Although the ACA has significantly reduced the percent of Americans who are uninsured, we have not yet come close to universal coverage. This has become a topic of focused debate among Democratic primary candidates. Short of achieving full coverage by passing a single-payer plan (which seems very unlikely in the near future), further gains in insurance coverage will come through means available through the ACA.

It’s worth revisiting, therefore, exactly who constitute the uninsured at this point. A better understanding could allow policymakers and advocates to focus their efforts on those populations. A recent report from the Robert Wood Johnson Foundation and The Urban Institute covered just that:

Data collected from the 2015 Current Population Survey— Annual Social and Economic Supplement (CPS-ASEC) provides information on those with and without insurance coverage from a large, federal, nationally representative survey (most of the data are collected in March, although there are some interviews in February and April;3 hereafter we refer to the data as having been collected in March 2015). Although the CPS-ASEC questionnaire changed in significant ways in 2014 such that it should not be used to compare 2015 coverage to 2013, the data allow analysts to assess the characteristics of those remaining uninsured following the first year of implementation of the ACA’s main coverage provisions and after two marketplace open enrollment periods

According to their most recent surveys, about 12.2% of the non-elderly, non-military, non-institutionalized population remains uninsured. This is just under 33 million people. About half of those people live in states that have refused the Medicaid expansion. This has certainly made a difference. The rate of uninsurance in states with the Medicaid expansion is 10.1%, compared to 15.4% in states which have refused it. It’s clear, therefore, that one way to reduce the numbers of uninsured at this point would increase the numbers of states participating in the program.

More than a quarter of the uninsured are eligible for Medicaid of CHIP. About two-thirds of uninsured children fall into this category. These are all people who could have insurance if they could overcome the barriers and hurdles necessary to sign up for coverage. It’s also possible this could be an information gap. Many of them may not know they are eligible, and may not have tried to obtain Medicaid or CHIP for themselves, or their children.

An additional 21% of the uninsured qualify for subsidies on the exchanges, but have not obtained plans. This, too, could be an information issue, where people do not know they are eligible for tax credits. It could be that they feel that, even with the tax credits, they still cannot afford coverage. It could also be that they simply do not want insurance, and would rather pay the penalty of the individual mandate.

Clearly, however, there is much to be gained from outreach. Efforts to increase enrollment in both Medicaid and CHIP, as well as through the exchanges, could significantly increase the number of people who are already eligible for coverage, but have not yet obtained it. More than 80% of the uninsured eligible for Medicaid or CHIP live in metropolitan areas. More than two-thirds of them live in families in which at least one family member is already receiving the earned income tax credit and some other public benefit. Nearly half have at least one school-aged child in their family. It’s possible to locate many of these people, and help them sign up for coverage.

In addition, furthering the Medicaid expansion is a straightforward way to decrease uninsurance. That will require more political efforts, and a different skill set.

Regardless, increasing the number of Americans who have health insurance is only one goal of improved access. Making sure that care is still affordable, and that underinsurance doesn’t become a bigger issue, is a whole different ball game.




Today, U.S. Department of Health and Human Services Secretary Sylvia Mathews Burwell announced that Andrew Bindman, M.D., has been named as the next director of the Agency for Healthcare Research and Quality (AHRQ). Dr. Bindman will begin his appointment on Monday, May 2, 2016.

Dr. Bindman is an established leader in health services and policy research with over 130 peer-reviewed articles and has been a longtime friend to AcademyHealth and the field of health services research.

Currently, Dr. Bindman is a professor of medicine, health policy, epidemiology and biostatistics at the University of California, San Francisco (UCSF) and director of the University of California Medicaid Research Institute (CAMRI) and UCSF’s Primary Care Research Fellowship. As Director of CAMRI, he has been instrumental in helping AcademyHealth establish the State-University Partnership Learning Network (SUPLN), a network of 23 partnerships in 19 states that works collaboratively to support evidence-based state health policy and practice with a focus on transforming Medicaid-based health care, including improving the patient experience, improving the health of populations, and reducing the per capita cost of health care. He is also the recipient of two prominent AcademyHealth awards: the Alice S. Hersh New Investigator Award (1996) and the Article-of-the-Year Award (1996).

