Can you give a little background on your experience in the health care world?
Absolutely. At the Pennsylvania Department of Human Services (DHS), I'm the Chief Innovation Officer, helping to lead our strategy to get more value out of our health care system, address the social determinants of health, and promote health equity. While this is my first job at the state level, I previously did stints at the U.S. Department of Health and Human Services, helping to implement the Affordable Care Act, and at the National Academy of Medicine.
I'm an avid health care writer. Some of my previous research focused on how insurance companies were making HIV medicines particularly expensive, which discouraged HIV positive individuals from enrolling in their plans. This helped lead to federal regulatory changes that reduced drug prices. I've also written about the opioid epidemic, Medicaid policy, discrimination, immigrant health, and protecting people with preexisting conditions.
My interest in improving our healthcare system stems from my own experiences as a doctor, and my patients' stories navigating our healthcare system. I'm a board-certified Internal Medicine physician (a general practitioner for adults), and I continue to see patients at the Penn State Hershey Medical Center.
What are some examples of health inequity in Pennsylvania?
Promoting health equity is one of the main goals of the Pennsylvania Department of Human Services. By health equity, we mean that everyone has the opportunity to live their healthiest life possible. One way we measure this is by analyzing health disparities.
Like many states throughout the nation, Pennsylvania has significant health disparities. For example, the life expectancy of a baby born in Pennsylvania is strongly tied to zip code. A newborn in North Philadelphia has a life expectancy of 68 years, when just five miles to the south newborns are expected to live to 88. An African-American child in Medicaid is ten percentage points less likely to get all of their well-child visits within the first fifteen months of their life than a white child in Medicaid.
Health shouldn't be predetermined by the color of your skin, the language that you speak, the country that you were born in, the zip code that you live in, the religion that you practice, or your disabilities, sexual orientation, gender, gender identity. As such, we are actively looking to better measure the disparities in our health care system and work towards their elimination.
What are some common misconceptions people have about Medicaid?
Some people think that Medicaid is a rigid, one-size-fits-all program. However, the federal government has given states significant flexibility to be innovative and find the best fit for the needs of the state. Innovations that are successful can be readily incorporated into other states. For example, managed care started as an innovation but has rapidly spread to becoming the standard way that Medicaid is administered for the majority of Americans.
In Pennsylvania we are working to achieve our goal of creating a healthier Pennsylvania by thinking creatively and being an innovative leader in health care delivery system reform.
How do the three areas of Health Innovations (Value Based Purchasing, Health Equity, and Social Determinants of Health) relate to each other?
Great questions! There's actually a significant amount of overlap.
Value-based purchasing means that we are linking health care payments to improved performance by providers— rewarding better health and lower costs. But moving towards value, and with it, better health, must include ways to address the social determinants of health and reduce health disparities. Let me explain.
Increasingly, we as a society have been realizing that better health is not only tied to what happens in the doctor's office. The social determinants of health—the conditions in which people are born, grow, live, work, and age—are closely tied to health as well. This means that if we address factors such as food, housing, transportation, and employment, Pennsylvanians will be healthier.
Additionally, measuring health outcomes across the entire Commonwealth misses the disparities in health that communities face. Explicitly designing our system to promote equity and address these disparities can, in turn, improve health for everyone. In the U.S., it has been estimated that the combined cost of health disparities and subsequent deaths due to inequitable care is $1.24 trillion dollars. There are many causes of health disparities, but the social determinants act as large contributing factors.
So, to tie this all together— value-based purchasing, health equity, and social determinants of health are closely intertwined. As we create value-based models for payment to move towards better health, we must integrate the social determinants of health and health equity as core pillars of these models. We aim to do just that.
What are some of the improvements we've already seen in Pennsylvania in regard to health care and access?
Pennsylvania has made great strides in health care and access under the Wolf Administration. One of the biggest initiatives of this administration has been the expansion of Medicaid. Now, over 700,000 newly eligible individuals have enrolled in Medicaid coverage, including over 100,000 parents. Our state's uninsured rate is at the lowest on record.
This means that Pennsylvanians can get the life-saving preventative care that they need. For example, women newly eligible for Medicaid have received 53,753 mammograms, detecting 1,730 cases of breast cancer in 2019. 30,061 of Pennsylvanians newly eligible for Medicaid have received colonoscopies, detecting 381 cases of colon cancer in 2019. Simply put, these are Pennsylvanians who might not be alive today if we didn't expand Medicaid.
Learn more about Health Innovations and DHS' plans for addressing health care reform in Pennslyvania.