Health, Healthcare, and Government Spending (and a Culture of Health)

November 29, 2016 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Information & Communications, Innovation, Medicaid, Medicare, Politics, Private-Employer Based Health Insurance, Public Health, State-Level Healthcare Reform / 1 Comment

Why governments care about health spending and healthcare, how they are connected to overall government spending and priorities, and why addressing social determinants of health is so important for making lasting improvements, were the subjects I covered in a presentation at George Mason’s graduate policy school in September. My goal was to provide the soon-to-be policy analysts and advisers with a framework for understanding those issues so they will be able to provide useful recommendations to their future decision making bosses. (See the slide below for the topics covered in the presentation.) Links to videos of the talk are below, along with short descriptions – I think that Part 6 is particularly good.…

Medicare and U.S. Healthcare Spending

June 22, 2016 / Michael D. Miller MD / Access to Healthcare, Economics & Financing, Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Medicare, Politics / No Comments

The second video from my guest lecture at George Mason University about Medicare and U.S. Healthcare Spending in now available – see below. (The first was an overview of Health Spending in the United States, and is in the previous blog and also on the HealthPolCom YouTube Channel.)

The other video segments from my guest lecture that I’ll be posting over the next week or so will be on the following subjects:

Challenges for Estimating Future Healthcare Spending
Medicaid: Federal and State Fiscal Issues
Changing U.S. Healthcare System: New Payment and Delivery Models

Enjoy. pass along to your colleagues and friends.…

Specialty Drugs: Getting What We Asked For

January 7, 2015 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Innovation, Politics, Therapeutic Substitution & Interchange / 1 Comment

The cost of so-called specialty drugs has become a major health policy issue largely because of spending projections for new medicines for chronic hepatitis C infection and cancers. Having worked on issues related to the development, approval, availability, use, and cost of medical treatments for more than 25 years, I’ve noted with concern and bemusement how cost and value issues are being discussed and presented in public debates and policy circles.

The Intense Debate About New Biopharmaceuticals Was Predictable

The introduction of significant new specialty medicines is reasonably predictable because information about biomedical research and the developmental status of new drugs and biologics is publically available from the FDA and company press releases.…

Health Reform Book

July 30, 2014 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Politics, State-Level Healthcare Reform / No Comments

Williams College Hopkins Gate - Accelerating Healthcare Improvements

In 2005 I started writing a book about health reform. As I was working on it, the structure and framework of the U.S. healthcare system kept shifting. I am now returning to work on this book, with the new working title, “Pivoting the U.S. Healthcare System: A Guide to Making Health Reform Work.” Below is a brief overview of the background about the book, which can also be found on my main website.

Comments, suggestions, and general inquiries about this project are welcome.

Overview – “Pivoting the U.S. Healthcare System: A Guide to Making Health Reform Work”

In my very first class in medical school, one of the first things the Professor said was, “Half of what we’re going to teach you is wrong.…

Sovaldi® and Curing Hep C – Myths and Other Facts

June 16, 2014 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Health Policy and Communications Blog, Innovation, Medicaid, VA/DoD / 7 Comments

The introduction of new oral medicines that can cure chronic hepatitis C infections (including Sovaldi®) have led to some intense discussions permeated with misleading information about the pricing of new medicines, how such medicines are “game changers,” and the implications for budget-crunched payers. Below I summarize some key points about those issues.

1. Myth #1: How Medicines are Priced

One of the perpetuating myths about biopharmaceuticals is that medicines are priced to recoup research and development costs.¹ It’s a myth. As I’ve written about elsewhere prescription medicine prices are set like everything else in a regulated free market: Companies set prices to maximize revenues and profits based upon the market opportunities and the value the new medicine provide compared to the consequences of the disease and other treatment options – including no treatment at all. …

CER, HIT, and Women’s Health Research

June 19, 2013 / Michael D. Miller MD / Access to Healthcare, Comparative Effectiveness, Delivery of Healthcare, Health Policy and Communications Blog, Information & Communications, Innovation, Public Health, Quality of Care & Safety / 5 Comments

Below is a video of my discussion with Phyllis Greenberger, President and CEO of the Society for Women’s Health Research, about the implications of comparative effectiveness research (CER) and information technology for women’s health and quality improvement.

What are your thoughts about CER and HIT? Will they lead to higher quality, lower cost, or more efficient/better healthcare? And if so, how soon?