In addition to these roles, Dr. Bindman has served as a senior advisor in the Centers for Medicare and Medicaid Services (CMS), where he worked on using data analytics to accelerate health care transformation in Medicaid. He also has extensive knowledge of patient safety issues, having worked as a physician and as the director of UCSF’s Primary Care Research Center, as well as pertinent Hill experience, serving as a Robert Wood Johnson Health Policy Fellow from 2009-2010 on the staff of the U.S. House of Representatives Energy and Commerce Committee.

We commend those in HHS and beyond for recognizing the tremendous contributions Dr. Bindman has made to improving health care with high quality evidence, a cornerstone of AHRQ’s mission.

“I couldn’t be more thrilled to hear of Dr. Bindman’s appointment, especially at this critically important moment in time,” said AcademyHealth President and CEO Dr. Lisa Simpson. “AHRQ is uniquely positioned to fund and support the research we need to understand the impact of all the changes in health care delivery and bring that evidence forward to Capitol Hill. I have witnessed first-hand Dr. Bindman’s ability to explain and convey the findings of health services research in an accessible way, and I look forward to working with Dr. Bindman in communicating the value of investing in health services research.”

AcademyHealth is excited to begin working with Dr. Bindman as we continue our efforts to bring the health services research to the forefront, illustrating how research, tools, and datasets – like those supported by AHRQ – can help us understand and improve a complex, costly health system and achieve better outcomes for more people at greater value.



As I wrote in my previous post, the vast majority of the two hours or so it usually requires to see a doctor is spent not seeing the doctor. Travel and waiting time take big chunks out of our day. With modern technology, for some kinds of care, that wasted time can be avoided.

Of course I’m talking about telemedicine (TM), which includes the use of the telephone, video conferencing, and secure messaging that can replace doctor visits. There are other forms of TM too, like remote patient monitoring, electronic ICUs, and others that aren’t intended to replace outpatient doctor visits. These help remote doctors advise ones proximate to the patient in the hospital or ED.

Does TM work? Is it at least as good as in-person patient care? The evidence I’ve found is strongly in the affirmative.

A recently completed systematic review and meta analysis by Gerd Flodgren et al. (2015) examined 93 randomized controlled trials (N = 22,047 participants; 23 trials for heart failure, 16 on diabetes patients). Interventions varied by study: chronic condition monitoring (41 studies), provision of treatment (12 studies), education/support for self-management (23 studies), consults for diagnosis or treatment (8 studies), clinical assessment (8 studies), screening (1 study). (Total adds to more than 93 because some studies examined more than one thing.)

Findings included no mortality differences between TM and non-TM heart failure patients, but improved quality of life for if they received TM; better glucose control for diabetes patients through TM; and lower LDL cholesterol and blood pressure with TM. No outcome differences for mental health and substance use disorder patients or dermatology patients. The study found inconsistent results on hospital admissions.

Many prior literature reviews and studies came to the same general conclusion that TM is associated with no worse, and often better, outcomes. With respect to heart failure, see this systematic reviewthis program at Partners Healthcare and Polisena (2010), which found lower mortality, readmissions, and health care use for TM patients. Other reviews found “improved outcomes of using TM in the delivery of cardiac rehabilitation and diabetes care” (Balas 1997); “improved clinical outcomes of TM in hypertension, but conflicting evidence for the effectiveness in diabetes” (Hersh 2001); “no differences in quality of life or in the number of emergency department (ED) visits, but a lower hospitalization rate for patients receiving TM, compared with the control group” (McLean 2010); “fewer ED visits and hospitalizations in chronic obstructive pulmonary disease (COPD) patients receiving TM as compared to control, and improved quality of life” (McLean 2011Polisena 2010a); “reduced number of patients admitted to hospital and fewer hospital bed days for patients receiving home TM” (Polisena 2009).

