HPSA Summer Internship Blog Series: The Role of Policy in Health Care Funding

Having grown up in Connecticut, I was elated to spend the summer interning at Hartford Healthcare, a newly formed health system headquartered in downtown Hartford. Hartford Healthcare (HHC) prides itself on being a fully integrated health system focusing on innovating the way healthcare is delivered through its robust operating model. Elliot Joseph, CEO and a graduate of the Health Management and Policy program here at the University of Michigan has led the transformation of healthcare in the state of Connecticut.

Like many states, Connecticut’s population is aging and hospitals are challenged to meet the specialized needs of the population. In response, Hartford Healthcare created the Bone and Joint Institute, Connecticut’s first and only orthopedic hospital. HHC is also working on several other initiatives related to access and patient experience which I worked on in my role within Clinical Informatics.

Despite Hartford Healthcare’s agility and innovativeness, policy implications are having a dramatic impact not only on Hartford Healthcare but all hospitals in the state. In 2012, Connecticut implemented a tax on healthcare providers that in effect has been steadily increasing over the years. The tax originally started with the idea that by moving cash from the hospital to the state, Connecticut would be eligible for higher Medicaid matching payments from the federal government. Hospitals would receive all of the funds they paid in taxes.

Over the years, hospitals have received less and less of their tax payments back. Instead of the state taking the tax revenue and sending it to the federal government for matching Medicaid funds, the state is using increasing amounts of the healthcare provider tax revenue for the general budget. The tax and the inability for healthcare providers to get their tax payments back is having a significant impact on operating margins and the ability for hospitals to innovate. Worsening the situation, as of September 8th Connecticut has not passed a budget for the new fiscal year that started in July. This budget impasse leaves healthcare providers in a literal state of financial uncertainty.

During my internship with Hartford HealthCare, I was able to see adaptive leadership in an ever-changing environment.  As health policy is shaped at the state and federal levels, Connecticut healthcare organizations must and will continue fulfilling their respective missions.

Quian Callendar is a second year Master's in Health Services Administration student at the University of Michigan's School of Public Health. He is passionate about advancing health care access and health equity. 

A Letter from the HPSA President

My fellow HPSA Wolverines,

As we return to campus and find ourselves acclimating to student life, our Congressional leaders plan to reconvene following their final summer recess. During the roughly 138 days since our last classes, the political back-and-forth we witnessed this summer is sure to have left our Senators exhausted. Having interned overseas, I was exhausted finding myself every day trying to explain the AHCA/ACA/BCRA discussions that clogged not only domestic news channels, but international as well. Americans’ attention is targeted on health care and the fate of many insurance plans, marketplaces, and laws. What will come next? Will there be an increase in premiums? Will I lose my insurance? What will come of my current coverage?

There are continuous inefficiencies, biases, and inequalities within our health system that need to be addressed and rectified. Now more than ever, we need to combine our collective talents, experiences, and passions to accept more than the status quo. As a nation, we have united in focus and uncertainty, despite the highly polarized and politicized nature of "health care". While we as health policy students may not all have career aspirations to work on the Hill, there is the blatant reality that health care policy will affect us, our neighbors, our professions.

In studying health policy (and management!), we students have an opportunity now, more than ever, to commit ourselves to understanding the nuances of health care policy in all of its forms as well as how the political process to enact and evaluate policy is evolving. The executive board of HPSA and I plan to engage and enable our colleagues to set the precedent on what we as students can contribute. We hope to discuss the situation not only on the Hill but also that within the field. We urge our peers to engage in discussions that will stimulate a deeper discussion, pursue solutions, and find their own voice to continue to promote the health of Americans, and continue to set the Michigan difference.

We have an exciting year planned and hope to see you at our events, leaving room for the flexibility and ever-changing tide of healthcare. Who'd have ever thought it could be so complicated?

Go Blue!

Marianthi

HPSA Summer Internship Blog Series: A Lifelong Passion for Advancing Pediatric Health Care

As an undergrad at Michigan, I spent the majority of my time not in the classroom, but serving as the Executive Director for Dance Marathon at the University of Michigan- a student run 501 (c)3 that fundraises and advocates for pediatric rehabilitation research and programming at C.S. Mott Children’s Hospital.  My passion for pediatric healthcare has only grown with time, and I was ecstatic to serve as the Administrative Intern for C.S. Mott Children’s Hospital this summer. As an intern at Mott, I have seen first-hand the operational impact that fundraising efforts from organizations like Dance Marathon have on kids and their families. 