FYI – The SWHR’s July 18-19 meeting mentioned in the video is “What a Difference an X Makes: The State of Women’s Health Research.”…

Health Reform and Low-Income People in Washington DC

April 11, 2013 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Federal Healthcare Reform, Health System Reform, Medicaid, Politics, Public Health, State-Level Healthcare Reform / No Comments

I recently sat down with George Jones, Bread for the City’s CEO, to talk about health reform and the challenges low-income people in Washington DC have accessing healthcare. The video of our discussion is below. A couple of notes: 1. George’s title changed from Executive Director to CEO about a year ago. I’ve known George for more than 15 years, so my bad when I introduce him as the Executive Director. 2. Please excuse my verbal stumbles and be impressed by George’s answers – we filmed this in one take in his small, hot office at Bread for the City. I’m confident there will be improvement in future videos – and of course, your feedback is always welcome!…

Accomplishments v. Activity in Healthcare

January 9, 2013 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Health System Reform, Information & Communications, Innovation, Public Health / No Comments

The phrase “Paying for Value not Volume” has been health reform’s mantra for several/many years. But the concepts embodied in “Paying for Value not Volume” are problematic on two levels. First, the term “Value not Volume” doesn’t convey a clear picture of the specific changes health reform is trying to achieve. This creates problems communicating the benefits of health reform and healthcare transformation to people who are not steeped in health policy, including most clinicians and patients.

And second, the “Paying for” part of the phrase indicates that the focus is on financial reforms. This creates a barrier to people (i.e.,…

8 Variables Fueling Increasing Healthcare Costs

July 20, 2012 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Health System Reform / No Comments

At a recent meeting about implementing the ~~Accountable~~ Affordable Care Act, Karen Ignagni, (President and CEO of the America’s Health Insurance Plans), listed 8 variables that are fueling increasing healthcare costs – and thus need to be addressed to “bend the cost curve”:

Prices of services (Not insurance premiums, which mostly reflect input prices, i.e., the cost of healthcare services and products.)
Variations in care delivery practices and how that impacts safety (She also suggested that transparency and reporting measurements for 10-12 key conditions would significantly help reduce care variation – which can improve quality and drive down costs)
Measurement (Alignment between public and private sector reporting requirements to make #2 more feasible for healthcare delivery systems already struggling with data collection, analysis, and reporting.)

…

Accountability in Healthcare – What People Think of the Coming Changes

December 16, 2011 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Health System Reform, Information & Communications / 2 Comments

Following up on my pre-Thanksgiving post, I’m reporting back on what friends and relatives think about some of the terms for new healthcare delivery entities, e.g., Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMH).

What I heard is consistent with my previous conversations: People think that ACOs are like HMOs, and Medical Homes might be nursing homes, home health, or hospice, etc. One great insight came from my cousin who is a teacher. She told me that teachers react negatively to the word “accountability” because of the No Child Left Behind (except those who don’t measure up) law – which according to a RAND analysis from the summer of 2010 is “encouraging teachers to focus on some students at the expense of others, and discouraging the development of higher-thinking and problem-solving skills.”…

Era of Accountable Care

October 24, 2011 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Federal Healthcare Reform, Health System Reform, Medicaid, Medicare, Private-Employer Based Health Insurance / 1 Comment

For many months I’ve been talking about the array of health transformation initiatives the Department of Health and Human Services has been deploying as both demonstrations and programmatic changes. I’ve been characterizing this strategy to create more accountability as an evolving menu, buffet, or map – sort of like those magical Harry Potter maps where the lines keep appearing on the parchment to create a recognizable image.

As part of releasing the final rules for the Medicare Shared Savings Program, HHS also put forth a document subtitled “Menu of Options for Improving Care,” which is a list of some of the landmarks in the future map of an Era of Accountable Care.…

Selling Healthcare Changes – Loss Aversion & Adoption of Innovations

September 26, 2011 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Health System Reform, Information & Communications, Medicare, Politics / 1 Comment

Healthcare issues ranging from national health reform to stem cell research have become a major force in political rhetoric – often overwhelming substantive information. This creates challenges for individuals and organizations seeking to achieve positive changes as their communications are swamped by election-driven messaging.

Creating and implementing successful communications programs in this turbulent environment is easier when the principles of “loss aversion” and the factors affecting the adoption of innovations are used constructively.

Loss Aversion & Campaign Messages: Swinging Votes Not Actions
Campaign communications – particularly negative messages – are very effective because they use loss aversion principles to leverage people’s reluctance to embrace change.…

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