Last week, we wrapped up the Initial Convening for the Office of Minority Health (OMH) Health Equity Leadership Development Initiative (HELDI) Fellowship at the Fitzhugh Mullan Institute for Health Workforce Equity! We kicked off the 2024-2025 fellowship year with sessions about health equity, policy, law, economics, and more. Thank you to everyone who joined us and made the Initial Convening a success! We look forward to building on these partnerships and topics throughout the fellowship year. The OMH HELDI fellowship program aims to develop and support future federal leaders in public health and health equity, with a focus on recruiting individuals from groups that have been underrepresented in federal government leadership positions. The program is sponsored by the Department of Health and Human Services (HHS) and led in partnership with the Office of Minority Health. You can read more about OMH HELDI online: https://lnkd.in/d66yyJMm. Maria Portela MD,MPH, FAAFPAkshita Siddula, MSPH Candice Chen Guenevere Burke
Robert Bowman
3mo
The rural discrimination is bad, but the combinations of worst public and private plans are about the weakest employers. And the 2621 counties have all of the deficits and little benefit from the health care design. Selective termination of hundreds of hospitals and countless practices is bad enough with major economic damage past present and future, ---but the destruction is even more as countless team members and their spouses have been lost to their key leadership in these counties. Communication is essential for the national and state leaders and designers to be able to improve their designs. Killing off the leadership and those who could communicate - is an act that kills the feedback and any hope of awareness regarding just how bad the situations have become. It is not the quality of the health care delivered that represents the major problem. It is the quality of our financial design - the foundation of health care delivery. The measure of a health care design should be how efficient and effective it is in supporting most and best delivery team members
Robert Bowman
3mo
And remember that Medicare pays too little demonstrating lack of accountability as they are supposed to cover the costs and violate these regulations. But they also have plans that pay less and less as levers of workforce go lower, as primary care becomes more important, and as the family practice positions filled by MD DO NP and PA are 30 - 100% of remaining health care workforce. Witness insurance that fails at major life events when health insurance is needed most. Witness the most vulnerable populations most behind by rurality, race, and ethnicity, and in 2621 counties lowest, which will be a majority behind and made worse by the 2060s. The 40% of the population in 2621 counties lowest in health care workforce has always had half enough primary care, mental health, women's health, geriatrics, and basic surgical workforce. RBRVS, worst insurance, regulatory capture, budget neutrality, and the most powerful lobbies will keep most Americans most behind and defeat basic health access increasingly over time.
Robert Bowman
3mo
Health care desperately needs health equity. Most Americans are falling behind by health care design. Within academic circles, this is apparently difficult to see. Academics view themselves as having important roles to play such as generating workforce - but what good are massive expansions when the financial design 1. Prevents their distribution where needed 2. Causes more and more harm to those delivering the care? For 41 years we have had designs moving in a direction that is the opposite of health equity. The designs have hurt basic health access for most Americans. They destroy what health care can bring to vulnerable populations and communities in health, education, leadership, organization, and more. The bottom line financial design harms most Americans and its failure hurts all Americans. There is only one purpose of health care finance and that purpose is the facilitate the care and caring of those who deliver the care. The insurance design is a major reason for decline by design for most Americans, most health services, and the most numerous health professionals - especially hospital nursing and basic health access team members. Concentrations of poor, elderly, disabled, and worst employers shape death by design
Robert Bowman
3mo
Designs like ours demonstrate wasted health care dollars - mainly because so many dollars disappear into the hands of those who do not deliver the care The readmissions designs and the CMMI innovation center failures are important to understand regarding failed performance based designs THEY ARE DIGGING IN THE WRONG PLACE! Cost and quality are mainly shaped outside of health care teams. CMMI went 5 for 52 demonstrating that their assumptions and innovations are wrong. Performance based or value based designs are dead wrong Note also that Seema Verma considered the one major investment in primary care in Michigan to be the biggest failure. 5 for 52 should mean termination, not replication. leaders who fail to value primary care and investments in primary care - should not lead health care for our nation.
Robert Bowman
3mo
Rural studies are helpful, since the population and health care in the 2621 counties is just as abused if not more so. An important concept to grasp for health equity, is the failure of the employer based health insurance design. It fails where the employers are weaker. The weaker employers have worst paychecks, benefits, and health insurance. In rural areas and in the 2621 counties lowest in health care workforce, the deficits are made permanent by the public and private plans with quality so poor and worsening by design. CMS and health care leaders and academics should not claim to support health equity, until there is an equitable insurance design. Expansions of the worst public plans - is not equitable as poor quality plans are the problem, the obstruction, the barrier that defeats care in 2621 counties forever behind. Only Hill Burton and the first decade of Medicare and Medicaid did much for these counties in terms of organization, leadership, funding, building up, and covering costs of inflation. Since the 1980s the policies and programs have facilitated worsening by design.
Robert Bowman
3mo
There is no excuse for worst quality health insurance among developed nations that helps to divide our nation into those favored and those not favored New coding is required because rurality, race, and ethnicity do not capture the full magnitude of the discrimination by design --Population density fails to cover 25% of the rural population doing well. --Race and ethnicity are also mixed To demonstrate disparities in health care research, it is important to follow the dollars and workforce concentrations The nation was divided by population into a --top 10% of the population with top concentrations of workforce (academic, big system, most lines of revenue that they help create, highest payments) --a higher concentration 156 with 20% of the population, also growing slowest along with the top 79 but the lines of revenue and payments and middlemen assure consumption of the most health care dollars, workforce, jobs, and economics. Already distribution important for health equity is violated -- a middle workforce concentration 30% that is growing faster, at times as fast as the lowest concentration counties. -- and a lowest concentration 2621 counties most behind in health care, insurance, outcomes, drivers of outcomes
Robert Bowman
3mo
Readmissions penalties illustrate the problems. In year 2 at top penalty level of 1 to 2% see how the design 1. hurts those with worst finances 2. makes their finances worse 3. ignores small numbers year to year variation that can result in penalties 4. suffers as the measurements are arbitrary, reflect quality poorly, and are often gamed - as in readmits 5. but mostly performance based designs and ratings discriminate against providers who serve populations inherently behind in outcomes and drivers of outcomes Again, why punish practices and hospitals already paid 15 - 30% less who face the worst public and private plans. What is helpful for populations to have deficits or local providers that avoid their plans? Left column indicates a few of the factors shaping poor outcomes with right column indicating urban 3% of hospitals vs rural with 9% with top penalty and a separate 2621 county category with 14% punished most
Basic Health Access
3moMost important to understand from rural research is that the public plans pay too little and the employer-based plans may be just as poor quality or worse. Now start to understand the distributions of the plans. The public plans are concentrated where the elderly, poor, and disabled are concentrated. Each of these populations is 43% - 45% found in the 2621 counties most behind. Mental health needs are about 45% and contribute to Medicare, Medicaid, and Dual numbers. So the worst public plans paying less than costs of delivery are concentrated in these counties where the employer based plans are weaker due to weaker employers. And governments have been cutting and centralizing their jobs - way from these counties. Health care and education also have good insurance and are being cut or centralized away. The deficits of health care effectively prevent recruitment and retention of better employers - thus preventing the only escape from deficits of workforce and access, and causing inequity. Now we can look at estimates of health insurance distributions and see another way that the design violates health equity. Because CMS does not take care of its own patients, it fails not only them but also vast regions of the country