From Policy Statement to Practice: Integrating Social Needs Screening and Referral Assistance With Community Health Workers in an Urban Academic Health Center

Social and economic factors have been shown to affect health outcomes. In particular, social determinants of health (SDH) are linked to poor health outcomes in children. Research and some professional academies support routine social needs screening during primary care visits. Translating this recommendation into practice remains challenging due to the resources required and dearth of evidence-based research to guide health center level implementation. We describe our experience implementing a novel social needs screening program at an academic pediatric clinic.

The Community Linkage to Care (CLC) pilot program integrates social needs screening and referral support using community health workers (CHWs) as part of routine primary care visits. Our multidisciplinary team performed process mapping, developed workflows, and led ongoing performance improvement activities. We established key elements of the CLC program through an iterative process We conducted social needs screens at 65% of eligible well-child visits from May 2017 to April 2018; 19.7% of screens had one or more positive responses. Childcare (48.8%), housing quality and/or availability (39.9%), and food insecurity (22.8%) were the most frequently reported needs. On average, 76% of providers had their patients screened on more than half of eligible well-child visits.

Our experience suggests that screening for social needs at well-child visits is feasible as part of routine primary care. We attribute progress to leveraging resources, obtaining provider buy-in, and defining program components to sustain activities.

The full article can be downloaded below.  

Here’s How Tripling Prices Could Save You 40% On Your Medications

Medication prices in the US have gone from wild to insane; from expensive to outright unaffordable. But a tripling in prices could save us all a lot of money. Here’s how that would work.

It’s a policy known as external reference pricing. The idea is simple. First, the US government would look at how much a drug company charges for a given medication in a handful of other developed countries. Next, it would tie the US price to some multiple of that international price.

The full Forbes article can be viewed at this link.  

The 2016 California policy to eliminate nonmedical vaccine exemptions and changes in vaccine coverage: An empirical policy analysis

Vaccine hesitancy, the reluctance or refusal to receive vaccination, is a growing public health problem in the United States and globally. State policies that eliminate nonmedical (“personal belief”) exemptions to childhood vaccination requirements are controversial, and their effectiveness to improve vaccination coverage remains unclear given limited rigorous policy analysis. In 2016, a California policy (Senate Bill 277) eliminated nonmedical exemptions from school entry requirements. The objective of this study was to estimate the association between California’s 2016 policy and changes in vaccine coverage.

The full article can be downloaded below.  

 The Rise of the Data-Driven Physician

Since its inception, the Stanford Medicine Health Trends Report has examined the most consequential developments and technologies that are changing health care delivery. Our 2020 report describes a health care sector that is undergoing seismic shifts, fueled by a maturing digital health market, new health laws that accelerate data sharing, and regulatory traction for artificial intelligence in medicine.

The full report can be downloaded below.  

FDA Finalizes Enforcement Policy on Unauthorized Flavored Cartridge-Based E-Cigarettes That Appeal to Children, Including Fruit and Mint

Amid the epidemic levels of youth use of e-cigarettes and the popularity of certain products among children, the U.S. Food and Drug Administration (FDA) today issued a policy prioritizing enforcement against certain unauthorized flavored e-cigarette products that appeal to kids, including fruit and mint flavors. Under this policy, companies that do not cease manufacture, distribution and sale of unauthorized flavored cartridge-based e-cigarettes (other than tobacco or menthol) within 30 days risk FDA enforcement actions.

The full HHS press office statement can be viewed at this link.  

Commentary: Two Threats to Precision Medicine Equity

In January 2015, President Barack Obama unveiled the “Precision Medicine Initiative,” a nationwide research effort to help bring an effective, preventive, and therapeutic approach to medicine. The purpose of the initiative is to bring a precise understanding of the genetic and environmental determinants of disease into clinical settings across the United States. The announcement was coupled with $216 million provided in the President’s proposed budget for a million-person national research cohort including public and private partnerships with academic medical centers, researchers, foundations, privacy experts, medical ethicists, and medical product innovators. The Initiative promises to expand the use of precision medicine in cancer research and modernize regulatory approval processes for genome sequencing technologies. In response, Congress passed the 21st Century Cures Act in December 2016, authorizing a total of $1.5 billion over 10 years for the program. Although the Precision Medicine Initiative heralds great promise for the future of disease treatment and eradication, its implementation and development must be carefully guided to ensure that the millions of federal dollars expended will be spent equitably. This commentary discusses two key threats to the Precision Medicine Initiative’s ability to proceed in a manner consistent with the United States Constitutional requirement that the federal government shall not “deny to any person . . . the equal protection of the laws.” In short, this commentary sounds two cautionary notes, in order to advance precision medicine equity. First, achieving precision medicine equity will require scientists and clinicians to fulfill their intellectual, moral, and indeed legal duty to work against abusive uses of precision medicine science to advance distorted views of racial group variation.