Mott is not unique in the world of children’s hospitals: Medicaid patients make up a significant portion of discharges (40% or higher is standard) and Medicaid payments are critical to the bottom line.  As U.S. health policy evolves and changes, Medicaid payments, and the number of patients eligible for Medicaid, is a constant conversation in the children’s hospital. With so much uncertainty, it has become more critical than ever for children’s hospitals specifically to secure funding in other ways, such as through enhanced community relationships and donor development.

Children’s hospitals are known for doing unique things for patients and families not typically seen in other care settings. For example, Mott Children’s hospital sponsors innovative therapeutic programs like horse-back riding, adaptive tree climbing, and a music therapy creation space. Programs like these are critical not only to the patient experience, but for giving kids the chance to be just that--- kids. Unfortunately, neither private insurance nor government programs like Medicaid, fund this type of programming and children’s hospitals are left to seek outside funding sources to bring innovative care practices to life.

My internship with C.S. Mott Children’s has allowed me to see the alignment between my undergrad fundraising and volunteer efforts, the way hospital’s provide excellent quality care for patients, and the health policy conversations in the news and in the classroom. I am more convinced than ever that providing quality pediatric healthcare is the best way to ensure a healthy society—and as our health policy landscape changes, I am more convinced than ever that children’s hospitals will need to rely heavily on community organizations like Dance Marathon and others, to fill the gap.

Jasmine Oesch is a second year Master's in Health Services Administration student at the University of Michigan's School of Public Health. She is passionate about advancing health care for women and children.

Reflections from HPSA President

One year ago, in the midst of studying for exams and gearing up for my summer internship, I was also thinking ahead on how I wanted to spend my last year of graduate school. I served as the Communications Chair for the HPSA Executive Board and knew that sharing my passion for health policy with my peers was among my goals for finishing my graduate experience. With that excitement, I was elected as the President of HPSA. Now, just weeks away from graduation, I wanted to share some of my reflections:

In planning for the year, many of our events revolved around the election, from baking First Lady cookies on the Presidential Election night to lining up the Second Annual #HealthPolicyMatters week with Inauguration Day. However, I was not as prepared as I thought I would be in regards to the election outcome, and HPSA was helped me to process those feelings. We quickly prepared a Post-Election Panel, inviting five faculty to share initial thoughts on what health policy would look like under the Trump Administration. The room was filled with students and community members seeking answers and the panelists did a great job of framing the issues. We were recently honored by the Public Health Student Assembly naming this as the Event of the Year! At a General Body Meeting in early 2017 we invited HPSA members for a facilitated dialogue on the implications of the new administration and concluded the meeting with the opportunity to write postcards to Senators advocating on behalf of the Affordable Care Act and other policies. And despite feeling uneasy about what was to come, we still went bowling on the eve of inauguration.

As the HPSA programming was amplified by the election results, our bond was simultaneously strengthened. We cultivated community through ice breaker activities at one of our first General Body Meetings and treated our committee members to an appreciation dinner. We also hosted a tailgate, inviting alumni and faculty attend, in collaboration with our sister student organizations, the Michigan Healthcare Executive Student Association (MHESA) and Women in Health Leadership (WiHL).

I am excited to share that we provided the opportunity for students to meet with more than nine industry leaders to join us for events throughout the year. These included speakers from academia, population health, and various levels of government for both our General Body Meetings and a Population Health coffee chat series. Additionally, we funded three students to attend the AcademyHealth National Health Policy Conference in January. These students represented the University of Michigan while networking with an array of alumni.

