Reed College Reedfayre 2013

Moving from sick care to healthy care: next steps after Obamacare

June 12-14, 2013
$300 per person, register online

• Introduction
• Presenter bios
• Reading list

Introduction

The November 2012 election determined that the health reforms embodied in the Affordable Care Act of 2010 ("Obamacare") are not likely to disappear, at least not in the next four years. While there is a general consensus among people who think about the delivery of healthcare that Obamacare represents progress, there is also a general recognition within this group that it is only a first step, and that more reform is needed to the American healthcare delivery system. Many Reed alumni—in their various roles as healthcare providers, health scientists, health-policy analysts, advocates, government officials, and informed citizens—have given thought to what the next steps in reforming our system should be. This Reedfayre ’13 Alumni College asks such alumni (and their relatives and friends) to come to campus and spend Wednesday afternoon, June 12 through Friday morning June 14 exploring this problem in depth to discover possible economically, politically, and technically implementable ways to make progress.

This Alumni College will be built upon three non-mutually-exclusive pillars of a healthy society, all of which can help lead to universal access to high-quality healthcare at a cost that is sustainable:

1. Public Health. It is not just visits to the doctor that make for a healthy society, but also steps entirely outside of the care of individuals. Indeed, clean air and water, food free of toxins, adequate diets, and being physically fit have contributed more to the remarkable extension of the human life span in the past century than anything else. For this pillar, we will feature presentations by:
   
   • Kenneth Kipnis '65 on "The Taxonomy of Catastrophe"
   • Laura Leviton '73 on "Evaluating Obesity"
   • Craig Mosbaek '83 on "Lessons from Internation Tobacco Control Efforts"
   • Katherine DeLand '95 on "WHO and Healthcare Systems"
2. Providers. There are a number of significant changes in how healthcare providers ply their trade; these changes affect not only physicians, but also nurse practitioners, midwives, mental-health providers, and others. Among such changes are movements to coordinated care, an increased focus on patient-centered care, and providing wellness care and identifying threats to health and treating them before more specialized and expensive care is required is more fully recognized. For this pillar, we will feature presentations by:
   
   • Annette Gardner '83 and
   • Marcia Yaross '73 on recent developments; their presentations will then be assessed by a panel including:
   • Catherine Dalton '98, a physiatrist
   • David Devine '96, a mental-health provider
   • Jessica Glenn '06, a patient advocate
   • Johanna Meyer-Mitchell '73, a primary-care provider
3. Pelf. “Follow the money” is often sound advice, and this is especially true when the U.S. spends 50 percent more per capita on healthcare than the second-most expensive nation. The most prominent question in the current political arena is how much to pay for healthcare. This is simplistic because it hides three crucial underlying questions: (1) For any amount of healthcare purchased, who pays for what? (2) Where does the money purchased go—to whom and for what?  (3) What does that money buy in terms of effective and efficient care? A simple answer whenever money is mentioned is “let the market take care of it,” but healthcare is so different from any classical definition of a market that what passes as simple is too simplistic. Thinking about pelf raises issues ranging from national health policy to local management of assets.  For this session, we have presentations by:
   
   • Chris Lowe '82 on on the benefits and drawbacks of a single payer
   • Sara Nichols '83 on an overview of the financial effects of ACA
   • Paul Pennington '67 on outcome-based reimbursement (aka pay for performance) and the cost aspects of new technology and drugs
   • Erich Richter '93 on cost aspects of electronic health records

Crosscutting themes over all three of these pillars are prevention and promotion.

• Prevention. While public health has a large stake in epidemiology, it has an equally large stake in preventative measures, almost all of which are outside of a medical clinic. Primary care, especially with the current emphasis on Primary Care Medical Homes, has an orientation on individual empowerment not only to manage chronic illness but to maintain a healthy status. And payment systems need to comprehend better than many currently do that the old saw, “An ounce of prevention is worth a pound of cure” is valid, even as we move to metric measurement. 
• Promotion. Promotion is a large component of public health; active outreach to promote healthy habits (not smoking, healthy diets, proper exercise) has long been an important aspect of federal and state public-health agencies. Primary-care providers are increasingly urged to use the medical encounter as a bully pulpit to promote the same habits. Payment for promotion is a concept under development, as insurers consider such innovations as subsidizing fitness-center memberships.