James Ralston and colleagues report that “recent trials [of TM] suggest a positive impact on control of blood pressure in patients with hypertension and glycemic control in patients with type 2 diabetes.” See also this study on improvements for PTSD patients using telemedicine.

Kaiser Permanente was one of the early leaders in offering online health services (portals) with which patients can view parts of their medical records, schedule appointments, refill prescriptions, or e-mail their doctors or pharmacists, among other functions. Kaiser Permanente Northern California (KPNC) offers additional TM services, including 10-15 minute telephone visits. According to Robert Pearl, 80% of dermatology cases involving rashes are resolved by digital communication at KPNC. Prior literature on teledermatology has demonstrated high rates of diagnostic accuracy, diagnostic concordance (i.e., level of agreement with face to face consultation), and patient and provider satisfaction.

KPNC’s after hours video visits provide a substitute for patients who might otherwise have to visit an ED. The vast majority of patients (85%) rated TM visits “very good” or “excellent” for meeting their needs. KPNC offers pregnant women at risk for substance use disorders support services via video visits. A 2008 study found this program associated with a lower rate of fetal death and preterm birth.

According Pearl, there is no apparent impact of electronic communication on the number of office visits. As KPNC’s virtual visits have grown, in-person visits have held constant. Suzanne Leveille and colleagues found something similar, examining 45,000 adult, primary care patients of a rural Pennsylvania health system (Geisinger Health System) and and a Boston academic medical center (Beth Israel Deaconess Medical Center) over one year before electronic portal implementation and one year after (2009-2011). They concluded that patients use portals after visits, but portal use does not drive an increase in future visits, consistent with North et al. Though another study, by Zhou et al., found portal use associated with more pediatric visits at Kaiser Permanente.

Kenneth McConnochie and colleagues: studied TM in Rochester, NY among 1216 children with access to it, matched to those who didn’t. The TM system was designed for “triage, diagnosis, and treatment of acute problems.” Children (or their families) with telemedicine access had 23.5% more overall visits (telemedicine + in person) but 22.2% less ED use. Reduced ED use associated with TM has been found in other work as well.

Intravenous, clot-busting drugs are effective at treating acute ischemic strokes. But, their application requires expertise that is less available in remote, rural areas. A 2010 systematic review of telestroke, which facilitates use of the drugs through videoconferencing between emergency department physicians in remote areas and distant stroke specialists who provide guidance on their administration, concluded that it “lead to better functional health outcomes, including reduced mortality and dependency, compared with conventional care.” Richard Nelson and colleagues estimated the cost-effectiveness of . The approach would cost more money than usual care but would improve outcomes. It was estimated to be cost-effective over the long term.

In general, TM cost estimates vary, as does methodology. Systematic reviews do not consistently find telemedicine more cost-effective than face-to-face care, but they also find that cost-effectiveness methodology of most studies to be weak. Few studies reported the opportunity costs of travel and waiting time.

Julia Adler-Milstein and colleagues used the IT supplement to the 2012 AHA Annual Survey of Hospitals (2,891 acute care, non-federal hospitals), combined with Area Resource File, Medicare inpatient claims, the Health Resource and Services Administration’s Health Professional Shortage Area files, and Dartmouth Atlas. They found that 42% of hospitals used TM in 2012 but with wide variation by state: close to 70% or more in Maine, South Dakota, Arkansas, and Alaska. Rhode Island had 0%. Utah just 13%.

Those that used TM tended to have greater technological capabilities more generally, were more likely part of a larger hospital system, more likely to be teaching hospitals, and more likely to be rural. TM use is more likely in states that require insurers to reimburse it the same as face-to-face visits and less likely in states requiring out-of-state providers to have obtain a license in the state in which they’re providing telemedicine care.