Please know that all of these accomplishments are not mine alone. You may have noticed that throughout this reflection, I have using the pronoun “we.” The “we” is referring to my Executive Board: Hayatt Ali, Liz Kelman, Janelle Papin, Kim Pham, and Pat Oungpasuk. I would like to share a tradition of ours and how we begin every Board meeting. Before jumping into business, everyone around the table shares something positive. We call it our rosebud. It actually began as rosebud/thorn, but we dropped the end to focus simply on the good. This tradition has been important to me as even at the most stressful points of the year, when I was dealing with a loss in my personal life or when I just had a long day, sitting down with my HPSA Board meant shifting toward positivity. Thank you to my team and phenomenal friends for your dedication to HPSA and for making this a great year. In closing out this note and this year, I will share a final rosebud with you all, a quote from one of my favorite authors, Kurt Vonnegut:

"Many people need desperately to receive this message: 'I feel and think much as you do, care about many of the things you care about, although most people do not care about them. You are not alone.'"

To my HPSA Executive Boards (past, present and future), the HPSA community, and all of the health policy nerds out there: continue caring, be persistent and remember that we are in this together. It has been an honor to serve represent HPSA and I look forward to continuing sharing why #HealthPolicyMatters in a new capacity.

Go Blue!

Haley Haddad, HPSA President

HPSA Executive Board 2016-2017. L-R: Liz Kelman, Janelle Papin, Hayatt Ali, Kim Pham, Haley Haddad, Pat Oungpasuk

Midwest Chapter of the American College of Healthcare Executives (MCACHE) Newsletter

We have the pleasure of sharing the latest issue of the MCACHE newsletter.

It includes a message from the MCACHE President, Nancy Susick, MSN, RN, NE-BC, FACHE and from the ACHE Regent, Christina M. Freese-Decker, FACHE as well as other articles including:

• Executive profile - Melany Gavulic, Chief Operating Officer, Hurley Medical Center 
• A closer look at ACHE's CareerEDGE with Cachet Colvard 
• Information on MACRA
• A perspective on the MCACHE ambassador program
• MCACHE Social Media: Moving forward into 2017 and beyond
• ACHE changes to the  requirements for FACHE status

The Midwest Chapter of the American College of Health Care Executives (MCACHE) is a professional organization first established in 1984 as the Southeastern Michigan Health Executive Forum. Today, MCACHE is 854 members strong and provides a local forum for the exchange of information and viewpoints to enhance professional development and facilitate networking opportunities. MCACHE is an authorized affiliate of the ACHE. For more information, please visit http://mcache.achechapter.org/about-us/. 

Member Dispatches from AcademyHealth 2017: Day 1

HPSA members, Marianthi Hatzigeorgiou, Liz Kelman, and Paawan Singh are at this year's AcademyHealth Conference and will be updating the blog to share their experience. Please stay tuned to hear more, and feel free to follow their live-tweets on Twitter: @Liz Kelman and @NotMaryAnthony.

L-R HPSA members: Paawan Singh, Liz Kelman, and Marianthi Hatzigeorgiou

Day 0: Each HPSA member is being hosted by a recent HMP/HPSA alum. Liz with Ruth McDonald (MPH/MPP), Marianthi with Jessica Lin (MPH ‘16) and Christopher Lee (MHSA ‘16), and Paawan with Emily Moore (MPH ‘16). Liz and Paawan met up with Emily for dinner at a Lao restaurant in Columbia Heights while Marianthi was getting to know the train and metro system between Baltimore and DC.

Day 1: The conference ran from 8am til 6pm, with a reception and student networking hour afterward. Given that we are only in town for two days, we took some liberties with our schedule to make the most of our time here! After a quick lunch break to meet with HMP alum and a photo detour to the Capitol building, we returned to the conference to hear Nancy Pelosi speak. We jumped back in to hear the second half of a panel on Reimagining Health Equity.

The closing plenary discussed innovation in healthcare. We met up with Megan Collado (MPH ‘12) at the reception, but skipped out early to head to the Supreme Court for the protest against Trump’s immigration ban. What a day!

Here are some of the take-away’s from the conference so far:

Living in a VUCA World

Lisa Simpson, President and CEO of AcademyHealth, kicked off the conference with an introduction to the current landscape of healthcare. Unfortunately, no one knows what will happen to existing laws, or predict what might happen in the very near future. The word “VUCA” (Volatile, Uncertain, Complex and Ambiguous; “cray” as the young folk say) describes the current situation, which is a little discerning when you consider how many lives are at stake. As Nancy Pelosi would later address, Repeal & Replace could cost over 32 million Americans their health insurance by 2023. Many fellow tweeters and attendees spent some time worrying about the implications of VUCA realities; and set a stage, if not of panic, of concern and prioritization for current policies.

