U.S. Healthcare – Moving Forward

US Healthcare System Talk - ACA Importance

Last week I gave a presentation to the leaders of some women’s health advocacy organizations about where the U.S. healthcare system is heading, i.e., where we go from the current situation with the A.C.A. We had a great discussion, and the organizer of the event emailed me afterward to say, “Amazing is all I can say. You are the first person who could speak to [the] ACA in which people listened and engaged.”

Some of the key points I made included:

Focus on the future. Don’t relive the past.
Move forward from today’s strengths and weaknesses. The slide below describes health insurance coverage for 2015 showing dramatic increases in coverage in individual insurance and Medicaid, and a decrease in the uninsured.

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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.…

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.…

Medicaid and State Level Health Transformations

July 8, 2014 / Michael D. Miller MD / Delivery of Healthcare, Economics & Financing, Information & Communications, Medicaid, Politics, State-Level Healthcare Reform / No Comments

I recently guest lectured on Medicaid and state level health transformation at a George Mason University public policy class.

To start, I led the class through a discussion of how states differ from each other around 14-plus factors related to healthcare delivery, financing, policy, and politics. In this discussion we talked about the importance of policy makers appreciating those factors as they consider how to improve health, and the different routes states have taken for Medicaid improvements and expansion. (See picture of white board below.)

We had a great discussion, and I emphasized the importance of both multi-stakeholder alignment, and health information systems that can provide data for transparency and accountability – which together are fundamental to health improvement and reform efforts.…

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 Transformation in San Diego & California

June 10, 2013 / Michael D. Miller MD / Delivery of Healthcare, Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Medicaid, Medicare, State-Level Healthcare Reform / 1 Comment

I recently sat down with Kevin Hirsch, MD, President of Scripps Coastal Medical Group* to talk about health reform and transformation in the San Diego region. (See video below.)

Dr. Hirsch’s insights are interesting and timely because California often precedes the rest of the country in adopting new approaches to healthcare delivery and financing problems. An example of this may be California’s 2006 Hospital Fair Pricing Act, which addressed very high hospital bills for the uninsured. This month’s Health Affairs includes an article that analyzes the impact of this law, and the authors’ findings contrast markedly with Steven Brill’s Time magazine article, “Bitter Pill: Why Medical Bills Are Killing Us.”…

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!…

Health Promotion, Prevention, Wellness, and Government Fiscal Policies

March 14, 2013 / Michael D. Miller MD / Delivery of Healthcare, Economics & Financing, Medicaid, Medicare, Politics, Private-Employer Based Health Insurance, Public Health / No Comments

I recently had the opportunity to give guest lectures at Georgetown University and the University of Virginia. At Georgetown I focused on employer’s perspectives on health promotion and disease prevention. (Videos of portions of that discussion are below.) At UVA’s Batten School of Public Policy I discussed fiscal issues and policies for government healthcare programs, e.g. Medicare and Medicaid. (A few slides from that discussion are below….. sorry no video.)

The opportunity to talk with our future clinicians, health system administrators, and policy makers was heartening and a bit terrifying. While the students are eager and passionate, I wonder about their historical understanding of our complex healthcare systems and the policies, programs, and initiatives that got us to where we are today.…

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.,…

Health Reform is Right On Target

January 7, 2013 / Michael D. Miller MD / Delivery of Healthcare, Economics & Financing, Federal Healthcare Reform, Health System Reform, Politics / No Comments

Support for the Patient Protection and Affordable Care Act (aka ACA or “the health reform law”) has never been very high since it was signed into law on March 23, 2010. As can be seen in the Kaiser Family Foundation’s Tracking Poll interactive graphic below (assuming the embedded link is working) the percentage of individuals with favorable and unfavorable opinions of the law have remained relatively close.

Public policy is often said to be in the right place if approximately equal numbers of people agree and disagree with the implementation of new laws and programs. The Heartland Monitor Poll described in a December 8^th National Journal article paints a slightly more complicated picture of the health reform law, i.e.…

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