Friday, September 08, 2017

From The Dean

Friday, September 08, 2017

In conjunction with Dr. Tom Lee’s visit to UND this week, I thought I would start my series of discussions regarding several aspects of health care delivery and health insurance that I promised. Tom is the chief medical officer at Press Ganey, the nationally acclaimed health care consulting firm. Dr. Lee, as I hope you know from meeting with him or hearing his talk, was our Visiting Professor this week and delivered yesterday’s Dean’s Hour lecture on “Five Ideas from Outside Health Care—and How they Fit Together.”

The five ideas that Dr. Lee discussed in his presentation were developed following discussions with five non-health care leaders. They are:

  1. Providers need to be a catalyst in striving to make value the driving goal in health care improvement, and health care delivery organizations must be strategically focused on delivering value (that is, higher quality care at lower cost)
  2. Competition in health care (as in many other industries) is a good thing and helps the march toward greater value
  3. People and their relationships really matter in health care, and teamwork is essential
  4. Altruism and caring also really matter in health care
  5. It takes passion and perseverance to push for improvement over a sustained time period

Since health insurance has clear implications for value delivery in health care and a patient’s overall health care experience, let’s consider the question I posed last month: How does the way most people think about health insurance differ from the actual intent and purpose of insurance? My answer is twofold. First of all, insurance is intended to protect against unexpected and catastrophic loss (think of an automobile accident or house fire), but not for routine things (like an oil change for your car or changing the filters on the furnace in your house). But that’s not the way we typically think of and use health insurance; rather, we use it to pay for health care in general, whether major and unexpected (treating a heart attack or cancer) or routine and expected (mammograms, routine physical examinations, and preventive services like checking for glaucoma, etc.).

The second major difference between health insurance and all other forms of insurance is that most of us either don’t pay for our health insurance premiums at all or pay only part of them—or don’t even realize that we actually are paying the premiums. For most people who have it, health insurance feels like having a credit card to pay for health care where someone else (whoever that may be) is paying for the charges on that credit card.

So who really is paying our health insurance bills? Let’s start with seniors. The vast majority of them are covered by Medicare, the federal health insurance program that is funded mainly by payments made over the years while people work (payments are made both by the employee and employer), premiums paid by seniors once they start drawing Medicare benefits, and general revenue dollars contributed by taxpayers. So while a portion of the costs of Medicare have in fact been paid for by the participants, the benefits that the typical participant gets from Medicare far exceed what the participant contributed; the ratio is in the range of three to one. This difference is in the order of several hundred thousand dollars per typical participant, and ultimately is borne by future generations because the shortfall contributes to the country’s budget deficit.

This highlights one of the principles of insurance–it functions as a transfer of wealth. For all forms of insurance, it is a money transfer from people who are lucky (those who don’t have an auto accident, house fire, or illness) to those who are unlucky (and suffer an accident, fire, or illness). But what is unique about health insurance (and likely one of the sources of controversy) is that it also involves a transfer of dollars from the more wealthy to the less wealthy (and from younger generations to older ones).

The next group affected by health insurance is the large minority of non-seniors (as well as many seniors) who do not pay for their health insurance at all, or pay only a small fraction of the cost. Many of these folks get health insurance from Medicaid (which is jointly funded by the federal and state governments; in North Dakota, the cost is split 50-50). A second smaller group are those who get their insurance through the exchanges established by the Affordable Care Act (ACA), and most of these folks have much of their insurance premium costs subsidized by the federal government. The substantial expansion of health insurance coverage that occurred under the ACA was largely due to an expansion of Medicaid, followed by coverage under the exchanges sought by non-Medicaid enrollees needing a policy (because their employer does not provide health insurance).

The last major group is composed of those who have insurance provided through their employers, like all of us who work at UND. Coverage through private employers constitutes the single largest component of non-senior health insurance, both in North Dakota and the United States. The interesting question, though, is “who pays for private health insurance?” The obvious answer would be “the employer” (UND, for example). But that answer would be wrong. It turns out that health economists say that the employee actually pays for much of the premium above and beyond their deductible or co-pay in the form of what is called “foregone wages,” meaning that employers would have to pay employees more if the employer didn’t provide health insurance coverage.

How did this come about? It turns out that the provision of health insurance by private employers started in large measure during World War II, when there were government-ordered wage freezes in place. To compete for employees in the tight labor market that existed then (since many Americans were directly involved in the war effort and/or employed by the military), companies started offering benefits like health insurance to attract the limited number of workers available. Thus, health insurance coverage and other benefits were given in lieu of higher wages—and thus today it really is the employee who is "paying for" the health insurance provided by the employer. But it just doesn’t feel that way to the typical employee; rather, it feels more like an entitlement that goes along with employment.

