It has been a while since I’ve discussed health management, financing, and policy issues in this column, but a recent article in the New England Journal of Medicine was so provocative and insightful that I thought I’d bring it to your attention. Co-written by Michael Chernew and Austin Frakt, it addresses the challenges facing the country (including North Dakota) as we struggle with our ever-growing federal health care bill. I knew Mike when I got my Master of Public Health degree from the University of Michigan where he was a faculty member. Since then, he has moved on to Harvard. The provocative title of the article is “The Inevitable Math behind Entitlement Reform” (N Engl J Med 2018; 379:211-213 DOI:10.1056/NEJMp1801807).
The authors note that health care expenditures are predicted to grow by more than five percent annually over the next decade, and that almost half of the growth in Medicare and Medicaid spending will simply be due to more enrollees. Almost all of the per-beneficiary cost growth will be due to what is called increased utilization; that is to say, we will be spending more on each patient for medicines, procedures, and visits as more people utilize the system itself. Interestingly, an increase in the price of services is not expected to grow much at all overall (although there are some exceptions such as certain drug prices).
So what do these simple math realities portend for cost-containment efforts? First, the authors consider the number of enrollees. Trying to limit the number of people enrolled to receive health insurance like Medicare or Medicaid would shift at least some health care spending to other payment mechanisms (thus, not necessarily saving money for the economy as a whole) and would be politically contentious. Thus, the authors address the two other variables: per-beneficiary expenditures/utilization and price. They argue that substantial price reductions for services, physician fees, nurses’ salaries, and so on would be politically difficult and unlikely to be successful to a significant degree.
So they conclude that the main remaining target for cost containment is through a limitation of per-beneficiary spending—that is, to reduce utilization of health care services and products by each patient. They outline four approaches that might be used, and critique each. The first is to increase the amount that the patient has to pay out of pocket to receive care (examples are co-pays and co-insurance). But the authors argue that for a variety of reasons, this approach is unlikely to be overly successful. They then suggest a second approach: encouraging preventive care so that health care costs are reduced down the line. They note that while these approaches may well improve the quality of life of participants, the long-term cost-effectiveness of such approaches varies. But there is no doubt that addressing the behavioral aspects of health and wellness—such as cessation of cigarette smoking, weight reduction, exercise, proper diet, and taking prescribed medications—will reduce health care costs in the long run. The third approach they suggest is to pressure insurance companies to reduce utilization, and there is some evidence that this approach can be effective and cost-saving. The final approach—and the one that they conclude is the most promising—is to change the way providers, health care organizations, and hospitals are paid. Rather than the current fee-for-service model that still is quite common around here, they posit that alternate payment models (such as the accountable care organizations or ACOs that you may have heard about) will become much more common and have the potential to generate some real cost-saving opportunities (these payment approaches have been termed “value-based payments”).
Chernew and Frakt conclude their article by acknowledging that achieving significant reductions in the rate of growth of health care expenditures in the future will be challenging, and that patience will be needed. I’ll discuss some of the ways the School is trying to be a positive force in these efforts in a subsequent E-News column. So, as I’ve said before, “Stay tuned!”
Finally, note that in conjunction with the rollout of the new School of Medicine and Health Sciences website, our E-News platform is getting a facelift. We’ll have more information soon, but suffice it so say for now that very little will change in terms of our Friday email. That said, the newsletter’s website will look different, and we’ll have a new name: For Your Health. So be on the lookout for that as well!
Joshua Wynne, MD, MBA, MPH
UND Vice President for Health Affairs
Dean, UND School of Medicine and Health Sciences
You are invited to join Dean Joshua Wynne for complimentary coffee or tea at Java with Josh from 8:30 a.m. to 9 a.m. on Thursday, Sept. 6 in the Tello-Skjerseth Atrium (across the hall from the Family and Community Medicine and Population Health suites) at the SMHS building in Grand Forks.
Dr. Wynne will discuss what’s new at the School and take any questions you may have.
To ensure adequate seating, we ask that you RSVP to Kristen Peterson by Monday, Sept. 3.
We hope to see you there.
UND Vice President for Health Affairs and Dean of the School of Medicine and Health Sciences (SMHS), Joshua Wynne, MD, MBA, MPH, invites the community and all students, faculty, and staff at the School and the University to advocate healthful lifestyles by joining him for Joggin’ with Josh, an informal 5K, 10K, or one-mile walk, jog or run on Thursday, September 6. This is a free public event. Everyone is welcome to participate, so please bring your family and friends.
A registration table will be located in the East Atrium of the School of Medicine and Health Sciences at the south entrance to the School, 1301 N. Columbia Rd. Event registration and T-shirt pickup starts at 4 p.m. The dean will speak to the group before the event, which starts at 4:30 p.m. To get a head start on your fellow participants, please complete the registration form available online and bring it with you to the SMHS on the day of the event. Forms will also be available in the SMHS East Atrium before the event.
Walkers, joggers, and runners are asked to gather on the patio outside the East Atrium before taking off on a route along the outskirts of campus. A water station will be located at the halfway point of the 5K, and water and healthful snacks will be available after the event.