Precision medicine scientists must decisively denounce and distinguish this Initiative from the pseudo-science of eugenics – the immoral and deadly pseudo-science that gave racist and nationalist ideologies what Troy Duster called a “halo of legitimacy” during the first half of the 20th century. Second, to combat the social threat to precision medicine, scientists must incorporate a comprehensive, ecological understanding of the fundamental social and environmental determinants of health outcomes in all research. Only then will the Precision Medicine Initiative live up to its potential to improve and indeed transform health care delivery for all patients, regardless of race, color, or national origin.

The full commentary can be downloaded below.  

Electronic Health Records Creating A ‘New Era’ Of Health Care Fraud

Derek Lewis was working as an electronic health records specialist for the nation’s largest hospital chain when he heard about software defects that might even “kill a patient.”

The doctors at Midwest (City) Regional Medical Center in Oklahoma worried that the software failed to track some drug prescriptions or dosages properly, posing a “huge safety concern,” Lewis said. Lewis cited the alleged safety hazards in a whistleblower lawsuit that he and another former employee of Community Health Systems (CHS) filed against the Tennessee-based hospital chain in 2018.

The suit alleges that the company, which had $14 billion in annual revenue in 2018, obtained millions of dollars in federal subsidies fraudulently by covering up dangerous flaws in these systems at the Oklahoma hospital and more than 120 others it owned or operated at the time.

The full Kaiser Health News article can be viewed at this link.  

Inside the 2019 Forbes Healthcare Summit

Healthcare is a $3.75 trillion dollar industry that touches every aspect of our lives. It’s also facing a number of challenges, from rising drug prices and the fragmentation of medical records to antibiotic resistance and more.

At the eighth-annual Forbes Healthcare Summit, which took place in New York City December 4-5, the brightest minds in healthcare converged to find solutions to these and other challenges facing the healthcare industry. Here, learn about key takeaways they shared on the future of healthcare for the brain, body and business.

Best Practices 

1. Eradicating the Mental Health Stigma - In an engaging discussion moderated by Dr. Mehmet Oz, media personality Charlamagne tha God, former congressman Patrick Kennedy, and NFL wide receiver Brandon Marshall discussed their own struggles with mental health and the importance of reducing the stigma around it so that people can get the help they need.
2. Replacing Antiquated Regulations with Market-Friendly Policies - Seema Verma is the administrator of Centers for Medicare & Medicaid Services, but she doesn’t think her office has all the answers in healthcare. “Government is not the solution, and government is often the problem,” she said. Her team spends a lot of time unraveling past policies that no longer apply to the way healthcare works today, she said.  Though Verma doesn’t always think government is the solution, she does think it can nudge the system toward more free-market principles—such as an increased emphasis on price transparency for medical treatments and drug prices.
3. Improving Patient Care with Better Data - Forty years after founding Epic, billionaire CEO Judy R. Faulkner shared a rare look inside the clinical database and healthcare software company. Considering the future of electronic health data, she predicts a Cambridge Analytica-esque challenge: the risk that family members’ data will be compromised by a members’ data authorization.
4. Saving Costs by Focusing on Primary Care - Moderator Moira Forbes joked with Sir Andrew Witty, President of UnitedHealth Group and CEO of Optum, about the mystery surrounding his company. “It is one of the biggest healthcare companies that no one knows anything about,” she said. Yet while many people may not know the inner workings of Optum, it touches millions of healthcare consumers across the U.S. What makes the company so profitable? A focus on efficiency without compromising patient care, Witty said.
5. Bring Technological Innovation to Emerging Markets - Partners in Health cofounder and Harvard Medical School professor Paul Farmer reflected on progress he made in 11 resource-poor countries the past 32 years, tackling widespread diseases like AIDS, tuberculosis, ebola and malaria. Asked what new technologies have been most critical in his mission, he emphasized that definitions of “technology” in healthcare should include vaccines, therapies and diagnostics—not just devices and gadgets.
6. Empowering Patients with AI and Telecommunications - How do you help patients make better health choices? Empower them to take control of their health with telemedicine, three digital health companies said. 

The full Forbes article can be viewed at this link.  

On the Digital Health Conundrum (Part II)

This is a continuation of the ideas laid out in Part I of this post. In this part, I’ll talk about how to think about changing healthcare and lay out my framework for the kinds of companies that can disrupt it. 

The full article can be viewed at this link.