Studies have consistently found TM to be at least as or more effective than traditional care. Of course, it’s not applicable to every type of care, and it may not always reduce costs (estimates vary). Finally, there are barriers to its provision in some states and not all insurers cover it (Medicare among them).

It seems inevitable that things will change, that TM will become more common. As it does, you and I will spend less time traveling to and waiting at doctors’ offices.

Austin B. Frakt, PhD, is a health economist with the Department of Veterans Affairs, an Associate Professor at Boston University’s School of Medicine and School of Public Health, and a Visiting Associate Professor with the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health. He blogs about health economics and policy at The Incidental Economist and tweets at @afrakt. The views expressed in this post are that of the author and do not necessarily reflect the position of the Department of Veterans Affairs, Boston University, or Harvard University.



By Lisa Simpson, President and CEO, AcademyHealth and Daniel Wolfson, EVP and COO, ABIM Foundation

The problem of overuse, unnecessary care, or “low value” care is increasingly a focus of the national health policy conversation. Estimates suggest that as much as one-third of health care spending in the United States is of low value. Many factors contribute to the problem, including increased patient demand, information asymmetry, perverse financial incentives for providers, and a culture of “more is better than less.” In fact, medical specialty societies participating in the Choosing Wisely® campaign have collectively published more than 400 tests and treatments they claim are overused or unnecessary. Initiatives created by organizations such as the American College of Physicians, the American College of Radiology, and the American Society of Clinical Oncology also attempt to stem the tide of overuse in their respective specialties and eliminate inappropriate care.

While there is a growing recognition that more care doesn’t equate to better outcomes, we lack a consensus on our path forward. We face challenges and gaps in our knowledge such as the lack of a common definition of overuse, identification of outcomes that are important to patients, and a complete understanding of the current evidence base.

To help close these gaps and develop a coordinated approach to research in this area, AcademyHealth and the ABIM Foundation have joined to create the Research Community on Low-Value Care to bring together researchers from across the health care system to achieve common goals critical in reducing low-value care:

  • Facilitate information-sharing, communication and coordination among researchers with an interest in reducing overuse;
  • Identify and characterize key challenges and priorities for strengthening research, practice and policy in reducing overuse;
  • Help generate collaborations for extramurally funded research;
  • Foster the exchange of innovative research methods and strategies for dissemination and implementation of research findings and lessons learned to end-user audiences; and,
  • Cultivate opportunities for connection and collaboration with other stakeholders to increase awareness and uptake of research findings.

The Research Community on Low-Value Care builds on the outcomes of a multi-stakeholder meeting held in 2015 that sought to focus attention on the emerging and needed evidence base on overuse. Along with the Veterans Affairs Health Services Research and Development Service (HSR&D) , Kaiser Permanente and the Hartford Foundation for Public Giving, we convened clinicians, patients, researchers, health systems, purchasers and policy makers to help prioritize future research needs. That meeting also built on work in 2014 to identify the landscape of research currently underway on overuse and low value care. It is thanks to the learnings from participants in these activities over the last two years that the seeds of the research community were sown.

There is an increasing urgency to address issues of waste and overuse in our health care system. In order for the many various efforts to reduce low-value care realize their full potential, they must be evaluated and the results shared broadly. To support this learning and facilitate its dissemination, researchers and stakeholders will come together in this community to learn from each other and share tools, methods and new approaches. We are excited about the role this new community will play in developing a shared agenda and moving us along our path forward.

To join the learning community, please contact: [email protected]


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By Charles Ornstein, ProPublica

Two years ago, when I attended my first Health Datapalooza, much of the hallway chatter focused on the dearth of data available to help patients and doctors make better health decisions. The Centers for Medicare and Medicaid Services had just started releasing massive data sets, but no one really knew how much data CMS was willing to release or how useful those data sets might really be. Information and tools from private insurers were few and far between.