So the bottom line is that most people in America have come to expect health insurance whether or not they pay for it—and in many cases, they pay only a fraction of the cost (or none at all). And even for those who are paying for it, in many cases it just doesn’t feel like it. Additionally, we use health insurance coverage to pay for routine and minor as well as emergency and catastrophic care. Thus, on these two issues—who pays for the insurance, and what is covered by that insurance—health insurance differs in major ways from all other forms of insurance. In my view, those differences are two of the root causes of the often contentious debate that surrounds health care and health insurance.

I plan to delve a little deeper into some further considerations of health care and health insurance in future columns of ENews. Please let me know your thoughts and comments.

Joshua Wynne, MD, MBA, MPH
UND Vice President for Health Affairs

Dean, UND School of Medicine and Health Sciences

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Welcome: Brenda Haugen

Brenda Haugen is the new communications specialist at the Center for Rural Health (CRH) at the University of North Dakota (UND) School of Medicine and Health Sciences in Grand Forks.

In this position, Brenda promotes the activities of the CRH and the Rural Health Research Gateway through media relations, social media, exhibiting, and special events. Along with spreading the word about the CRH, Brenda also helps maintain the Center's connections with the 11 federally-funded Rural Health Research Centers across the country. Her supervisor is Marv Leier.

A native of Wyndmere, N.D., Brenda graduated from UND with a degree in journalism. An award-winning journalist, she worked as a reporter, editor, and managing editor at newspapers in Williston, N.D., and Burnsville, Minn., for more than 14 years. After leaving the newspaper business, Brenda served as a senior editor with Capstone Publishers, a children’s book publisher headquartered in Mankato, Minn. Along with editing hundreds of books, she has written more than 50 biographies aimed at middle school-age readers. She has also done freelance work, including writing stories for UND’s Founders Day program for 11 years.

"I know first-hand the challenges rural folks have in accessing health care that may be many miles away," said Brenda. "Because of this personal experience, the educational mission of the Center for Rural Health immediately felt like a good fit for me.”

Established in 1980, the CRH is one of the nation’s most experienced rural health organizations. It has developed a full complement of programs to assist researchers, educators, policymakers, healthcare providers, and, most important, rural residents to address changing rural environments by identifying and researching rural health issues, analyzing health policy, strengthening local capabilities, developing community-based alternatives, and advocating for rural concerns.

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Simulation Center Open House to be held on Monday, September 11

The Simulation Center at the University of North Dakota School of Medicine and Health Sciences (SMHS) will host an open house on Monday, Sept. 11, 2017, from 11 a.m. to 12:30 p.m. The event, in which guests can participate in self-guided tours and experience simulation in action, is open to everyone.

Simulation, or the creation of realistic circumstances in order to teach skills and enhance competencies, is rapidly changing the face of healthcare education. For this reason, the Society for Simulation in Healthcare, of which the Simulation Center at the SMHS is a member, is sponsoring the first ever Healthcare Simulation Week, to be held Sept. 11-15, 2017. The purpose of Healthcare Simulation Week is to raise awareness about the importance of health care simulation in improving performance and reducing errors in patient care.

The SMHS Simulation Center is a hands-on simulation training facility for multidisciplinary health care providers. The state-of-the-art space offers a clinical setting where health professionals can actively apply their knowledge in simulation, observation, and debriefing of real-life patient scenarios, with the goal of improving patient safety and care. The innovative facility is the only one of its kind in North Dakota; its mission is to use interactive simulation in an effort to teach providers, educate the public, and provide an arena for research in health care.

“Simulation has changed the way we teach students. Before, we learned on patients. Now, we learn on incredibly lifelike manikins, where harm can’t be done. That way, when students get to the real patient, they have significantly more experience and therefore are better prepared,” said Dr. Jon Allen, director of the UND SMHS Simulation Center. “We’re very excited to be part of the inaugural Simulation Week. The simulation technology here has already enhanced the skills of health care providers across the state—from physicians and nurses to first-responders.”

A Simulation In Motion-North Dakota (SIM-ND) mobile education unit, a custom-built, 44-foot long learning lab on wheels, will also be on-site for tours and to provide information regarding the SMHS statewide simulation program. SIM-ND units bring simulation education to all third-year medical students training on SMHS campuses away from Grand Forks. Units also provide health care education to rural areas of North Dakota so emergency responders and other providers can upgrade their skills closer to home rather than leave their service areas for training.

