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Posts from the ‘Diana Mason’ Category

Change the Conversation on Obamacare: From Penalties to Promoting Health

ACA

The March 31st deadline for people to sign up for insurance coverage under the Affordable Care Act (ACA) has come and gone. Media coverage prior to the deadline reached a feverish pitch and no doubt helped the Obama administration to exceed its revised target of 6 million people enrolled under the health insurance exchanges. But it is foolhardy to believe that simply covering more people to receive care in a dysfunctional, acute-care-oriented system will promote the nation’s health and reduce health care costs. Perhaps now we can shift the national conversation to the many components of the ACA that can change how and where we can promote the health of people where they live, work, and play. Health promotion–not insurance penalties–is what the health care system needs more of.

Most people are unaware of the law’s provisions that can change what kind of health care— is delivered–and where and how. For example, “Independence At Home” is an initiative built into the ACA that expands capitated programs for all-inclusive care–physical, psychological, social, and functional–of older adults provided by physician- or nurse-led interprofessional primary care teams. These programs already exist and have been shown to be successful in keeping older adults living in their own homes, out of nursing homes and hospitals, and engaged in health and social activities, with improved quality of life and lower costs.

At the other end of the life spectrum, the ACA expands funding for home visitation programs for high-risk mothers and their newborns, based largely upon the Nurse-Family Partnership (NFP). The NFP has decades of research documenting the short- and long-term benefits to the physical, psychological, and social health of participating women and their children, with a significant return on investment–a $5.70 return for every dollar invested in a high-risk family.

Demonstration projects are already under way to expand models of transitional care that help patients and their family caregivers better manage their acute and chronic illnesses in ways that reduce 30-day hospital readmissions. The focus on reducing the rate of readmissions has already moved most hospitals to test new ways of partnering with community-based health care organizations to smooth the transition from hospital to home.

The ACA also includes grants for employee wellness programs. Initiatives such as Wise Health Decisions, a nurse-led employee wellness program in Indiana that contracts with employers to provide on-site health promotion and coaching services, have demonstrated improved health indicators while reducing employers’ spending on health care. The investment in health promotion enables health risk assessments, early detection of health problems, and helping people become more engaged in living healthier lives.

Two other elements of the ACA have great potential for promoting the health of communities: the community benefit requirement for nonprofit hospitals and the expansion of nurse-managed health centers. The former requires nonprofit hospitals to conduct a health needs assessment of a community they serve, develop a community improvement plan, and demonstrate how they are helping to implement this plan–ideally, in partnership with the local public health department and other community stakeholders. Some hospital executives view this requirement cynically as simply more paperwork to keep their nonprofit tax status. But it’s an opportunity to engage one of the most powerful employers in a community to be vested in a healthy future. We may need to put some teeth into this requirement by developing value-based payments for hospitals that can show meaningful engagement and progress on community improvement plans.

Finally, the ACA authorized nurse-managed health centers (NMHCs), but did not mandate funding them. Most NMHCs were started by schools of nursing through funding from the U.S. Health Resources and Services Administration to create clinical practices that serve the needs of vulnerable and underserved populations and to provide sites for faculty practice and clinical teaching of students. Today, there are about 150 NMHCs, some of which are federally qualified health centers. Most are served by interprofessional teams of nurses, physicians, nutritionists, social workers, and others to provide primary care and wellness services to individuals, families, and the whole community. For example, the Eleventh Street Family Health Service in North Philadelphia recognized that the leading health problems in the community it serves are obesity, diabetes, hypertension, and heart failure. In addition to individual and group health services to address these problems, the clinic organized a local farmer’s market on site and created a community garden that is tended by the neighborhood youth as ways to bring healthy eating into this community, which had no supermarket before 2011.

Meeting the “triple aim” of improving people’s experiences with health care, improving the health of the population, and reducing per capita health care costs requires more than improving access to coverage. The ACA provides opportunities to test, refine, and expand models of care that can reduce the need for acute care. But it’s only a beginning. Many of these models should be available to communities across the nation, instead of being an uncommon experience. It’s time to change the conversation away from insurance coverage and penalties and toward program investments that truly matter if we’re to become a healthier nation.

Diana J. Mason is the Rudin Professor of Nursing at Hunter College, a member of the doctoral faculty at the Graduate Center, CUNY and President of the American Academy of Nursing. Donna Nickitas is a professor of nursing at Hunter College and the executive officer of the nursing doctoral faculty at the Graduate Center, CUNY.