It’s amazing to think how much things have changed in such a short time: Government agencies (and CMS in particular) have released data sets at a pace faster than I expected, and the discussions are shifting from what data needs to be released to what to do with all this information.

ProPublica, for one, has created and updated tools that let people examine their doctors’ prescribing patterns within Medicare’s drug program (and compare them to others in the same specialty and state), review the services their doctors perform in Medicare (and similarly see it in context) and find the payments the doctors have received from drug and medical device companies.

The Wall Street Journal has a great look-up tool to compare doctors. Others, including Amino, Docspot and Consumers’ Checkbook, have developed tools, too. And data journalist/agitator Fred Trotter has some interesting data projects under way at DocGraph.

To be sure, there’s a lot more information that still needs to be released publicly.

I personally would like to see data on the services delivered in Medicare Advantage (a growing sector of health plans serving Medicare beneficiaries) and state Medicaid programs (which now cover more than 70 million people). Why stop there? It also would be great if the Department of Veterans Affairs and the Department of Defense publicly released detailed data on the health care services they pay for.  And private insurers should play a role too, pooling their data and releasing it publicly with little or no charge.

But while liberating data will always be fun, the new questions data journalists and the broader health data community face are just as pressing, if not moreso. What are the stories that need to be told with this data? Is there such a thing as a good doctor and bad doctor, and can we find the answer in the data? How do we connect all of this information in a way that means something to real people? How much do people care about having data at their fingertips?

I look forward to Datapalooza this year because the discussion, access to newsmakers and hallway conversations will give me new ideas, cause me to question existing ones and make me smarter.

Charles Ornstein is a senior reporter at ProPublica, a nonprofit news organization in New York. He is the recipient of the 2014 Health Data Liberators award from the Health Datapalooza and serves on the 2016 Health Datapalooza steering committee.



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It has been a surreal 72 hours for AcademyHealth. On Friday, we officially closed our doors on 17th street and bid a fond farewell to our former home. Today, we eagerly gather to a welcoming hello as we begin the next phase of our work in AcademyHealth’s new offices on K Street.

Leaving our “old” offices after over seven years of memories and milestones is bittersweet. In fact, it was in our 17th street  offices where we worked to save the Agency for Healthcare Research and Quality (AHRQ), founded the Translation and Dissemination Institute (TDI), established new conferences Concordium and the National Child Health Policy Conference, and launched our online peer-reviewed journal eGEMs, among other successes. And on a personal note, it’s where I first settled in as your President and CEO, and embraced the incredible opportunity to build on the legacy of Dr. David Helms, and Alice Hersh before him. We saw two of our esteemed and longtime programs, State Coverage Initiatives and the Changes in Health Care Financing and Organization (HCFO) sunset there, having laid a foundation for ongoing work with our partners and members to develop new state-focused and researcher supporting programs that advance the field of HSR to generate useful, high-quality evidence and move evidence into policy and practice.

In the past seven years, we’ve also seen tremendous growth—not only in the number of our dedicated staff members, but also in the number of events, learning communities, advocacy initiatives, and professional development opportunities we offer to our members and the field more broadly.

Our new space is symbolic of where we are as an organization. As health and health care continue to evolve, we aim to find new, innovative approaches to advance our mission. Our move signals the need and desire to embrace and build upon that change, and to do so with a renewed sense of energy. This new space will allow for the continued growth and success of AcademyHealth and our field, and I am confident it will foster increased forward-thinking and collaboration, both inside and outside our walls. Case in point: our new space will give us the ability to host large in-house convenings, a benefit we are also excited to extend to our Organizational Affiliates! We look forward to hosting our brightest minds in the new offices of the same professional home for health services and policy research that’s been serving you for over a decade.

To our members and community—thank you for your support of AcademyHealth and the broader field of HSR. We look forward to serving you in our new and improved offices.