The open house will be held at the UND School of Medicine and Health Sciences, 1301 N. Columbia Rd. Guests may park in the School’s main south lot. Simulation Center staff will be available to answer questions and provide an interactive experience during guests’ self-guided tours. Light refreshments will be served. For planning purposes, and to receive a reminder e-mail with directions, RSVP online here or e-mail

Zen in 10 returns

Zen in 10 focuses on stretching, breathing, and having fun with coworkers. Go back to work with less stress, more energy, and better body functioning.

Sessions are from 10:40 a.m. to 10:50 a.m. on Tuesdays and Thursdays from Sept. 12 to Oct. 19 on the east patio at the SMHS in Grand Forks. In the event of inclement weather, the event will move to W201 on Sept. 12 and Oct. 10, and the Charles H. Fee, MD, Auditorium on all other days.

Services provided by Kay Williams, Certified Yoga and Relax and Renew Instructor®.

Andrew J. McLean, MD, MPH, presents next Dean's Hour on Sept. 14

Andrew J. McLean, MD, MPH, chair of the Department of Psychiatry and Behavioral Science at the University of North Dakota School of Medicine and Health Sciences and medical director for the North Dakota Department of Human Services, is the next Dean's Hour Speaker. He will give a presentation entitled "Medical Assisted Treatment for Opioid Use Disorder" at noon on Thursday, Sept. 14, in the Charles H. Fee, MD, Auditorium (E101) at the SMHS in Grand Forks.

Lunch will be provided for those on the Grand Forks Campus. If you plan to attend in Grand Forks, please RSVP here.

This presentation will be broadcast to the following UND SMHS campus sites:

  • Bismarck, Southwest Campus, Room 2108
  • Fargo, Southeast Campus, Room 219
  • Minot, Northwest Campus Office - Trinity Location

Or, you may view Dr. McLean's presentation online here.

For additional information, contact the Office of the Dean at (701) 777-2514.


Interment Ceremony honors donors of SMHS Deeded Body Program on Sept. 15

An interment ceremony honoring the memory of persons who donated their bodies for the benefit of medical education will take place at the University of North Dakota School of Medicine and Health Sciences (SMHS) plot at Memorial Park Cemetery in Grand Forks on Friday, September 15.

The service, wherein the School pays respect and tribute to Deeded Body Program donors, begins at 2:00 p.m.

“This service is a way to give thanks to both the donors and their families, and a way to express honor for the gift we have been given through their donation,” said Mandy Meyer, PhD, assistant professor in the departments of Occupational Therapy and Biomedical Sciences and director of the Deeded Body Program at the SMHS. “The education these individuals have given is invaluable to our future health care providers; they truly teach students about the form of the human body and in many ways are students’ first patients.”

The School conducts the interment ceremony once every three years to inter the cremated remains of donors who have chosen to be interred in the UND School of Medicine and Health Sciences plot. Family members of donors being interred have been invited, as have the School’s faculty, staff, and students, who often look forward to the opportunity to show their respect and appreciation for the donors who have contributed to their learning and scholarship.

At the event, Meyer and Pat Carr, PhD, assistant dean for medical curriculum at the SMHS, will speak from a faculty perspective about the value and significance of the Deeded Body Program. UND clergy participating in the service include Chad Brucklacher of Christus Rex Lutheran Campus Center and Luke Meyer of St. Thomas Aquinas Newman Center.

To attend the service, turn east off of Columbia Road onto 10th Avenue North and proceed to the Memorial Park entrance. There will be signs posted to direct you to the exact location.

UND Host-Pathogen Interactions CoBRE Symposium set for September 18

The Center for Biomedical Research Excellence (CoBRE) for Host-Pathogen Interactions is inviting UND faculty, staff, and graduate and undergraduate students to attend the Annual Host-Pathogen CoBRE Symposium to be held at the University of North Dakota Gorecki Alumni Center on Monday, September 18, 2017. This event will bring together experts studying cellular and molecular mechanisms underlying host responses in acute infections and chronic disease conditions, and will include a poster session showcasing research carried out by UND faculty and UND graduate and undergraduate students.

Confirmed Speakers for the event are:

  • Dr. Elaine Tuomanen (St. Jude Children’s Research Hospital): “Expanding bacterial signaling vocabulary from inflammation to neuroproliferation”
  • Dr. Anjana Rao (La Jolla Institute for Allergy and Immunology): “Epigenetic and transcriptional responses driven by the calcium-calcineurin-NFAT pathway in T cells”
  • Dr. Nadeem Khan (University of North Dakota): “A double edge function of host type 17 immunity in pneumococcal infections”

In addition, investigators from the University of North Dakota will present their research related to infection and immunity.

