quality and disparities across the state.

Projects worth noting include the Center for Hospital Quality and Patient Safety, an initiative of the North Carolina Hospital Association and The Duke Endowment, and Medicaid’s very successful Community Care Program, which is attracting national attention for the way in which physicians are drawn into the process of setting practice standards.

The Institute for Emerging Issues is adding to the network of collaborative institutions and individuals aspiring to improve quality and reduce disparities in North Carolina. The North Carolina “Best Care” initiative is designed to encourage academic medical leaders, local practicing physicians and hospital leaders to jointly determine evidenced-based but flexible standards of care that are most advantageous for communities across the state.

The effort to reduce variation in the way care is delivered is neither new nor easy. Providers and insurers have disagreed for years over efforts to impose or encourage practice guidelines. Moreover, the effort to reduce disparities and improve quality involves more than standardized care protocols. It will also require significant progress in the utilization of information technology, pay for performance and a new approach to tort reform.

The Institute’s proposal will result in evidence-based “best practices” tailored to the needs of local communities. This will help combat some of the nation’s leading causes of death such as stroke, heart disease, and cancer. Ultimately, the goal is to improve health care quality for all North Carolinians and to ensure that the quality of health care delivered will not depend on patients’ personal characteristics, assets, or place of residence. This is an initiative that will place North Carolina on the front lines in the national crusade to improve quality and reduce disparities in health care.

Roland Stephen is the Assistant Director for Research and Policy at the Institute for Emerging Issues

Posted by Roland Stephen at 04:40 PM | Permalink | Comments (0)

Walmart draws many of its employees from among the working poor, but even within that pool (prone to obesity and other preventable conditions) it faces a challenge faced by many employers who offer healthcare coverage--money quote from the New York Times article:

A risk that a company like Wal-Mart faces, especially when it competes with smaller retailers that offer no insurance at all, ... is attracting too many workers who want the job primarily for the health coverage.

Posted by Roland Stephen at 02:45 PM | Permalink | Comments (0)

by Sara Lawrence

Paying for the goods and services we care about is an increasing dilemma for state leaders. As the recent News and Observer Editorial “Schools in a Crunch” points out, there are no ideal solutions to pay for the increasing costs of schools. Yet providing a good education is a critical function of government, and is critical to the future livelihood of all North Carolinians.

North Carolina’s economy and society, like all states, has changed dramatically over the last quarter century and state revenue systems have not kept pace. In the meantime, most solutions to the financing gap tend to be ad-hoc and temporary in nature. It is time for a larger discussion about sustainable and reliable funding sources for these critical services.

The more fundamental issue that desperately needs attention from state leaders across the nation is how do we fairly and efficiently save and pay for North Carolina’s needs in the future? We should establish public and private practices that create the fiscal climate necessary to enjoy all the benefits provided by a 21st Century economy.

Now that this year’s budget negotiations are over, North Carolina leaders can take advantage of the break to step back and address the larger issues that underpin these constant budget woes. Let’s have a discussion on innovative ways to structure revenue streams to pay for the good and services the state provides.

There are many options, and they are not black and white. To name a few, we could increase the sales tax or the property tax. We could have a flat tax, or we could have a value-added tax. All of these options have trade offs. For example, many think a flat tax is unfair to the poor, because those with very little means give up the same percentage as those with more money to spare. However, some European countries that have implemented a flat tax are finding out that the rich are actually paying a larger share of total tax revenues. In addition, flat taxes often make it difficult for corporations to take advantage of exemptions, so all businesses end up paying much more of their “fair share”.

These kinds of tradeoffs apply when rethinking other sources of revenue such as the property tax or the sales tax. But one option we don’t have is to continue the status quo.

In 2030, we will be older, we will be younger, we will be more Hispanic, we will hold more temporary jobs, we will live in a service and technology-based economy, we will receive fewer benefits, we will move around a lot, and education will be more expensive. How do we build an enduring structure of public and private financial preparedness that reflects all these dynamics?