We will approach all three of these pillars using a common format, beginning with a session of lectures and panel sessions presented by the experts among us, followed by parallel conference sessions where we take that information and bring to it each individual participant’s knowledge and orientation. Also for each pillar, there will be a short list of reading material that will be available online. We encourage attendees to read this material, but the sessions will not require that. There are no examinations. (There is, however, a group term paper—see below.) All of this will take place in the Wednesday afternoon, Thursday morning, and Thursday afternoon sessions.

Friday morning we will begin with parallel conference sessions that independently synthesize the previous two days of work to develop recommendations for the next steps in reforming the American healthcare system. After the parallel sessions, we will meet in a final plenary session in which the conclusions of each of the conferences will be placed side by side. Conclusions that appear in most or all of the conferences (which we call “robust conclusions”) will be recognized. Discussion in this plenary session will attempt to reconcile conclusions that differ from conference to conference. An aspiration of the entire Alumni College course is to develop a short paper representing the consensus of the participants that would be published (with collective authorship) in Reed magazine at a minimum and possibly a more formal health-oriented journal or other influential outlet.

If you have any questions not addressed above, please contact Jim Kahan '64 at jimkahan@alumni.reed.edu.

Presenter bios

Katherine DeLand '95

Katherine DeLand works at the World Health Organization (WHO), in the new department of Noncommunicable Disease Prevention, focusing on the intersection of public health and trade law, providing expertise and advice regarding the strategic direction of WHO's noncommunicable disease agenda, and working closely with the Bloomberg Philanthropies international health team on its global tobacco control project. In 2011, she founded DeLand Associates to fill a growing niche for independent, flexible, highly trained and responsive consulting, advising, and project management in international law, health, and public policy. Deland’s professional focus has been on multilateral negotiations, large-scale public health project management and donor relationships, and sustainable health and development policy design and implementation. She has worked in many countries, developed and low- to middle-income, while based in Switzerland, Kenya, Australia, and the United States for organizations including WHO, the L’Etwal Foundation, the World Bank, the U.S. Centers for Disease Control and Prevention, and the University of Sydney. She graduated from Reed in 1995 with a degree in biochemistry and molecular biology; in 2001, she received a degree in law and a master’s in public health from UCLA. 

David Devine '96

David Devine earned his MS in psychology at Pacific Graduate School of Psychology. He worked in private practice and community mental health in Portland for two years. Since June 2009, he has worked with Vancouver Coastal Heath Authority (VCH) in Vancouver, BC. Currently he is a concurrent-disorders clinician at Stepping Stones Concurrent Disorders Service.

Annette L. Gardner '83

Annette Gardner is an assistant professor in the department of social and behavioral sciences in the School of Nursing, University of California, San Francisco. A political scientist, her research focuses on passage and implementation of federal, state, and local healthcare reform, including strengthening the healthcare safety net and supporting county-level coverage expansions. For example, she recently completed a study on safety net integration activities in five California counties and an assessment of the financial impacts of federal and state reform on California’s community clinics. Additionally, her research focuses on advocacy capacity and the tactics required by organizations to achieve policy gains benefiting the medically underserved, including directing an eight-year, mixed-method evaluation of 18 non-profit advocacy groups. Gardner has studied the adoption of delivery systems reforms, such as the integration of mental health and primary care and adoption of HIT by California safety-net providers. Lastly, she is a futurist and has consulted on several health futures projects, such as the future of the alternative and complementary therapies. She also teaches a course on the future of US health in the School of Nursing at UCSF. She received her PhD in political science and MPH in health administration and planning from the University of Hawaii at Manoa.

Jessica Glenn '06

Jessica Glenn is a book and author publicist, squirrel whisperer, musician, cook, and inventor. Her book-publicity company of six years, MindBuck Media, produced two best sellers in 2011. Glenn uses her wide network of media contracts to provide highly personalized author and book publicity services, ensuring the highest level of success possible for authors and their publishing companies using print, television, web 2.0, radio, and guerrilla strategies.

