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.…

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!…

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.…

Health Propoganda

February 27, 2013 / Michael D. Miller MD / Health Policy and Communications Blog, Information & Communications, Public Health / No Comments

Zocalo Public Square asked me to write a short answer to the question “What has been your favorite health propaganda campaign in world history–whether for its success or for its other qualities–and why?”

I wrote about the positive contribution of the Robert Wood Johnson Foundation funded Aligning Forces for Quality (AF4Q) initiative, and the negative effects of fake medicines. You can see my full piece along with the other 6 contributions here: http://www.zocalopublicsquare.org/2013/02/25/this-is-your-brain-on-health-propaganda/ideas/up-for-discussion/

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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.,…

Cutting Employer Healthcare Costs

November 26, 2012 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Economics & Financing, Health Policy and Communications Blog, Private-Employer Based Health Insurance, Public Health, Quality of Care & Safety / 1 Comment

Over the past 20+ years larger companies have tried many tactics to control the growth of their healthcare spending, including HMOs, consumer-directed healthcare, wellness programs, value-based insurance design, selective contracting for high-cost procedures, personal health assessments, etc. While some of those efforts temporarily reduced employers’ healthcare spending, they did not change the long-term trends, in part because they only targeted employees and did not focus on high or very high cost individuals – many of whom are not active workers. [A recent Health Affairs article analyzing conditions associated with employee healthcare spending reflects this “searching under the streetlamp” phenomenon.]

Company Health Benefit Costs Do Not Equal Employees’ Healthcare Spending

The cost of providing health benefits for most larger companies includes not only the health benefits for employees, but also costs for retirees, and spouses and dependents of active workers.…

Why Healthcare Spending is Slowing – A New Normal?

June 1, 2012 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Economics & Financing, Federal Healthcare Reform, Health System Reform, Innovation, Medicare, Nutrition, Public Health / 3 Comments

The growth in healthcare spending has slowed in recent years. Many experts and pundits have sought to explain why – while also worrying, (or predicting), that this slowing is only temporary, i.e. past performance will predict the future.

Healthcare Delivery and Financing are Dynamically Evolving

The future will be significantly different than the past because our healthcare system, society, and economy are evolving into what might be called a “New Normal” state. Assuming current priorities and pressures continue, public and private sector organizations at all levels will increasingly emphasize value¹ in their decisions about spending and preferences for healthcare services – including choices about substituting one treatment option for another. …

Smoking is So Bad For You That……..It Makes Me Sick

October 13, 2011 / Michael D. Miller MD / Clinician-Patient Relationships, Health Policy and Communications Blog, Information & Communications, Public Health / 4 Comments

The evidence for the ill effects of smoking keeps getting stronger and scarier. If one were to construct a balance sheet of tobacco’s pros and cons it would look much worse than the one Bernie Madoff was hiding from his investors and the SEC.

Making the Risk of Smoking Personal

I was recently talking with one of my IT consultants and we started discussing tobacco use since he thought his smoking might have been one reason he’d been denied health insurance. What he – and many people – don’t realize is that the major health risk from smoking is not lung cancer, but how damaging it is to the heart and blood vessels, i.e.,…

Healthcare Prevention – Value, Savings and Strategies

October 6, 2011 / Michael D. Miller MD / Health System Reform, Politics, Public Health / No Comments

Prevention is often portrayed as either the savior or the step-child for reforming, transforming, or saving the US healthcare system. How prevention would specifically benefit people and society is presented in various ways to make these points:

US Doing Worse in Prevention Activities

The Commonwealth Fund recently released a study showing the US is doing poorly in reducing deaths from preventable causes. (Variations in Amendable Mortality – Trends in 16 High-Income Nations.)

While this study isn’t a definitive prescription for systemic changes, it illustrates the performance deficiencies of the US healthcare system – and is consistent with other reports looking at related metrics.…

Patient-Centered Care? Or Not?

July 11, 2011 / Michael D. Miller MD / Access to Healthcare, Clinician-Patient Relationships, Delivery of Healthcare, Health Policy and Communications Blog, Health System Reform, Innovation, Politics, Public Health, Quality of Care & Safety / No Comments

The term “patient-centered care” has increasingly been used to describe healthcare structures that deliver better quality care – as well as often doing so with lower costs. And today there was a news story about how some medical schools are assessing applicants’ interpersonal skills, something that is fundamental for being a patient-centric clinician.

While there are have been numerous articles demonstrating the value of patient-centered care and concluding that it is better and should be promoted – including those looking at the ill named “Patient-Centered Medical Homes” – I’ve found myself pondering the following questions:

“What type of care have clinicians been providing if it hasn’t been patient-centered?…

Smoking, Exercise and Obesity – The Big Three

February 2, 2011 / Michael D. Miller MD / Economics & Financing, Health System Reform, Information & Communications, Public Health / No Comments

I’ve been working with a Midwestern community for the past 7 months to improve the quality, efficiency, and value of their healthcare – as measured by public health population status, and the cost and quality of medical services. This experience has reinforced what I’ve been hearing repeatedly for the 28+ years I’ve been working with healthcare challenges: The three most significant areas for improving quality and controlling costs related to illness and healthcare are reducing smoking, increasing exercise, and reducing obesity. (The latter two are connected, but they also have separate and important benefits.)

While I will be writing more about each of these health problems in the coming weeks, (along with many other health policy issues involving innovation, system transformations, and the ongoing debate about health reform legislation), I first wanted to lay out some top line perspectives on smoking, exercise, and obesity.…

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