Financing North Carolina’s future in a sustainable and equitable manner will require a comprehensive group of state of leaders to champion the modernization of public and private finance over a sustained period of time. To accomplish this crucial task the Institute for Emerging Issues will be calling on current Senators and Representatives, Mayors and County Commissioners, the leadership to be elected in 2008, and the next generation of leadership to work together on effective ideas for change. We also call on all North Carolinians to champion change in this arena, because all our futures are at stake. In order for us to own our futures we must find better ways to save and pay for it.

Sara Lawrence is the Manager of Policy Initiatives at the Institute for Emerging Issues.

Posted by Roland Stephen at 02:25 PM | Permalink | Comments (0)

by Roland Stephen

Even the most devoted blue-state voter must have some sympathy these days for President George W. Bush. The war in Iraq remains in doubt, his management credentials have been dented by Hurricane Katrina, and conservative followers are restless because of a variety of deviations from orthodoxy.

Yet there exists an obvious opportunity for action by the President that could restore his reputation as a leader and address one of the most pressing issues facing the country. It is an opportunity that lies easily within his grasp because it doesn’t require the cooperation of the legislative branch. It won’t cost any money, but instead it would save the country literally billions of dollars. And it is a way to add measurably to the health and happiness of millions of Americans. Best of all, it is an opportunity for which Bush himself is almost ridiculously well qualified.

The fittest President this country has ever had presides over the most obese population in our history. Obesity is an epidemic in the United States, ruining the health of tens of millions of Americans and undermining healthcare budgets. According to the National Center for Health Statistics over 30% of the U.S. population is now obese, adding over $100 billion in unnecessary costs onto the national healthcare bill. Worst of all, the current rate of increase in obesity means that, for the first time in the history of the United States, the generation now in grade school may have a lower life expectancy than their parents.

President Bush should take the lead in attacking this problem not by proposing legislation, but by acting as many CEOs have done: by setting an example, by using the bully-pulpit of his position, and by changing the day-today practice of the millions of federal employees who work for him.

He would be in good company. Tommy Thompson, his first Secretary of Health and Human Services, changed meal plans in his department, distributed pedometers so his employees could measure how much they walked, and even snatched cigarettes out of their hands. Governor Huckabee of Arkansas, who lost over 100 pounds after being diagnosed with adult-onset diabetes, wrote a book with the title “Stop Digging your Own Grave with a Knife and Fork”.

Some commentators have suggested that there is no “epidemic” of obesity, that it is just a conspiracy by the “food Nazis” to deprive us of an inalienable right to eat French fries. It is true that the health consequences of being overweight are indeterminate. But being overweight is not the same thing as obesity (although one often leads to the other). Millions of obese Americans are so fat that their health is impaired and their lives shortened.

For example, obesity is linked to hypertension and diabetes, which in turn can lead to heart disease and heart failure, and most health researchers see an important link between obesity and stroke. In short, obesity is much more dangerous to the average American than any Al-Qaeda operative.

The opportunity here is that obesity is almost entirely preventable. Too many of us spend the day slumped in front of computers, eating packaged food and drinking sodas stuffed with empty calories. This junk sends our metabolism on a rollercoaster ride fueled by fat and sugar, leaving us in a hungry stupor.

CEOs across the country are getting the message. Obese employees are more likely to miss work for health reasons, and more likely to make claims on increasingly expensive health plans. And since it is the modern workplace that is partly responsible for our doughy physiques, that is where change must occur.

A workplace that emphasizes good health by encouraging the use of the stairs, by stocking the canteen with healthy choices, or by providing free check-ups, is not only good for the employee, it is good for the corporate bottom line as well. It is also the kind of environment that encourages employees to take responsibility for their own health, which is the best way to keep people out of the healthcare system in the first place.

Our CEO President is perfectly positioned to join his peers in spreading the word on health and wellness in the workplace. Using the bully-pulpit alone he could have a positive impact on the bottom line of the whole country, to say nothing of the impact on his approval ratings.

Roland Stephen is the Assistant Director for Research and Policy at the Institute for Emrging Issues

Posted by Roland Stephen at 02:42 PM | Permalink | Comments (0)