James Paul Kahan '64

James Kahan is a consultant in Portland, Oregon. After an academic career, he was from 1981 to 2007 a senior behavioral scientist at the RAND Corporation, and he spent 1994 to 2005 at RAND Europe in Leiden, the Netherlands, where he was the director of research. He holds a Ph.D. in mathematical social psychology from the University of North Carolina at Chapel Hill. Kahan is a Fellow of the Association for Psychological Science and of the Society for the Psychological Study of Social Issues. He has served on the editorial boards of major professional journals in social psychology and health policy and is a frequent reviewer for JAMA. Kahan was named the 2002 Distinguished Alumnus of the Department of Psychology of UNC and gave the 2005 commencement address at Reed. In 2011, he received the Jean Babson Award for Outstanding Service to Reed. In his 26 years at RAND, he participated in and led a variety of projects in the areas of health policy, drug policy, criminal justice, education, transportation safety, governance, science and technology policy, strategy analysis, military command-and-control, and Army training. Kahan is internationally known for innovations in many methods having to do with individual and group decision making, including game theory, seminar gaming, scenario techniques, Delphi techniques, focus groups, and foresight. In the area of health policy, his work includes: development of measurement of the appropriateness and necessity of medical and surgical interventions, refining and expanding the Resourced-Based Relative Value Scale (RBRVS) for physician work, assessing what should be in the basic package of healthcare benefits, health insurance reform, evaluation of healthcare systems, and ex ante and ex post evaluation of health policy and healthcare.

Kenneth Kipnis '65

Kenneth Kipnis is a professor of philosophy at the University of Hawaii at Manoa, having taught medical ethics for 35 years. After serving on several hospital ethics committees and drafting health-related legislation, he chaired the Committee on Philosophy and Medicine of the American Philosophical Association, served as a visiting senior scholar at the American Medical Association's Chicago headquarters, developed ethics curricula for the University of Hawaii's schools of medicine and nursing, worked regularly as an expert witness in ethics-related court cases, and has written broadly on ethics in pediatrics, legal practice, prison and military medicine, criminal justice, research ethics, early-childhood education, and disaster medicine. More recently he has been a visiting senior faculty member at the University of Texas Medical Branch in Galveston, TX.

Laura Leviton '73

Laura Leviton is senior advisor for evaluation at the Robert Wood Johnson Foundation in Princeton, New Jersey, a position that the foundation created for her to advise and consult on evaluations across its many initiatives and national programs. She has been with the foundation since 1999, overseeing more than 90 national and local evaluations. Leviton was formerly a professor at two schools of public health, where she collaborated on the first randomized experiment on HIV prevention, and later, on two large place-based randomized experiments on improving medical practices. She received the 1993 award from the American Psychological Association for Distinguished Contributions to Psychology in the Public Interest. She has served on three Institute of Medicine committees: the committee to evaluate preparedness for terrorist attack (2001), the committee to assess the Hearing Loss Prevention Program of the National Institute on Occupational Safety and Health (NIOSH) (2006), and the committee to evaluate progress in preventing childhood obesity (2012). She was appointed by the Secretary of DHHS to the National Advisory Committee on HIV and STD Prevention of the Centers for Disease Control and Prevention (CDC). Leviton was president of the American Evaluation Association in the year 2000 and has co-authored two books: Foundations of Program Evaluation and Confronting Public Health Risks. She is interested in all aspects of evaluation methodology and practice. She received her Ph.D. in social psychology from the University of Kansas and postdoctoral training in research methodology and evaluation at Northwestern University.

Chris Lowe '82

Chris Lowe did his initial graduate work at Yale in African history and was visiting assistant professor of history & humanities at Reed from 1991-96, teaching mainly Humanities 110 with other courses related to African history and African-American history. In addition to further history teaching, he has worked as a professional editor and researcher. From 2005-08 he studied epidemiology and biostatistics intensively at Oregon Health and Science University. Since 2008 Lowe has been an activist advocate for public universal health insurance ("single payer") in the context of the Portland Jobs with Justice Healthcare Committee. From that base he has been centrally involved in the formation and development of the Health Care for All - Oregon (HCAO) coalition now working to build an organized mass political base to establish statewide public universal health insurance in Oregon. He also serves on the Board of Oregon Physicians for Social Responsibility. He holds a Ph.D. in history from Yale University.