A full schedule for the event is available here.

This event aims to promote interaction and collaboration among researchers in the area and provide opportunities for learning about cutting-edge tools, approaches, and resources to advance their research in broad areas of infection and inflammation as it applies to human disease.

The event, which runs from 8:30 a.m. to 5 p.m., is free; a continental breakfast and lunch will be provided. Prior registration is appreciated. The Gorecki Alumni Center is located at 3501 University Avenue in Grand Forks, N.D.

American College of Physicians - ND Chapter Annual Meeting set for September 22

Registration is now open for the 2017 American College of Physicians - North Dakota Chapter Meeting! The meeting will be held on Friday, September 22, 2017, at the Hilton Garden Inn in Fargo.

In addition to the networking potential and collegiality offered by our meeting, it is also a valuable learning opportunity. For the chapter meeting, the American College of Physicians (ACP) designates this live activity for a maximum of 6 AMA PRA Category 1 credit(s).™ Physicians should claim only the credit commensurate with the extent of their participation in the activity.

To view the full meeting program, visit the Chapter website.

Members can register online. Or, members and non-members may contact the ACP Customer Service team to register via phone at 1-800-523-1546, ext. 2600, and refer to Course Code: RM1823.

Contact Carla Mosser with any questions.

We hope to see you in Fargo in September.

Neville Alberto, MD, FACP
ACP Governor, North Dakota

Inaugural Scientific Meeting of the Great Plains IDeA-CTR Network is October 23-24

The UND SMHS is a member of the Great Plains IDeA-CTR Network, which will hold its inaugural scientific meeting on Oct. 23–24, 2017, at the University of Nebraska Medical Center's Truhlsen Event Center in Omaha.

The Great Plains IDeA-CTR Network was created by a $20 million grant from the National Institutes of Health to the University of Nebraska Medical Center in Omaha (UNMC), the largest grant ever in the center’s history. Funding is provided through the Institutional Development Award (IDeA) program and the NIH’s National Institute of General Medical Studies. It will focus on developing early career researchers into independent scientists and increasing the infrastructure and other resources needed to support clinical/translational research (CTR) around the region.

Jonathan D. Geiger, Chester Fritz Distinguished Professor in the Department of Biomedical Sciences at the UND School of Medicine and Health Sciences, serves on the leadership team.

In addition to UNMC, the Nebraska institutions involved in the network include the University of Nebraska-Lincoln, University of Nebraska at Omaha, University of Nebraska at Kearney, and Boys Town National Research Hospital. Other participants are the University of North Dakota, North Dakota State University, the University of Kansas Medical Center, and the University of South Dakota.

The program will highlight presentations on clinical and translational research and resources, team science, community engagement activities, a mock study review panel, and more!

UND / USD Alumni Reception in Boston on November 4

In conjunction with the annual meeting of the Association of American Medical Colleges, a reception will be held for University of North Dakota and University of South Dakota alumni on Saturday, November 4, 2017, in Boston, Mass. The reception will be held from 6:30 p.m. to 7:30 p.m. in the Dartmouth Room of Boston Marriott Copley Place, 110 Huntington Ave., in Boston, Mass.

Hors d’oeuvres and refreshments will be served. All UND / USD alumni and friends are welcome!

Please RSVP by October 9.

More information on this gathering is available here.

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New SMHS Building Post-Occupancy Evaluation Survey

Now that faculty, staff, and students are settled in the new SMHS building, our architecture team (JLG Architects and Steinberg Architects) would like to help us with a Post-Occupancy Evaluation, which includes a survey, focus groups, and a town-hall forum. Through these three processes, we aim to learn more about what works well in the new building and what we could improve upon, with the ultimate goal of implementing some improvements. So, if you have not already, please complete this survey, which will be open only through Friday, Sept. 6, 2017. If you choose to provide your e-mail address at the end of the survey, you will be entered into a drawing for one of four $25 gift cards from Café 1905. More information is forthcoming about the town-hall forum. Thanks in advance.

North Dakota Simulation Center receives sustaining grant

The Simulation Center at UND’s School of Medicine and Health Sciences (SMHS) has received the first half of a two-year $250,000 grant for a project entitled “Sustaining the SIM-ND Program.” The multi-sponsor grant was awarded jointly by five health care providers from across the state: Altru Health System, Essentia Health, CHI St. Alexius Health, Sanford Health – Fargo, and Trinity Health. Each provider has agreed to contribute $25,000 per year to the SMHS Simulation Center for two years.