X-Rays don’t show immigration status

Though the AcademyHealth conference focuses on healthcare policy and health services research, health policy is more than just healthcare policy. To quote Simpson, “Immigration policy is health policy that will affect us in a very real way.” (But all you SPH students know that!)

What’s Reality Without Some Fact?

Evidence-based policy is still important, even though policymakers (particularly in proposed Repeal & Replace solutions) seem to put less faith in evidence and more in...alternative facts, or predisposed notions on healthcare. (see tweet exchange) There’s a worry that stories, albeit powerful, should not be used in place of data to strengthen arguments: “the plural of anecdote is not data”, rather, we should consider marrying the two to create the most effective policies

Sen. Bill Cassidy’s Proposal: #SAD!

Simpson introduced Sen. Bill Cassidy (R-LA) to speak. He had helped author the Patient Freedom Act of 2017, and we were really interested to hear about the alt-solutions to the ACA. Though Paawan and Marianthi only have had a semester of HMP/SPH education, it took no time for them to start looking quizzically around the room. Thankfully, they weren’t the only ones. In a room of educated experts in health policy and basic economic understandings of the healthcare market, Cassidy quickly lost the traction he was hoping to gain from the audience. The solution wants to remove mandates yet keep the same amount of people covered while covering their preexisting conditions. Women, expect to naturally pay more than men because, ya know, “they’re all having children”. States, valued as the core of America per the GOP (his words, not ours), should keep the ACA if they want to, or get rid of it, or use federal money, or their own! Everyone wins!! O__o Feeling like we were oddly at a taping of Oprah, we looked to Twitter to see what others thought of the “have your cake and eat it, too” solution. Thankfully, we weren’t the only ones unimpressed. Hoping that, should Repeal & Replace be our next reality, we have something a little more realistic to consider.  

Bills, Bills, Bills….& Drugs, Drugs, Drugs

The drug pricing panel offered us insight into how we could possible reformat payment policies to lower the costs of drugs. What’s the new trend? Value-Based Care. (Value-Based Care is basically the new brunch of the pharma pricing). Drug pricing wants to incorporate more value-based care, but also, per the Bristol Meyer Squibb panelist, any changes should go to experts who “really think about that” before implementation. Though the facts and figures are available in predicting how value-based care can benefit consumers and overall health spending, there is often a hesitation from manufacturers to readily accept these payments. However, staying with the status quo is not a safe fallback. 

On rising prices, the consumer perspective was, “Innovation is useless if no one can afford it”. What do you consider in such considerations, then? Spending is the wrong metric- it's easy to reduce spending alone. The goal is efficient healthcare delivery and maximum value. There was considerable time spent discussing quality metrics that should be considered and reconsidered before price adjustments were implemented. However, there again was some discrepancy among the panel of what constitutes as quality metrics and how much time can be allotted here before consumers were negatively affected. 

Mama MACRA, Here we go again

Liz was able to attend the “MACRA: What Now?” panel discussion. There was a lot of insight and focus again on value-based care: specifically, how quality metrics are needed to successfully implement or evaluate new payment models. Kate Baicker, a panel speaker, noted how “Healthcare policy tries to balance promoting competition and care coordination”. How can they or do they work in aggregate? There is still a lot to consider and many evaluation challenges ahead for MACRA, but some great takeaway points. 

A lot of the discussion was centered around the idea of incentivizing high value care for patients and aligning that with payment systems, echoing many of the points considered at the University of Michigan’s Center for Value-Based Insurance Design.

#HMPeverywhere #MichiganMafia

As mentioned earlier, we were fortunate enough to use the lunch break for a quick dash to the Hill to meet a fellow HMP alum. Daniel Ochylski, an SPH alum and current Robert Wood Johnson Health Policy Scholar in the Ways and Means Committee, was kind enough to take the time out of his day to chat for awhile in the staff meeting room. We discussed the intimate association between advocacy groups and committees, the uncertainty of the current administration, how the most important thing anyone can be doing is getting involved. Later, he told us about his PhD research that involved developing a simulation program for the practical training of nurses; training of home-care workers in an attempt to establish qualification standards. Before we had to head back, he gave us a tour to the #room(s)whereithappens!