By Angélica Rodríguez, AcademyHealth

At a recent meeting full of leaders in health services research, one expert expressed significant concerns for the next generation of health services researchers: the steep learning curve of fundraising. Funding is critical to any endeavor – funding a new business, conference attendance, a ski trip to Colorado and, of course, any research project in the pipeline.

To make your life and the lives of researchers everywhere easier, we have instituted a new members-only benefit: SPIN. SPIN is a database with over 40,000 funding opportunities from more than 12,000 global sponsors valued at over $1 billion, and it’s just a few clicks away. As an individual member of AcademyHealth, it is completely free to access. . In fact, you don’t even need another login name and password to access this robust database. Instead, you can just use your AcademyHealth login details.

One of the best features of SPIN is that you can dramatically cut time and effort by finding the most relevant and up to date grants and awards currently available for your organization, using the automated alerts system, SMARTS. SPIN has over 20 training videos available to show you exactly how to use the database to achieve the most success.

SPIN was created with researchers, principal investigators, administrators and coordinators in mind:

For researchers and investigators:

  • Spend less time searching and more time doing research
  • Get results that match your research criteria
  • Uncover funds that other search software misses
  • See accurate summaries for quick qualification determinations

For administrators and coordinators:

  • SPIN is truly intuitive and easy to use
  • It yields faster result than any other search software
  • SPIN is customizable to match your style

Additionally, for those of you who are still in the academic phase of your career, AcademyHealth offers members access to a pool of scholarships, internships and fellowships through our Member Resource Library (link).

When it comes to funding, it’s important to think about the Return on Investment (ROI), and at AcademyHealth, we are invested in looking at ways to enhance member value so you get an optimal ROI for your membership investment. Stay tuned for more as next time we dive into the hottest topics of the industry in the last post of our membership series.


ARodAngélica Rodríguez is the Director of Membership for AcademyHealth. In her role, Angélica is responsible for the recruitment, retention and engagement of members and affiliate organizations and will oversee the development of AcademyHealth’s Interest Groups and Student Chapters. Ms. Rodriguez brings many years of membership experience to her new role at AcademyHealth. Prior to joining AcademyHealth, Ms. Rodriguez worked at the National Law Enforcement Officers Memorial Fund as the director of major gifts building partnerships and sponsorship support from corporations nationwide. Additionally, she launched the Annual Partners Membership Program to enhance partner engagement with the Memorial Fund. Angélica spent eight years at the National Retail Federation as a senior director and worked with retailers nationwide. In that role she served as a liaison for 11 committees, members and governing boards and also acted as an NRF spokesperson on loss prevention topics including, organized retail crime, gift card fraud and business continuity/crisis management. Angélica has received the Federal Bureau of Investigation for Excellent Service in Public Award, Law Enforcement Online Award and Nassau County Police Department Public Service Award. Angélica graduated from Rice University in 1999 with a Bachelor of Arts in Political Science.


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Among my first concerns when scheduling a visit to a doctor — whether for me or one of my children — is the length of the visit, including travel and waiting time. How much of my day will it take? In my experience, end-to-end, most doctor visits take at least two hours. To me, that time away from work or other more enjoyable activities is a massive cost, and one we rarely discuss.

But two papers, published last year by Kristin Ray and colleagues do discuss it. The findings of both papers are entertainingly summarized in this video:

The first paper, published in the American Journal of Managed Care quantifies patients’ burden of doctor visits in time and opportunity cost (time monetized by wage rate). Using data from the 2003-2010 American Time Use Survey (ATUS) and the 2003-2010 National Ambulatory Medical Care Survey (NAMCS), the authors found that the average physician visit takes just over two hours.

Of those two hours or so, just 20 minutes (or 17% of the time) is spent with the doctor. The rest is travel time (37 minutes, on average) and time in the clinic not seeing the doctor (64 minutes, on average). That non-doctor clinic time is a combination of all other activities at the clinic, which includes waiting, consulting with nurses, paying one’s bill, or making the next appointment. I suspect that most of this time is spent waiting, though.

