Brad Wright, assistant professor of health management and policy, was named one of five recipients of the Presidential Scholarship for the AcademyHealth Institute on Advocacy and Public Policy. This award provided complimentary registration and funding to attend the 2015 National Health Policy Conference (NHPC) held Feb. 9-10 in Washington, D.C.
“The day before the conference, the Presidential Scholars participated in a public policy boot camp,” says Wright. “Then the day after the conference, we engaged in advocacy training in support of science policy and funding for health services research, before heading to the Hill to meet with staffers from Sen. Ernst’s office, Rep. Loebsack’s office, and Sen. Grassley’s office. In fact, I got to meet Sen. Grassley and talk to him about the research I’m conducting here at the UI College of Public Health. It was a tremendous opportunity.”
Community health care centers and rural health clinics face resource constraints that may limit their ability to respond to the opportunities and challenges of the Affordable Care Act, according to a recent study published by the University of Iowa Public Policy Center and College of Public Health.
About 25 million individuals are expected to gain insurance coverage over the next five years through the Affordable Care Act (ACA). At the same time, as many as 31 million individuals will remain uninsured.
“The implementation of the ACA and the corresponding expansion of insurance coverage will result in an increased demand for primary care services,” says the study’s lead author Brad Wright, assistant professor of health management and policy at the University of Iowa. “Safety net providers will be called upon to provide a significant amount of care to help meet this demand, in addition to continuing to care for those who remain uninsured. Whether they will have the capacity to do so is unknown.”
Data show both community health care centers and rural health clinics are not fully staffed, have difficulty recruiting professionals to fill vacant positions, and report challenges referring patients for specialty care.
The study, funded by The Commonwealth Fund, indicates the need for safety net providers is only going to increase, and their ability to meet the increased demand for primary care services – while continuing to serve the uninsured – will be critical for access to care for vulnerable populations. The full policy brief is available here.
Each year, about 1 million Medicare beneficiaries who visit the emergency room find themselves held for observation rather than being admitted to the hospital. Researchers have found the rate of observation care—a hospital-based outpatient service used to evaluate and treat acutely ill patients for extended periods—has increased nationally over the past decade, and it has become a common alternative to full hospitalization. This outpatient care saves hospitals money, but does it benefit the patient?
According to Brad Wright, assistant professor of health management and policy in the University of Iowa College of Public Health, critics suggest observation care costs patients more and may result in reduced quality of care. Previous studies also point to racial and geographic variations in the use of observation care. In a national study funded by the National Institute on Aging, Wright and colleagues from Brown University and the University of Michigan will analyze Medicare claims data from 2007-2011 to determine the causes and consequences of racial and geographic disparities in observation care among Medicare patients.
“We want to see if the variation in who receives observation care occurs within or between hospitals,” said Wright. “Are certain hospitals more likely to use observation? Or is there an inherent racial bias no matter which hospital you go to?”
Wright will also investigate whether observation care leads to better or worse health outcomes, examining mortality rates and how many patients return to the emergency department or get readmitted within 30 or 90 days.
“Are there important quality outcome differences?” asked Wright. “Maybe they don’t get the level or intensity of services they need and end up coming back. Or are they more likely to be admitted because more observation leads to better clinical decisions?”
Wright hopes the study’s findings will help inform changes in hospital policy and Medicare coverage of observation services.
The U.S. health care system is large and complicated. In fact, it makes up nearly one-fifth of the entire U.S. economy, and all of us—at one time or another—utilize health care. Yet, few Americans truly understand how the system works or what is being done to try and make it work better. Most people don’t think much about health policy or health services research, even though it can determine whether or not they have access to affordable, high-quality health care.
In an attempt to change that, I started a blog, Wright on Health, that aims to translate complex health policy and health services research issues so that they can be more effectively communicated to an educated lay audience.
In my experience, most people aren’t going to pick up and read a copy of Health Affairs or Health Services Research, but that doesn’t mean that they wouldn’t be interested in the information contained in those publications if the relevant implications were explained to them. Helping the public make that connection is a responsibility that researchers should embrace far more often than they do. Consequently, my goal is always to focus on answering the “big picture” or “so what?” questions. For example: “What will this policy do?” “What did this study find?” “Why is that interesting?” “Why does it matter to me?”
In 2009, amidst a mountain of misinformation, I created Wright on Health to objectively explain “ObamaCare” and the need for health reform. Today, our broader goal is to educate the public about their health care system.
Some of the topics we’ve written about include the “doc fix” bill, the cost of health care, quality initiatives, and enrollment in health insurance exchanges. We want to be a place where researchers and policy analysts learn about each other’s work, where Congressional staffers and state legislators turn for innovative ideas that are easy to digest quickly, and where everyone can engage in a constructive dialogue about what works and what doesn’t in American health care.
After nearly five years and more than 750 posts, our work has appeared on NPR, Kaiser Health News, The New Republic, Real Clear Politics, The Health Care Blog, The Huffington Post, Health Works Collective, and KevinMD. Blogging alongside me are: Nicole Fisher, founder and principal at Chicago-based HHR Strategies (a health care and human rights advising firm); Dr. Shirie Gale, a Boston-based anesthesiologist; Dr. Robert Hackey, director of the health policy and management program at Providence College; and Maggie Mahar, former contributor to Barron’s, Time, and The New York Times, creator of the HealthBeat blog, and the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much.
As we continue growing, we’re exploring ways to partner with the UI College of Public Health. We’re also looking for additional contributors to help us achieve our vision of expanding our network of bloggers, enhancing our content, and reaching more people. If you’re interested in writing for us, or would like to learn more about the mission of the blog, please contact me at firstname.lastname@example.org.