UND's Homecoming 2018 (Sept. 17-22) will soon be here, and as always the SMHS is involved in many of the week's events. Unless otherwise noted, SMHS-related events will be held at the new SMHS building, 1301 N. Columbia Rd., Grand Forks, N.D. For more information on any of the days' events, contact Kristen Peterson at 701.777.4305 or kristen.peterson@med.UND.edu. To register for any of the following events, please visit the UND Alumni Association & Foundation's website.
Continuing Education Symposium
Held in room W201-W202 of the SMHS building from 8:30 a.m. to 11:30 a.m. on Friday, Sept. 21, the Continuing Education Symposium will focus on Infectious Disease. Presenters include physicians from area health systems and SMHS faculty-researchers. Business attire is suggested.
New Building Tours
The Office of Alumni and Community Relations will provide tours of the new SMHS building from 1 p.m. to 3 p.m. on Friday, Sept. 21. Tours of the new facility start in the main floor lobby.
An SMHS Homecoming banquet will be held from 5 p.m. to 8 p.m. on Friday, Sept. 21 at the Grand Forks Hilton Garden Inn's Buchli/Bahl Banquet Room, located at 4301 James Ray Drive. Milestone and Biomedical Sciences alumni will be recognized at the event. Business attire is suggested.
2018 Homecoming/Potato Bowl Parade
And don't forget to attend the joint Homecoming/Potato Bowl parade, which starts at 10 a.m. on Saturday, Sept. 22. The parade route will again be in downtown Grand Forks.
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 will be held at the SMHS from 10:40 a.m. to 10:50 a.m. on Tuesdays and Thursdays from July 31 through August 30 on the East Patio, weather permitting. In case of inclement weather, Zen in 10 will meet in the SMHS auditorium (E101).
Services provided by Kay Williams, Certified Yoga and Relax and Renew Instructor®.
On Thursday, September 6, Dr. Eric Johnson, associate professor in the SMHS Department of Family & Community Medicine, will host a discussion with theologian and Duke Divinity School professor Kate Bowler. Given her training, Bowler is no stranger to dealing with questions involving life and death. But when she was diagnosed with stage IV colon cancer, she began to research the uniquely American concept that tragedy is a test of character. She'll talk to the audience and with Dr. Johnson about her book Everything Happens for a Reason and Other Lies I've Loved in an on-stage discussion.
The event, which is free and will begin at 7 p.m. at the Empire Arts Center in Grand Forks, is part of the 2018 Humanities North Dakota GameChanger ideas festival. Humanities North Dakota (formerly known as the North Dakota Humanities Council) is a statewide nonprofit dedicated to providing communities with programs and events that challenge citizens to ask big questions and become informed about the issues that affect us all. Each year the group selects a new theme for its festival; this year's theme is "The Pursuit of Health and Happiness."
As a follow-up, on Friday, September 7 the Empire Arts Center will host a premiere of the play "A Beautiful Hell," which chronicles the true story of a mother's loss of her young son from cancer. Based on the book of poetry by the same name, the author—local writer and grief counselor Carol Kapaun Ratchenski—will take the stage following the performance to discuss grief and resilience.
These two events will be followed in October by the Bismarck GameChanger ideas festival, which will bring in a doctor, a historian, a clinical psychologist, an anti-agism activist, a mortician, and more to North Dakota to talk health and happiness.
See you there!
If you haven't noticed, the new UND School of Medicine and Health Sciences website is live at: https://med.und.edu.
Here are more answers to some questions we've heard a lot over the past week:
Q: Where is much of the course content that was on the previous SMHS website?
A: UND has asked all colleges to put detailed course-content into courses' appropriate Blackboard sites only, not on web pages accessible to external users/non-students. So, most course-specific content was removed from the new SMHS website. Sorry.
Q: Update: Why can't I see the new website using the URL provided?
A: In addition to having "old" pages in your wb browser's cache, it could be that at times you are trying to access various SMHS web pages from bookmarks you placed on your web browser that are no longer valid. Remove those bookmarks and create them anew in your browser.
Q: Without the "A to Z index" function how do I find _____?
A: UND made the decision to remove the "A to Z index" from the entire UND website and all college sites. That said, the new search function (very top-right in black on your desktop view) is much improved over that of former website, and will get even better with time. As users use the search tool, and staff with website editing authorization enter keywords and page descriptions into their pages on the back-end, the search will get even more refined and accurate. But this takes time and use.
Q: Where are our policy links, and where is Information Resources?
A: SMHS policy links (plus the link to HIPAA training) can be found in the green footer at the bottom of every SMHS webpage. The Information Resources pages, which includes "medical media" downloads, logos, and so on, can be found on the "Current Students" and "Faculty & Staff" pages under the "Info For" link in the black header at the top of every SMHS webpage.