Access to Care and Scope of Practice

My latest blog post for JAMA News Forum focuses on access to care and scope of practice:  http://wp.me/p13lz7-33R

I wrote it right before NYS passed a budget that removed the written practice agreement requirement for experienced NPs in the state but was able to add mention of this in the blog. The new law still doesn’t remove all scope barriers and a sunseting clause will require continued vigilance. It’s a step forward but more needs to be done.

I welcome your thoughts.

Diana

Veterans and Depression

A recent report noted that 22 veterans commit suicide each day–almost one person each hour. We’ve all heard about PTSD (post-traumatic stress disorder) among veterans and the anxiety and depression that can accompany a veteran’s attempt to return to a “normal” life. Pressure on the Veterans Health Administration has led to changes in screening for these health issues, but are the responses the right ones?

Tonight on Healthstyles, producer Diana Mason, RN, PhD, interviews two nurses who are calling for a re-examination of how we work with veterans who may suffer from depression and anxiety, in particular. Kathryn Steele, RN, MA, is a veteran Navy nurse at the University of Minnesota where she is studying integrated approaches to helping veterans with these health problems, including developing social supports from their family, other veterans, friends, and their communities.  Kathleen (Kate) Wheeler, PhD, APRN, is a mental health practitioner and professor of nursing at Fairfield University, where she studies the use of Eye Movement Desensitization and Reprocessing (EMDR) therapy.

Tune in for this important discussion about depression and suicide among veterans, tonight on Healthstyles, on WBAI, 99.5 FM (www.wbai.org) at 11:00 PM, or click here anytime to listen to the interview: 


 

Healthstyles is sponsored by the Center for Health, Media & Policy at Hunter College.

Nurse Radio in Liberia

 

 

Earlier this week, PBS’s News Hour featured a story about Aaron Debah, a nurse in Liberia who is the only mental health worker for a half million people in Liberia–a country that was engaged in civil war  for 14 years. The story notes that 40% of the population suffers from PTSD, and this includes the child soldiers who were forced into killing and maiming and now suffer the psychological consequences. Debah uses the airwaves to encourage people to talk about their emotional struggles, hoping that their stories and conversations will encourage others to realize that they are not alone.

Two points from the video are striking. First, Sean Mayberry of StrongMinds notes that 90% of the developing world has no access to mental health services. And the need isn’t just in war-torn countries. This week on Frontline, a stunning report on TB in Swaziland showed the emotional devastation that TB has inflicted on whole families. It’s not just the TB, including those who suffer daily with multi-drug-resistant (MDR) TB. It’s the often-toxic medications that must be taken precisely or the person can develop XDR, an even more resistant and deadly form of TB. The story included examples of people with MDR and XDR who are suffering from severe depression that has sometimes led to suicide because of the miserableness and hopelessness of their lives. The need for mental health care is great.

Second, the Carter Center is working to expand Swaziland’s capacity for  mental health care by training nurses to develop their knowledge and skill in providing mental health care. Former First Lady Rosalyn Carter has long been an advocate for improving mental health care worldwide. This program will be an interesting one to watch. It doesn’t seem like enough but it’s a start.

In the U.S., we are struggling with implementing the Affordable Care Act’s requirement for mental health parity–requiring insurers to cover mental health problems to the same extent that they cover physical health problems. Certainly, the primary care workforce in the U.S. struggles to provide frontline mental health care. Mental health nurse practitioners and clinical nurse specialists can help our situation, though barriers remain to these clinicians being able to practice to the full extent of their education and training. In the face of Liberia’s situation, it’s hard to justify our own continuing restrictions on mental health workers in the U.S.  Time to get perspective.

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing

 

 

Bodies in Balance

RubinThe Rubin Museum of Art has launched an exciting new exhibition called Bodies in Balance. It’s the most comprehensive exhibition of Tibetan medicine that has been staged in the U.S. It’s an interactive and creative exhibition that includes opportunities for people to assess their own ‘life forces’ and learn about what can bring their bodies in balance through foods, herbs, meditation and other traditional Tibetan approaches to health and healing. And, of course, one is able to view various works of art that portray the philosophy and approaches to Tibetan medicine.

Tonight on Healthstyles, producer and moderator Diana Mason, PhD, RN, discusses the exhibition and related special events with Tim McHenry, Director of Public Programs and Performance at the museum, and Jon Van Alphen, the museum’s Director of Exhibitions, Collections and Research.  The Rubin Museum focuses on art of the Himalayas and is a gem in the heart of Manhattan. Bodies in Balance opened on March 15th and will continue until September 8th.

Tune in tonight at 11:00 on WBAI, 99.5 FM (www.wbai.org), or click here to listen anytime:


Healthstyles is sponsored by the Center for Health, Media & Policy at Hunter College.

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