A Haven in the City

An article in the Yale Journal of Public Health describes HAVEN, a Saturday morning free primary care clinic providing care to residents of the Fairhaven neighborhood in New Haven. HAVEN was conceived by and is staffed by students from Yale’s medical, public health, physician assistant and nursing schools and is held at the Fair Haven Community Health Center. The clinic provides an array of primary care services, including prescriptions, patient education, medical intepretation and social services, to uninsured adult Fairhaven residents free of charge. Patients get help accessing any care or services that can’t be provided on-site, as well as application assistance for public programs and hospital free care. HAVEN started in 2004 as a response to the growing need for services for uninsured community residents. As of May 2007, the average medical debt of HAVEN patients was $10,498, while the average annual income was $10, 274. The clinic is supported through donations and grants; no government funds are used.
Ellen Andrews

CT family premiums grew by 21% from 2001 to 2005; median income grew by 2.4%

A new report explains why CT families are feeling like they are moving backward. “Squeezed: How Costs for Insuring Families are Outpacing Income” by the Robert Wood Johnson Foundation found while the percent of premium that CT families pay dropped slightly from 2001 to 2005, total average family premium payments increased 6.4%. In more bad news, the number of CT employees that work at firms offering health insurance dropped by 91,512, CT residents with private coverage dropped by 5.4% and uninsured residents rose by 2.9%. The study only looked at premiums and did not consider rising copayments, deductibles, co-insurance and the erosion in covered benefits – so the real burden of health costs on CT families is likely much worse.
Ellen Andrews

Highlights from CT Health Notes

Thursday’s issue of CT Health Notes, our biweekly list serv, includes
Aging baby boomers intensify looming health care workforce shortage -- a new report from the Institute of Medicine finds that the growing number of older patients with more complex health care needs will overwhelm an already stressed health care workforce.
Health care becoming “employer of last resort” -- Tuesday the Wall Street Journal reported on the increase in health care jobs, especially where manufacturing jobs are disappearing. The interactive map is fascinating – see the increases in health care employment in CT, particularly in New Haven, and the decreases in manufacturing.
Something is not always better than nothing in health insurance -- A recent report in Health Affairs compares the assets of uninsured households with cost sharing requirements under high deductible health plans. Among families with at least one uninsured member, only about 15% had net assets sufficient to cover single-person cost-sharing levels for an HSA.
Survey finds 76% of CT cardiologists cite a great need for health care reform -- A survey of CT Chapter of the American College of Cardiology members published in this month’s CT Medicine, found that while a large majority believe health care reform is needed, only 9% are familiar with the presidential candidates’ proposals.

For more on CT Health Notes, including how to search the archives, click here. To subscribe, click here.

Donaghue Foundation Annual Meeting & Conference

Wednesday, I went to the Donaghue Foundation Annual Meeting and Conference. The Donaghue Foundation was established to “promote medical knowledge which will be of practical benefit to the preservation, maintenance and improvement of human life.” Three very different projects were highlighted.

The first panelist, Harlan Krumholz, MD (Yale School of Medicine) presented on a project he undertook to reduce the time to intervention for patients presenting with a particular kind of heart attack. The good news is that this goal can be reached with a relatively modest financial investment from hospitals. The bad news: it requires a cultural shift in most healthcare organizations, empowering various team members – EMS staff, ER docs, cath lab staff – to make decisions they are trained to make, rather than waiting on a primary care physician to come in and make the call.

The second presentation was by Elizabeth Pivonka, PhD, RD, from the Produce for Better Health Foundation. They are the “5 a day” people. She talked about the investment that the Produce for Better Health Foundation made in social marketing that would reach its target audience of Gen X moms. Because of the research, focus groups, and surveys they’ve undertaken, “5 a day” is becoming “fruits & veggies: more matters.” The foundation has strong relationships with both public & private partners. Whereas the “5 a day” campaign really looked to healthcare workers to disseminate the message, the “fruits & veggies: more matters” campaign is looking to moms themselves to spread the word to each other.

Finally, Veronica Nieva, PhD, discussed a new toolbox that the Agency for Healthcare Research & Quality (AHRQ) is pulling together, called AHRQ Health Care Innovations Exchange. This website is designed for health care professionals of all stripes to share with each other innovations that improve quality and care of patients.

The three projects on which the conference focused present a well-rounded picture of necessary action to improve our healthcare systems:
1. We need to improve the efficiency and efficacy of our systems of care.
2. We need to address the broader environmental factors that impact our health status.
3. We need to make sure that practitioners, policy makers, and other stakeholders are communicating best practices and thinking collaboratively & strategically about how to implement those practices in different settings.

I would have liked to hear more about the policy implications arising out of each of these projects. In each case, I believe that policy action bolsters significantly the impact of the work described. I guess that part’s what we do here!
Connie Razza

New report details questions and answers on implementing medical interpretation for CT Medicaid consumers

A new report, Medicaid Payments for Medical Interpreters: Implementation Questions and Recommended Action, commissioned by the CT Health Foundation lays out details the state needs to consider in implementing legislation passed last year providing medical interpretation services to Medicaid consumers. Questions addressed include how much should DSS pay and to whom, in what situations will the services be available, and will payment be an administrative expense or a covered service. The report explores the experiences of 12 states and the District of Columbia and makes recommendations to ensure that every CT Medicaid recipient receives high-quality health care.

Life expectancy drops for women in 183 US counties

From 1983 to 1999 life expectancy in many US counties decreased, especially for women (183 counties) while life expectancy for all Americans grew by 7 years for men and 6 years for women from 1960 to 2000. The last time US life expectancy experienced any decline was in the 1918 Spanish flu epidemic. The authors of a study published today in the peer-reviewed, open access journal PLoS, blame a slowdown in preventing deaths from heart disease together with a modest rise in diabetes, lung cancer and other lung diseases. The researchers found disparities in life expectancy between US counties growing since 1983 after declining for decades. Four percent of American men and 19% of US women experienced either a decline or stagnation of life expectancy between 1983 and 2000. The 183 counties with declining life expectancy for women had lower average incomes, fewer residents who complete high school and a higher proportion of black residents than counties with increasing life expectancy. Counties with declines were clustered in the Deep South, Appalachia, the lower Midwest and one county in Maine.
Ellen Andrews

Retail medical clinic issue brief

Connecticut now has at least fifteen retail medical clinics, mainly Minute Clinics in CVS stores, but more are coming. Go to our Policymaker Issue Brief No. 44 for more on what these clinics are, their potential as an affordable source of care, concerns about safety and impact on the rest of the health care system, and what other states are doing to regulate these clinics.