L-R: Marianthi Hatzigeorgiou, Dan Ochylski, Liz Kelman, and Paawan Singh

Throughout the rest of the day, they were lucky to meet with Megan Collado (MPH ‘12) and discussed her role with AcademyHealth, Randel Richner (MPH ‘90), Donna Friedsam (MPH., ‘90) Health Policy Programs Director at the University of Wisconsin Population Health Institute, and Dr. Neil S. Fleming (VP of Quantitative Sciences, Baylor Scott & White Health).

Innovations Disrupting Healthcare

Going ahead, we hope to see a shift from in house hospital and clinic healthcare delivery models to a delivery system that uses technology to care for patients in their homes. Healthcare startups and innovators are set to gradually begin disrupting parts of the brick and mortar hospital system. The imminent change in healthcare landscape sees consumers playing the central role in steering ahead (more care outside hospitals, home-care, technology aided early interventions, etc.) The evolution is not going to wait for providers or policies to drive. Consumers are now equipped with more information than ever before, and have changing healthcare needs that are being met by innovators. “Healthcare is a team sport” (Nancy Gagliano) and partnership is key to enabling effective change.

Chronic care patients can hope to benefit from this and as, Dr. M. Christopher Gibbons said, “the term ‘noncompliant patient’ needs to be eradicated and we need to transition to thinking of patients as compliant but lacking the right tools to succeed. Rasu Shrestha, a panel member, wants chronic-care patients discharged with the technology to help prevent their readmission. The best part is that it’s already happening! 

#HealthPolicyMatters Week: Jan 16-20, 2017

By Kim Pham

I first experienced HPSA's #HealthPolicyMatters campaign last year, when HPSA engaged with students, faculty, and staff in the SPH lobby by asking everyone why health policy matters to them. My answer still rings true back then as it does now: health policy matters because affordable, high-quality health care should be seen as a human right.

In light of what has transpired in the U.S. political climate this year, the HPSA Executive Board found it befitting to kick off #HealthPolicyMatters Week on Martin Luther King Jr. Day. As we reflected on the theme of U-M's 31st MLK Symposium, Sounds of Change, we have felt the impact and importance of health policy now more than ever. According to Symposium's Theme Statement, "[Sounds of change] implicitly addresses the plurality of change: positive, negative, and ambivalent... It can represent dialogue that motivates, noise that drowns out discussion, and indeed, silence itself as a means of creating change."  

“Ultimately people are the producers of sound and so are the agents of change.”

— U-M MLK Symposium 2017

With this sentiment, we were excited to hold an Advocacy workshop led by UM-SPH Director of Governmental Relations, Jen Martin, followed by our signature #HealthPolicyMatters campaign in the SPH lobby. This culminated with a HPSA social event for our members before the inauguration of the 45th U.S. President, Donald J. Trump. Our goal with this campaign, as well as our mission, is to help others better understand how this is relevant to them, and to help them become involved in health policy.

We are grateful to our HPSA members, faculty advisors, and collaborators for supporting us in our endeavors, and we hope everyone enjoyed this year's #HealthPolicyMatters week. Please feel free to share your thoughts in the comments below.

Conference Funding Opportunity: Academy Health 2017

For anyone interested in attending Academy Health, it will be taking place on January 30-31st, 2017 in Washington D.C. One of our goals this year is to help send as many people as possible to the Academy Health conference. Please take a look at this year's conference agenda at http://www.academyhealth.org/node/2451. To find out more about HPSA funding, please reference the guidelines and complete an application here:  http://www.hpsa-um.org/conference-funding-criteria/.

>>DEADLINE FOR CONFERENCE FUNDING: Friday, 12/23/2016 by 11:59pm<<

Applications will be reviewed over the holiday break and applicants will be informed of their status during the first week of January. 

Some anticipated costs: 

Conference fee: $415, Travel fee: $200, and other Miscellaneous costs like food, etc. We are currently in the process of attempting to secure lodging options hosted by alumni.

Please note: 

The conference falls on Monday & Tuesday, 1/30-1/31. We recommend holding the entire week (i.e. Saturday-Thursday) as we are hoping to have the option for alumni networking activities in the days prior to or after the conference.