According to the study, people accompanying others — whether children or other adults — spent even more time on a typical doctor visit. Average time with the doctor was about the same as above (approximately 20 minutes), but those accompanying a child spent 110 minutes beyond that traveling and waiting. Those accompanying another adult spent 118 minutes on those activities. This makes sense. When I take my kid to the pediatrician, in addition to the time it’d take me to get there and wait, I also have to get my kid out of and back to school (if it’s a school day). That takes time.

Monetized by wages (as had been done in prior work), the opportunity cost of a physician visit is about $43, according to the study. That’s the monetary value of time lost to see a doctor, only a small fraction of which is, well, actually seeing the doctor.  This figure is higher than typical out-of-pocket costs for physician visits, $32, though it is well below the $279 total, average cost, most of which is paid by insurers.

Put anther way, to see a doctor, we spend more with our time than with our out-of-pocket dollars. Across the entire US population, we spend 2.4 billion hours annually seeing doctors — most of is spent not seeing them — at an opportunity cots of over $52 billion. These figures are equivalent to the total, annual working time and income of 1.2 million people. The time cost of physician visits adds about 15 cents to every dollar spent on them (including insurance payments).

A second paper, by the same authors and published in JAMA Internal Medicine, characterizes disparities in the time cost of care. According to the study, time spent in the clinic during a physician visit and travel time is longer for racial/ethnic minorities  and unemployed individuals.

For example, clinic time [which includes time spent in the clinic, including with the doctor, with nurses, completing paperwork, and waiting] for non-Hispanic whites was 80 minutes vs 105 minutes for Hispanic individuals (P < .001). [...] [T]ravel time for non-Hispanic whites was 36 minutes vs 45 minutes for non-Hispanic blacks (P < .001).

But, these groups spent no more time face-to-face with a physician. All told, total time for visits is about 25% longer for racial/ethnic minorities and unemployed individuals. The authors emphasized that the difference was driven by clinic time — more waiting, time with nurses, or doing paperwork for minorities and the unemployed.

It’s possible that, in some cases, we could cut down the time required for office visits. Options include improvements in scheduling to reduce waiting time, placing clinics in schools, at workplaces and in or adjacent to stores people visit anyway (retail clinics) to reduce travel time, and greater use of telemedicine, when appropriate. I will return to the last of these (telemedicine) in a subsequent post.

Austin B. Frakt, PhD, is a health economist with the Department of Veterans Affairs, an Associate Professor at Boston University’s School of Medicine and School of Public Health, and a Visiting Associate Professor with the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health. He blogs about health economics and policy at The Incidental Economist and tweets at @afrakt. The views expressed in this post are that of the author and do not necessarily reflect the position of the Department of Veterans Affairs, Boston University, or Harvard University.


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By Clare Roche, AcademyHealth

You! AcademyHealth encourages students from a wide range of academic backgrounds to participate in our robust student chapter program. Currently, AcademyHealth is home to 26 student chapters from universities and colleges across the U.S. and Canada. Our student chapters are based in various schools and disciplines including: health services research, health policy, public health, nursing, medicine, health administration, dentistry; the list goes on. We believe that through multidisciplinary collaboration, students can experience a more comprehensive learning experience.

Student chapters were created to enhance the learning and professional development experience for students in health services research and health policy. Typically, a chapter is comprised of elected leadership, a faculty advisor, and students enrolled in multidisciplinary programs related to health services research and/or health policy. Each chapter is required to meet once a semester, but on average our current chapters host four events each academic year. Events can range from faculty-student socials to viewing a webinar to hosting a speaker series – the possibilities are endless.

As long as you are a student located at an accredited college or university, initiating a student chapter program is free.

We’d love to have you enroll and receive your benefits as soon as possible. Should you have any questions about the program or application process, please contact Student Membership and Chapter Coordinator, Clare Roche.