Johanna Meyer-Mitchell '73

Johanna Meyer-Mitchell, MD, attended Reed 1969-71, then followed Emerson Mitchell '71 to Wisconsin, where she earned a BS and MD. She received graduate training in California, and became a board-certified family physician. Early in her career she worked at Kaiser Permanente. When she moved to northern California, she went into solo practice of family medicine, doing everything except delivering babies (which she'd done in residency, but is hard to do with babies of one's own). She was active in medical-staff affairs, serving as chief of staff of what was then Mt. Diablo Hospital. For the past 16 years she has been a part of a group practice of primary-care physicians in Contra Costa County, CA, John Muir Medical Group. She spends half-time in the office practice of family medicine (think GP), quarter-time doing nursing home care, and eighth-time doing administration, all of which adds up to a bit more than 40 hours a week. Her practice includes geriatrics, internal medicine, pediatrics, gynecology, urgent care, and lots of counseling and care coordination.

Craig Mosbaek '83

Craig Mosbaek’s focus is advocating for evidence-based policies and using data and evaluation to inform program decisions and policy change. He also has a keen interest in messaging and communication issues, having worked for a market research firm and interned as a reporter for Willamette Week. In 2010, Mosbaek received a fellowship and worked in Washington, D.C., for Senator Daniel K. Akaka and then the House Ways & Means Health Subcommittee. Craig is currently president of Mosbaek Consulting, where he works on projects to improve public-health policy through communications, research/evaluation, and strategic planning. He spent the first ten years of his career in criminal-justice policy research, working for research organizations and later the Oregon Criminal Justice Council. Mosbaek was the founding president of the Portland Farmers Market and was also on the founding boards of Upstream Public Health, Sockeye Magazine (a non-partisan public affairs magazine), and the Northwest Media Literacy Center. He has an MPH in biostatistics and epidemiology from Oregon Health & Science University and a BA in physics from Reed.

Sara Nichols '83

After 20 years working as a consumer advocate for single-payer healthcare and campaign-financing reform in Washington, DC and Sacramento, CA, Sara Nichols has spent the past two years working as a lobbyist for the Service Employees International Union in California to implement Bob Dole's health reform alternative--you know it as “Obamacare.” She will give you the progressive skinny on the ACA: what's good, what's not so good, how the implementation is going nationwide and in California.

Erich Richter '93

As a healthcare IT consultant, Erich Richter brings a unique perspective to the table. His specialty is pulling data from hospitals for reporting—for the hospital staff and for the government. Richter can answer the question you did not think to ask: “What data is the federal government tracking from hospitals?” The answer to this question gives surprising insight into what the government considers important in understanding the health of Americans. While assisting hospitals across the nation installing Electronic Health Record (EHR) systems, he has seen many different styles of hospital management and how that helps or impedes the flow of vital information. He spent the first years of his career in the trenches—installing PCs, running phone lines and other general IT work in small hospitals—and then transitioned into the data side of hospitals where he has worked for the last twelve years with independent hospitals and large healthcare organizations. He earned a BA in history from Reed in 1993.

Marcia Yaross '73

Marcia Yaross is a vice president of worldwide clinical, regulatory, and health policy at Biosense Webster Inc., a Johnson & Johnson company. Her areas of expertise include clinical research, medical-products development and regulation, and health policy. Yaross holds a Ph.D. in developmental and cell biology from the University of California at Irvine. Following completion of her graduate studies, she conducted postdoctoral research in stem cell biology and myogenesis at the University of Virginia and Stanford University School of Medicine before returning to UC Irvine as an assistant research biologist. Over the past 25 years she has held a variety of positions in the medical-device industry, including senior management roles in clinical research, regulatory affairs and quality at Pharmacia Ophthalmics, MiniMed Technologies, and Allergan Inc./Advanced Medical Optics. She is a past president of OCRA, the Orange County (California) Regulatory Affairs Discussion Group. Yaross also served as industry representative to two panels of the FDA Medical Device Advisory Committee, the Ophthalmic Devices (1997-2001) and Circulatory System Devices (2005-2008), and the Risk Communication Advisory Committee.