“Simulation in Motion–North Dakota has reached more than 11,000 learners, provided more than 1,100 continuing education hours, and traveled at least 94,000 miles in the four years the program has existed,” said Amy Malheim, M.S., program administrator for the Simulation Center. “Through the continued partnership between the UND SMHS and the five major health systems in the state, SIM-ND will continue to carry out its mission of improving the health of all current and future North Dakota residents.”

The SMHS Simulation Center is a hands-on simulation training facility for multidisciplinary health care providers. The state-of-the-art space offers a clinical setting where health care professionals can actively apply their knowledge in simulation, observation, and debriefing of real-life patient scenarios, with the goal of improving patient safety and care. The innovative facility is the only one of its kind in North Dakota; its mission is to use interactive simulation in an effort to teach providers, educate the public, and provide an arena for research in health care.

The funding of “Sustaining the SIM-ND Program” allows the Center to continue its original mission of providing health care simulation for health professionals from across the state, as well as assist in providing continued simulation education to third-year medical students.

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Writing an NIH grant proposal? Update your Personal Profile

The Grants Management Office at the SMHS encourages any faculty, staff, and graduate students developing grant proposals for the National Institutes of Health (NIH) through the Application Submission System & Interface for Submission Tracking (ASSIST) system to update their NIH personal profile, including the employment section. Why? We have learned that some information is automatically pulled into ASSIST through the researchers’ NIH commons ID. Updating your profile will not only guarantee that your most current information is “caught” by the ASSIST system, but should save you time—and possibly some headaches—come submission time.

And as a reminder, applicants can also apply for NIH grants using Workspace, which separates the application package into individual forms. Applicants can create a workspace, complete the individual PDF forms, and submit their application workspace package. For any funding opportunities where applicants have downloaded the legacy PDF application package, they will be able to continue to submit that package until March 31, 2018. For any funding opportunities where applicants have NOT already downloaded the legacy PDF application package, they will be able to continue to download and submit through December 31, 2017.

For more information about Workspace, please visit our various Workspace resources:

For more information, feel free to contact Diane Hillebrand, CRA, Grants Manager at the SMHS, at

Great Plains IDeA-CTR Scholars Program applications due September 11

The Great Plains IDeA-CTR Network is pleased to announce that funding through a National Institutes of Health (NIH)/National Institute of General Medical Sciences grant is available to support two faculty who are in the early stages of their career.

To apply for the grant, send a letter of intent (maximum of two pages) to the Great Plains IDeA-CTR Network by Sept. 11, 2017. In your letter, please include: project title, principal investigator and mentor(s), participating institution(s), study aims, hypothesis, methods (brief overview of design, sample, measures, statistical analysis plan), and a statement addressing how the project advances clinical and translational research. Also, include a specific paragraph listing your training needs to support your research program. Finally, submit your NIH biosketch.

Up to 10 applicants will be invited to submit a full application. Those invited to submit full applications will be notified by Oct. 2, 2017. The RFA and requirements for invitees are detailed below. Please email your letter of intent and NIH biosketch as a single PDF document to the Great Plains IDeA-CTR Office at

Solicited applications will be due Nov. 20, 2017.

More information is available here.

Public Health Service Financial Conflict of Interest Education--NEW DATE: Monday, September 18

U.S. Public Health Service (PHS) requires that all PHS grantees, or those considering submitting grant applications to PHS, complete a mandatory education class. According to the policy, all grantees working on research funded by PHS agencies must be trained in Conflict of Interest every four years. UND's Division of Research & Economic Development will conduct a PHS Conflict of Interest session on the following date:

  • Monday, September 18 – 9:00 a.m., Memorial Union, President’s Room (NOTE the new date, which replaces the cancelled Thursday, Sept. 21 session)

PHS grantees only need to attend this session if you have not attended one in the past four years.

PHS agencies include:

  • National Institutes of Health (NIH)
  • Food and Drug Administration (FDA)
  • Centers for Disease Control and Prevention (CDC)
  • Agency for Healthcare Research and Quality (AHRQ)
  • Agency for Toxic Substances and Disease Registry (ATSDR)
  • Health Resources and Services Administration (HRSA)
  • Indian Health Services (IHS)
  • Substance Abuse and Mental Health Services Administration (SAMHSA)

Sessions will be coordinated by Barry Milavetz, Ph.D., Associate Vice President for Research & Economic Development.

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