Student chapters are a vital part of the AcademyHealth community, and we are committed to ensuring their long-term success. To that end, there are countless benefits in forming and participating in a chapter. AcademyHealth offers chapter members discounts on event registrations, access to career resources, networking and mentoring opportunities, and funds for hosting your own events on campus.

There are a few things you need to complete prior to being an official AcademyHealth student chapter:

  • First, you’ll need to identify chapter leadership, including selecting a Faculty Advisor. The make-up of the rest of your leadership is up to you. We encourage you to create a structure that will best address your needs.
  • Second, you’ll need to create requirements and guidelines for your chapter. We’ve made this step easy by providing you with model bylaws that you can locate on the AcademyHealth website.
  • Third, a percentage of your student chapter body will need to register as AcademyHealth student members. As a nationally recognized organization, we’re happy to work with you and your school to receive funding for this fee.
  • Finally, you must submit a student chapter application. This application is the final step to beginning a chapter at your university or college.

Once the application has been approved, your chapter will be able to participate in monthly check-ins and receive benefits from AcademyHealth. We look forward to you joining the AcademyHealth family!

Clare Roche is the Student Membership and Chapter Coordinator at AcademyHealth where she manages all student chapters and student members, as well as coordinates the scholarships and awards programs. She encourages you to get involved with AcademyHealth through the formation of student chapters which enhance the learning and professional development experience for students in health services research and health policy. Clare graduated from the George Washington University as a double major in Communication and Business. Contact her at [email protected].


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By Caroline Ticse, AcademyHealth

Spring may have sprung in Washington, but with the late arrival of the flu this season, I’m glad that a few months ago I decided to couple an errand run with my annual flu shot. At the time I thought: why not save time, money, and myself from the hassle of scheduling a doctor’s appointment? At my convenience, I waltzed into the nearest drug store and headed for the pharmacy in the back, prepared to wait in a modest line of like-minded individuals. To my surprise, I was next in line and vaccinated within the half hour.

Until recently, many patients received their flu shots in the traditional office setting, often laden with long wait times and inconvenient hours. In recent years, however, a more convenient and accessible option emerged, offering preventive services like immunizations as well as treatment for low-acuity conditions. Enter: retail clinics. Located in pharmacies, grocery stores, and other retail settings, retail clinics have grown as an industry of their own, reaching six million visits per year. Given how simple, quick, and inexpensive my experience was, I’m not surprised that retail clinics are an attractive option for many Americans. But is there a catch?

For more than 25 years, AcademyHealth has managed the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization (HCFO) grantmaking program. In this final year of the program, AcademyHealth is working with our grantees to disseminate their research findings.

One such grantee is AcademyHealth member Ateev Mehrotra, M.D., M.P.H., of Harvard Medical School. In a HCFO-funded study, Mehrotra and his colleagues examined the impact of retail health clinics on health care utilization and costs. In a paper recently published in Health Affairs, they found that roughly two-thirds of retail clinic visits for low-acuity conditions represented new utilization of health care services by patients who otherwise would not seek care, rather than substitution for more costly visits, resulting in a modest increase of 21 percent higher spending for these conditions. These findings suggest that rather than reducing health care spending, retail clinics increase utilization and spending for low-acuity conditions. Highlights of the study are also available here.

So is an increase in utilization, and subsequently in spending, a bad thing for the health care system? On one hand, retail clinic visits may contribute to early diagnosis and prevent costly treatments down the road. On the other, they may disrupt a patient’s relationship with his/her primary care provider and impede care coordination. It is also important to consider the ailments for which patients are seeking treatments – would they get better on their own, or do they require medical attention? Whichever perspective you take, the study shows that if the goal of retail clinics is to reduce spending, we may need to pursue an alternative mechanism.


Caroline Ticse is a Research Assistant at AcademyHealth, where she supports the work of a number of Robert Wood Johnson Foundation-sponsored initiatives, including the Changes in Health Care Financing and Organization (HCFO) program.


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