The Evidence-Based Teaching Group (EBTG) will meet on Tuesday, September 4 to discuss "Applying Type-A Tendencies to Teaching: Tips to Coordinate the Chaos and Support Student Success." The meeting will be held from 11 a.m. to noon in SMHS room W201. You are invited to attend!
Research continues to show that practices such as active learning, project-based or case-based learning, formative feedback opportunities, and personalized educational experiences are beneficial to students. Engagement, retention, transfer of knowledge, and positive outcomes are often increased in comparison with traditional course formats. Studies have shown that these benefits are further bolstered when students feel that their professor knows them, cares about their progress, and regards the class and topics as important. But where can faculty find the time to deliver rich content, interact, provide feedback, evaluate, and develop meaningful relationships with students? Day-to-day scheduling constraints and responsibilities related to and beyond teaching make it difficult to find dedicated time to engage. Plus, time zones and technology present as additional obstacles to effective and efficient online instruction.
This session will apply organizational and resource management methods to the "madness." Tips and tools designed to support intentional, meaningful, timely, and personalized interactions with students will be discussed. Furthermore, strategies and tools designed to help faculty efficiently manage the evaluation of authentic learning activities, close the feedback loop, and cultivate rewarding instructor-student relationships will be explored.
The session will be led by Adrienne Salentiny, PhD, Education Resources.
The EBTG hosts events based on topics determined by the expressed interests of its members. The EBTG meets the first Tuesday of every month in rooms W201 or W202 and meetings are free and open to anyone—no RSVP needed! Past topics include assessment, online learning, precepting, active learning, simulation, ADA compliance, and educational scholarship. Many of the past events can be streamed from our website. If you are interested in anything related to evidence-based teaching, join us! If you have any questions, would like more information, or would like to suggest (or lead!) a future meeting topic, please contact Adrienne Salentiny at firstname.lastname@example.org.
On Wednesday, August 29 the Host-Pathogen CoBRE team and the SMHS Department of Biomedical Sciences will host a presentation by Dr. Richard K. Plemper entitled "Developing Novel Therapeutics against Influenza Viruses and Respiratory Viruses Associated with Influenza-Like Disease."
A professor at Georgia State University's Institute for Biomedical Sciences, Dr. Plemper is an experienced molecular virologist and biochemist by training who has assembled a strong research team that brings together collaborators with diverse areas of expertise including molecular virologists, synthetic and medicinal chemists, and pharmacologists to meet the drug development goals of its studies. He has established a productive antivirals discovery and development research program (with particular focus on pathogens of the myxo- and pneumovirus families) that has advanced the fundamental understanding of paramyxo- and pneumovirus entry and replication, and the development of novel antiviral candidates.
After 12 years at Emory University, in 2013 he joined the newly established Institute for Biomedical Sciences at Georgia State University with his research team. Enjoying tangible institutional support to advance infrastructure and equipment of his laboratory, he built a state-of-the-art automated drug-screening facility at GSU. Combined with an outstanding biochemistry infrastructure and vivarium in the building, his laboratory has full control over all mission-critical pre-clinical stages of the drug discovery and development pipeline.
The presentation is free and open to everyone. It will be held in SMHS Room E101 (the Charles H. Fee, MD, Auditorium) at noon.
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 UND School of Medicine and Health Sciences on Tuesday, September 25, 2018. The Symposium will bring together experts investigating both microbial infectious agents and host responses to those infectious agents.
Confirmed Speakers for the event are:
In addition, investigators from the University of North Dakota will present their research related to infection and immunity in both oral and a poster sessions.
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.
Researchers investigating host-pathogen questions are encouraged to submit an abstract for poster presentation (to be held in the afternoon on Sept. 25) to Kim Dickman (email@example.com) by Friday, August 31. Prior on-line registration is appreciated.
The Symposium will be from 8:30 a.m. to 5 p.m. Complimentary continental breakfast and lunch will be provided. The School of Medicine and Health Sciences is located at 1301 North Columbia Road in Grand Forks, N.D.
The Great Plains IDeA-CTR network is excited to announce a funding opportunity: the Great Plains IDeA-CTR Superstar Competition.
The GP IDeA-CTR group is requesting a brief research pitch (2 pages maximum) to include: project title, principle investigator(s), participating institution(s), study aims, hypotheses, methods (brief overview of design, study sample, measures, budget and statistical analysis plan), one year deliverables, a statement addressing how the project advances CTR, and a lay summary. In addition, we ask that applicants provide a biosketch for PI and all key personnel.
The grant will be awarded at the GP IDeA-CTR Annual Scientific Meeting on October 10, 2018. Funding will be awarded to an innovative research project based on criteria delineated in the full application.
The goal of this opportunity is to raise awareness of CTR by promising scholars who are developing innovative tools and methods for medical research. The winning investigator/team will receive a pilot grant award to catalyze cutting-edge research that may translate to a sustainable product or a larger federal grant.
The winner will receive up to $20,000 for one year, and access to resources of the GP IDeA-CTR to support these research efforts.
The application deadline is September 24, 2018 (5 p.m.). For more information or to find a full application, see the GP IDeA-CTR website.