Archive for May, 2018

Health Wonk Review – Instagram Style

Thursday, May 17th, 2018

A picture’s worth a thousand words, and today Jason Shafrin proves it at Healthcare Economist. Jason has a photo, a chart, a graph and even a cartoon (for you Sponge Bob lovers) to illustrate what Health Wonk Review authors are posting.

We’re heading toward summer, although you’d never know it from the weather we’ve been gifted here in Massachusetts. Regardless, grab a mug of whatever you like, sit back, put your feet up and take a stroll through a Wonk garden filled with some excellent health care policy thinking.

It’s The Zip Code, Stupid! Update

Thursday, May 10th, 2018

At the end of February 2018, we wrote about a May 2017 study in JAMA Internal Medicine that concluded that where one lives is a bigger factor in health care outcomes than actual health care. This from our February post:

Geography is the biggest X-Factor in today’s American Hellzapoppin version of health care. The study analyzed every US county using data from deidentified death records from the National Center for Health Statistics (NCHS), and population counts from the US Census Bureau, NCHS, and the Human Mortality Databas and found striking differences in life expectancy. The gap between counties from lowest to highest life expectancy at birth was 20.1 years.

And, surpirse, surprise, it turns out if you live in a wealthy county with excellent access to high level health care, like Summit County, Colorado (life expectancy: 86.83), you’re likely to live about 15 years longer than if you live, say, in Humphries County, Mississippi, where life expectancy at birth is 71.9 years.  So, yes, Zip Code matters.

The concept of  zip code influence seems to be gaining traction. Today, from AIS Health Daily, we learn  a number of Blues Plans are planning on targeting the “where you live” problem with innovative strategies. Here is the AIS Daily release:

Blues Plans Work to Combat “ZIP Code Effect”
The Blue Cross and Blue Shield Association (BCBSA) recently launched the Blue Cross Blue Shield Institute, a subsidiary of BCBSA created to address social and environmental issues, as evidence mounts that health outcomes may be affected as much or more by social determinants of health as they are by actual medical care.
The Blue Cross Blue Shield Institute says it will address what it calls the “ZIP code effect,” which encompasses transportation, pharmacy, nutrition and fitness deserts in specific neighborhoods. It is partnering with Lyft, Inc., CVS Health Corp. and Walgreens Boots Alliance to address transportation and pharmacy deserts. The institute says it plans to deal with fitness and nutrition deserts in 2019.
Meanwhile, Highmark Inc. will launch a transportation initiative this summer to provide rides for members with chronic health conditions who live in a transportation desert. The service will begin in Pittsburgh as a pilot.
On April 17, Highmark’s Allegheny Health Network opened its Health Food Center, which acts as a “food pharmacy” where patients who lack access to food can receive nutritious food items, education on disease-specific diets and additional services for other social challenges they may face.
Other Blues plans also are addressing social determinants of health. For instance, Blue Cross and Blue Shield of North Carolina intends to invest part of its savings from the Tax Cuts and Jobs Act of 2017 into community health programs.
At Independence Blue Cross, the Independence Blue Cross Foundation’s Blue Safety Net Program offers “mobilized services” to medically underserved communities. The IBC Foundation sponsors the Philadelphia Eagles Youth Partnership’s Eagles Eye Mobile to conduct free vision screenings and eye exams and provide prescription glasses to under-insured and uninsured children.
We salute the Blues for recognizing the problem and trying to do something productive about it.
Final thought: If you do not subscribe to AIS Health Daily, you should.

On Empathy And Thoughtful Leadership

Thursday, May 10th, 2018

In his May 1 column for Risk & Insurance, Roberto Ceniceros, evoking the memory of Abraham Lincoln, describes and recommends a leadership style radically different from that of the tweet-driven current occupant of 1600 Pennsylvania Avenue.

Like Mr. Trump, Lincoln had quite a temper. However, over the course of his life he came to recognize it as a weakness. In many cases, when someone caused his blood to boil, which happened frequently during the Civil War, rather than immediately lashing out, he would often withdraw and write a letter to the offending party detailing in stark terms his great disappointment. He would then put the letter in a desk drawer and more often than not never send it. This mental health exercise would calm him and allow him to deal with the issue in a more thoughtful manner.

in his column, Mr. Ceniceros suggests Lincoln’s method defines a highly self-aware and empathic person. He writes that this behavioral characteristic was shared by four other historical figures described in “Forged in Crisis: The Power of Courageous Leadership in Turbulent Times,” written by Harvard Business School historian Nancy Koehn.

As described by Mr. Ceniceros, Keohn’s book:

…includes the story of Ernest Shackleton, hailed in previous business-management books for leading his shipwrecked and isolated crew off Antarctic ice flows. The other biographies feature abolitionist Frederick Douglass; Dietrich Bonhoeffer, imprisoned by the Gestapo and murdered for opposing the Third Reich; and scientist and author Rachel Carson, who raced against cancer to finish her manuscript on the dangers of mass pesticide use.

All five of these courageous people overcame nearly impossible challenges, but Shackleton, who simply refused to let anyone under his commend die on their perilous journey, and Lincoln, who simply refused to let the Union die on his watch, embody an empathy of heroic proportion.

Another person who should be included in this group is Ulysses S. Grant, 18th president of the United States. Grant was a great leader, but a total disaster as an administrator, primarily because of his trustful nature. His presidency is historically noted for profound corruption and scandals. In private life he failed miserably, both before the war and after it. In 1884, after his final business venture left him penniless, he contracted terminal cancer. His friend, Mark Twain, suggested Grant write his autobiography, which Twain would publish, giving Grant extremely favorable royalties (30%). Faced with impending death, Grant simply refused to die and leave his family in abject poverty. He raced to complete the Personal Memoirs of Ulysses S. Grant, an autobiography Twain described this way:

I had been comparing the memoirs with Caesar‘s Commentaries. …I was able to say in all sincerity, that the same high merits distinguished both books—clarity of statement, directness, simplicity, unpretentiousness, manifest truthfulness, fairness and justice toward friend and foe alike, soldierly candor and frankness, and soldierly avoidance of flowery speech. I placed the two books side by side upon the same high level, and I still think that they belonged there.

Grant died five days after finishing the book. His heirs received royalties of about $450,000, which, in today’s currency, comes to about $12 million.

 

 

Lincoln, with his letters, Shackleton, his loyalty, and Grant, with an indomitable will to provide for his family, personify dedication to others on an heroic scale. Roberto Ceniceros’s column is a poignant reminder that character matters, that a forceful personality can be used for good or ill, that humility is the foundation of empathy.

Donald Trump should start writing letters.