Reading list:

• "Bitter Pill: Why Medical Bills Are Killing Us," Steven Brill, TIME Magazine
• OHA Director's Message: "Oregon is getting ready," Bruce Goldberg
• Shared Decision Making to Improve Care and Reduce Costs, Emily Oshima Lee, M.A., and Ezekiel J. Emanuel, M.D., Ph.D., New England Journal of Medicine
• Lessons from Boston, Arthur L. Kellermann, M.D., M.P.H., and Kobi Peleg, Ph.D., M.P.H., New England Journal of Medicine
  
• Addressing the Social Determinants of Health Within the Patient-Centered Medical Home, Arvin Garg, MD, MPH, Brian Jack, MD, and Barry Zuckerman, MD, JAMA
• Connecting to Health Insurance Coverage, Howard Koh, MD, MPH, and Marilyn Tavenner, RN, MHA, JAMA

Paideia-style Alumni College

June 12-15, 2013
Free

“Reunions Paideia” is a small pilot program to explore the idea of alumni and others offering short-form classes in the spaces between the two "traditional" Alumni College programs. Interested alumni who would like to facilitate a 60-120 minute class are encouraged to do so. Please fill out the online proposal form; as the (limited and finite schedule) fills, sessions shall be listed there.

Courses shall mostly take place at 9 a.m., 10:30 a.m., 1 p.m. and 3 p.m. Wednesday through Saturday, with a computer lab, seminar room, and other facilities available. For this year, suggested topics include healing from Reed, career planning, and mid-life transition, but other topics are welcome. We hope to have a fairly small number of high-quality, clearly-directed sessions of interest.

More info and a class-proposal form at http://ReedPaideia.net. Have questions or suggestions? Please send email to Rory Bowman '90 at rbowman@alumni.reed.edu or make a comment on the blog above.

Developing a Quality Aesthetic: Touching All the Senses

June 16-19, 2013 (after Reunions!)
$300 per person, register online

As we explore how we develop a notion of quality and a quality aesthetic, we will spend time stimulating all our senses and actually exploring what makes something of good to excellent quality. This class is limited in size because in addition to thinking and discussing, we will be doing. Helping guide the intellectual discussion will be Jan Mieskowski, professor of German. Leading the selected hands-on the elements will be master woodworker Gary Rogowski '72, and cookbook author and cooking expert Diane Morgan '77. More surprises are in store as well.

Here is what is in store for the group:

Sunday: We will head to the Northwest Woodworking Studio for a day-long, hands-on experience with Gary Rogowski. We will learn some basics of woodworking and working with tools, and then each person will build a milking stool. Kant would call this craft.  But that matters not--the point is to experience rather than contemplate what it means to create something of true quality.

Monday: The morning will be spent discussing the texts and the experience with Rogowski. From Professor Jan Mieskowski: In this seminar, we will discuss two selections from Immanuel Kant's Critique of Judgment (1790), one of the most influential texts on aesthetics in the Western canon. In the first section (§1-§9), Kant attempts to explain what happens when we judge something to be beautiful. He asks what "taste" is and what it would mean to offer a universal basis for it. In the second section (§43-§47), Kant defines art and artistic genius and distinguishes art from craft.

Then in the afternoon, we will examine issues of actual taste (as well as aesthetic taste). Diane Morgan '77 just won a coveted James Beard Award for her cookbook Roots.  We will learn in her kitchen as she takes the group through a series of foods and ingredients, and we taste and discuss what makes some better than another.

Tuesday: Today the group will be looking at art and discussing the relative qualities and why certain pieces are acclaimed and others not. Then the group will try their hands at calligraphy and instead of a milk stool, we will create letter forms.

This Alumni College will conclude on Wednesday with an examination of music.  We will listen to different forms of music as well as different versions of the same piece and discuss the relative differences. Then it will be time to summarize and discuss what we learned and discovered, both about ourselves and the issues at hand.

For more information, send email to to Mike Teskey, director of alumni & parent relations.