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Karen DeSalvo

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Population-health programs vs. hospitals


Eric Hunter, CEO of safety-net health plan CareOregon, said that if its population-health efforts were as successful as he’d like, hospitals would significantly cut back on their services.

“I tell hospitals, and they hate when I tell them this, ‘In my perfect world, I would never need you,’” Mr. Hunter told panelists at a Politico event. “My goal is to put you out of business. If we can do the right thing, all you’ll have is an ER for when somebody gets in a car wreck.”

But many  providers won’t have  access to strong community health programs such as CareOregon’s.

Karen DeSalvo, M.D., former national coordinator for health information technology at the the Department of Health and Human Services, pressed for culture changes that include breaking down data silos that block providers from seeing the full picture of a patient’s, or a  community’s, health.

Dr. DeSalvo said: “It means that we really have to rethink how we look at health.”

To see the Politico event, please hit this link.


A new blueprint for U.S. public health


1802 caricature of Edward Jenner vaccinating patients who feared it would make them sprout cowlike appendages.

A new blueprint is needed to guide  U.S. public health,  focusing on food and housing security, good schools and transportation, as well as directly on medical care and illness and injury prevention, wrote Karen DeSalvo, acting assistant secretary for health at the Department of Health & Human Services, and Georges Benjamin, executive director of the American Public Health Association, in Health Affairs.

In other words, run American public health services more as governments do in the many other developed nations, in Western Europe and East Asia, that have far better health outcomes than does the U.S.

“Public Health 3.0” sees   public health leaders  as chief health strategists for their communities, in which there would be many cross-sector partnerships, including employers, insurers, education leaders and other stakeholders.

The blueprint would build on such earlier public health efforts as mass vaccinations, antibiotics, laboratory science, food and water safety and the professionalization and standardization of public health agencies.

“We must address the upstream drivers of health that touch everyone, no matter where they are born, live, learn, work, play, worship and age,” the authors wrote. “Public health is the essential infrastructure for this work, but it needs to innovate, and in many ways, reinvent itself so that we have what it takes to ensure that the American people are healthy, ready, and competitive in this global economy.”

Giving urgency to their proposals is that after decades of life expectancy growing in the U.S.,  average levels have been flat over the past three years and have actually dropped in some areas.

“Cross-sector partnerships to improve public health are already occurring across the country. ‘The traditional ‘silos’ of medical, behavioral and social services can’t meet the needs of our population alone,’’ Jim Hickman, CEO of Better Health East Bay, in California, told Healthcare Dive recently. “Partnerships, enabled by technology and amplified by data-sharing, are the first step in changing the way we deliver care.”

Other Public Health 3.0 blueprint steps include ensuring that all public health departments are nationally accredited, thus providing communities with “timely, reliable, granular-level … and actionable data,’’ establishing metrics to measure public health programs’ success and more flexible and sustainable funding sources.

To read the Health Affairs article,  please hit this link.

To read a Healthcare Dive analysis, please hit this link.

Alliance to push to make EHRs easier to use

The Obama administration has announced that  tech companies, hospital systems and physician groups have agreed to act to make electronic health records (EHRs) easier for consumers to  use.

EHRs systems often don’t talk to each other, limiting their usefulness to patients, especially those with complex health problems.

“Now is the time for this data to be free and liquid and available,” said Karen DeSalvo, head of the  Department of Health and Human Services  office overseeing the transition to computerized medical records from paper ones.

The Minneapolis Star Tribune noted that “Taxpayers have ponied up about $27 billion in subsidies to encourage the adoption of electronic medical records by hospitals and doctors’ offices. But the results so far have fallen short of the data-driven transformation that proponents envisioned. With new personal health applications for mobile devices hitting the market, there’s a renewed push to clear obstacles rooted in different technologies and clashing competitive priorities among vendors and healthcare providers.”

Those in the agreement said they’d work to:

  • Improve consumer access. “Theoretically, patients would be able to easily access their records from one provider and transfer them to another. That second provider would be able to seamlessly import the earlier records into its system,” the Star Tribune reported.
  • Stop blocking health-information sharing. “A report last year  found that some healthcare organizations were blocking the sharing of information outside their group.”  But “some experts say that’s already changing with greater use of something called ‘direct exchange,’ a secure messaging pathway between registered medical providers,” the paper reported.
  • Put standards for secure, efficient digital communications into effect.


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